在加拿大启动透析时报告eGFR的变化:一封研究信
Michael Chiu1, Samuel A Silver2, Laura Berall3
1Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada.
Canadian journal of kidney health and disease
|October 3, 2023
概括
加拿大各省在透析启动时定义和跟踪估计的膜过率 (eGFR) 中显示出显著的差异. 标准化这一关键质量指标对于改善全国末期病患者护理至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 提高质量 提高科学 提高质量
- 医疗保健服务研究 医疗服务研究
背景情况:
- 估计的膜过率 (eGFR) 是末期病 (ESKD) 患者的关键质量指标.
- 指导方针建议推迟透析开始,直到出现症状或eGFR降至≤6mL/min/1.73m2.
- 目前在加拿大开始透析时定义,收集和跟踪eGFR的做法尚不清楚.
研究的目的:
- 确定加拿大省级脏计划在透析启动时如何定义eGFR.
- 为了比较加拿大各省目前的做法.
- 评估延迟开启透析的一致基准是否存在.
主要方法:
- 从2021年7月到11月,向省级脏计划 (不包括北克) 的医疗领导分发了一项横截面调查.
- 该调查由CSN-QUIS指标工作组设计,收集了关于eGFR定义,收集,报告和数据收集障碍的信息.
- 国家高级脏领导人论坛协助确定主要的省级联系人进行调查传播.
主要成果:
- 在九个省级脏计划中,有八个响应了调查.
- 实践差异很大:五个省份报告了所有新开始透析的eGFR,而三个省份仅报告了慢性患者.
- 在定义慢性透析患者 (30天与90天触发器) 和用于eGFR计算的肌素值方面存在不一致.
- 三个省份在透析开始时缺乏eGFR的基准目标,现有的目标从<9.5到<15毫升/分钟/1.73平方米不等.
- 所有受访者都支持建立一个国家基准.
结论:
- 在加拿大范围内,在透析启动时测量和报告eGFR的方法存在显著的变化.
- 对于启动透析的基准目标没有达成共识,这影响了推迟透析的战略.
- 在透析启动时标准化目标eGFR对于促进国家报告和ESKD护理质量改善举措至关重要.
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