透析を開始する時期:提案された米国のガイドラインが生存率に与える影響
J C Korevaar1, M A Jansen, F W Dekker
1Department of Clinical Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, Netherlands. j.korevaar@amc.uva.nl
Lancet (London, England)
|October 9, 2001
まとめ
早期に透析を開始すると,生存に利点があるかもしれませんが,証拠は限られています. 現在のガイドラインは,末期性腎疾患のすべての患者にとって費用対効果的または実用的ではない可能性があります.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 腎臓置換療法とは,腎臓置換療法です.
- クリニカル・プラクティスのガイドライン
背景:
- 米国国立腎臓財団のガイドラインでは,早期に透析を開始することを推奨しています.
- これらのガイドラインの実施は,費用を増加させ,患者の生活に影響を与える可能性があります.
- これらのガイドラインを支持する現在の証拠は限られており,主に意見に基づいています.
研究 の 目的:
- ガイドラインで推奨される早期の透析開始が患者の生存に与える影響を評価する.
- 現在の透析開始ガイドラインの臨床的証拠と実用的な意味を評価する.
主な方法:
- オランダにおける (1997年-1999年) 展望的多中心研究.
- 腎機能の残留データを持つ新しい末期腎臓病患者も含まれています.
- 死亡率や検閲については2000年8月までフォローアップ.
主要な成果:
- 37%の患者は,推奨より遅れて透析を開始した.
- 遅いスタートは,非有意な増加した死亡リスク (aHR 1.66) を示した.
- タイムリー・スターターは,3年以上にわたって推定2. 5ヶ月生存の利点を持っていた.
結論:
- タイムリーな透析による観察された生存増加は,おそらく早期の疾患発症を反映しています.
- 現行ガイドラインの実施による臨床的利益は疑わしい.
- ガイドラインを採択する前に,患者への影響とリソースへの影響を考慮してください.
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