什么时候开始透析:拟议的美国指南对生存率的影响
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
概括
早些时候开始透析可能会带来生存益处,但证据有限. 目前的指导方针可能对所有末期病患者来说都不具有成本效益或实用性.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 脏替代疗法治疗 脏替代疗法
- 临床实践指南 临床实践指南
背景情况:
- 美国国家脏基金会的指导方针建议较早启动透析.
- 实施这些指导方针可能会增加成本并影响患者的生活.
- 目前支持这些指导方针的证据有限,主要是基于意见.
研究的目的:
- 评估指南推的早期透析启动对患者存活时间的影响.
- 评估当前透析启动指南的临床证据和实际影响.
主要方法:
- 在荷兰进行的前性多中心研究 (1997-1999年).
- 包括新的末期病患者,其残留的功能数据.
- 到2000年8月为止,对死亡率或审查的后续行动.
主要成果:
- 37%的患者比推时间晚开始透析.
- 较晚开始的患者显示死亡风险增加不显著 (aHR为1.66).
- 及时开始的人在3年内估计有2.5个月的生存优势.
结论:
- 随着及时透析的观察到的生存率增加可能反映了早期的疾病发病.
- 实施当前指南的临床益处是可疑的.
- 在采用指南之前,请考虑患者影响和资源影响.
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