慢性肾脏病分层个案管理模式对慢性肾脏病4～5 期患者肾脏终点事件发生率的影响

石钰; 陈艳; 邓俊娜; 彭红梅; 何静

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中国血液净化 ›› 2019, Vol. 18 ›› Issue (11) : 750-754.

临床研究

慢性肾脏病分层个案管理模式对慢性肾脏病4～5 期患者肾脏终点事件发生率的影响

石钰¹,邓俊娜¹,陈艳¹,彭红梅¹,何静²

作者信息 +

The influence of hierarchical and individualized management model on the incidence of renal end-point events in chronic kidney disease patients at stage 4-5#br#

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摘要

【摘要】目的分析慢性肾脏病(chronic kidney disease，CKD)分层个案管理模式对CKD4～5期患者终点事件发生率的影响。方法本研究为回顾性队列研究，研究对象为2014 年9 月～2015 年12 月入住陆军军医大学新桥医院肾内科CKD4～5期非肾脏替代治疗的患者，按照是否入组慢性肾脏病管理中心长期规律随访分为管理组和对照组。2018年12月收集患者死亡、肾脏替代治疗情况，对2组进行比较。结果共233名患者纳入本研究，其中管理组91人，对照组142人。截至研究结束，管理组死亡8人，对照组死亡11人(c2＝0.081，P＝0.776)；管理组肾脏替代治疗36人(肾移植2人、腹膜透析3人、血液透析31人)，对照组肾脏替代治疗76人(肾移植9人、腹膜透析6人、血液透析61人)(c2＝4.330，P＝0.037)；首次进入血液透析使用动静脉内瘘，管理组7 人，对照组2 人(c2＝8.677，P＝0.003)。结论分层个案管理模式减少了CKD4～5期患者肾脏替代治疗发生率，并减少了进入血液透析时临时导管使用率。

Abstract

【Abstract】Objective To analyze the influence of hierarchical and individualized management model on the incidence of end-point events in chronic kidney disease (CKD) patients at stage 4-5. Methods This was a retrospective cohort study that enrolled the hospitalized CKD patients at stage 4-5 but without renal replacement therapy (RRT) from Sept. 2014 to Dec. 2015 in the Department of Nephrology, Xinqiao Hospital of Army Medical University. They were divided into experimental group and control group based on whether they received the long-term regular follow-up in the CKD Management Center. Death and renal replacement therapy were compared between the two groups at December 2018. Results A total of 233 patients were enrolled

in this study, in which 91 were in experimental group and 142 were in control group. At the end of the study, 8 patients in experimental group and 11 patients in control group died (χ2＝0.081, P＝0.776); 36 patients in experimental group (kidney transplant, 2 patients; peritoneal dialysis, 3 patients; hemodialysis, 31 patients) and 76 patients in control group (kidney transplant, 9 patients; peritoneal dialysis, 6 patients; hemodialysis, 61 patients) treated with RRT (χ2＝4.330, P＝0.037); 7 patients in experimental group and 2 patients in control group used arteriovenous fistula for blood access at the beginning of hemodialysis (χ2＝8.677, P＝0.003). Conclusions The hierarchical and individualized management model can decrease the use of RRT and temporary catheterization for blood access in CKD patients at stage 4-5.

导出引用

石钰, 邓俊娜, 陈艳, 彭红梅, 何静. 慢性肾脏病分层个案管理模式对慢性肾脏病4～5 期患者肾脏终点事件发生率的影响[J]. 中国血液净化. 2019, 18(11): 750-754

The influence of hierarchical and individualized management model on the incidence of renal end-point events in chronic kidney disease patients at stage 4-5#br#[J]. Chinese Journal of Blood Purification. 2019, 18(11): 750-754

中图分类号： R692.5

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