血管接入规划中的功能衰竭风险方程:一项基于人口的研究,支持决策中的价值
Mohammad Atiquzzaman1,2, Bingyue Zhu1, Alexandra Romann1
1BC Renal, Vancouver, Canada.
Clinical kidney journal
|February 8, 2024
概括
功能衰竭风险方程 (KFRE) 改善了血液透析患者的血管接入计划. 与eGFR转介一起使用KFRE可以增加及时创建动脉静脉/移植,并减少过早的手术.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 血管外科 血管外科
- 医疗保健服务研究 医疗服务研究
背景情况:
- 血管接入 (VA) 规划对于经过血液透析 (HD) 的慢性病 (CKD) 患者至关重要.
- 目前的转诊实践依赖于估计的淋巴细胞过率 (eGFR),但其在优化VA创建时间方面的实用性仍有争议.
- 衰竭风险方程 (KFRE) 可能为预测未来透析需求和指导VA规划提供更精确的工具.
研究的目的:
- 为了评估KFRE得分的有效性,作为CKD患者基于eGFR的血管接入规划的辅助.
- 为了比较基于eGFR的推和KFRE信息的推下的VA创建和利用模式.
- 评估KFRE对及时预防性VA创建和过早VA创建的发生率的影响.
主要方法:
- 一项基于人口的队列研究包括2581名CKD患者 (eGFR<20mL/min/1.73m2) 在加拿大不列颠哥伦比亚省 (2010-2020年).
- 患者根据转诊策略进行分类:基于eGFR,eGFR+KFRE-2风险得分>40%,或eGFR+KFRE-2风险得分≤40%.
- 测量结果包括2年内从动脉静脉/移植 (AVF/G) 开始的HD患者的比例,以及2年内创建但未使用的AVF/G的比例.
主要成果:
- 与单独基于eGFR的转诊相比,辅助KFRE-2显著增加了从AVF/G开始患HD的患者比例 (58%对49%,P<.001).
- 纳入KFRE-2显著降低了过早创建AVF/G的速度 (18%与31%相比,P<.001).
- 尽管61%的患者发病了HD,但在2年的研究期间,有11%的患者在开始透析前死亡.
结论:
- 将KFRE评分集成到现有的基于eGFR的转诊协议中,可以优化血液透析患者的血管接入计划.
- 这种方法通过增加及时创建AVF/G并最大限度地减少不必要的早期程序来提高VA资源利用率.
- 需要进一步的前性研究来验证这些发现,并完善KFRE在临床实践中的作用.
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