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功能衰竭风险方程对血管接入规划的临床影响
Ulrika Hahn Lundström1, Chava L Ramspek2, Friedo W Dekker2
1Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
概括
衰竭风险方程 (KFRE) 与传统的eGFR值相比,为慢性病 (CKD) 患者提供了改进的血管接入规划. 实施KFRE>40%和KFRE>50%可以提高置换治疗的预测准确度.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 血管外科 血管外科
- 公共卫生 公共卫生
背景情况:
- 动脉静脉 (AV) 通道创建计划可以从基于风险的门中受益.
- 功能衰竭风险方程 (KFRE) 是一种提议的工具,用于优化血管接入转诊时间.
研究的目的:
- 评估使用KFRE用于慢性病 (CKD) 患者的血管接入转诊的临床影响.
- 为了比较KFRE值与传统估计的膜过率 (eGFR) <15 mL/min/1.73 m2值的有效性.
主要方法:
- 分析了16102名瑞典CKD患者 (2008-2018) 使用瑞典脏注册表.
- 重复计算KFRE并确定何时超过值或eGFR<15 mL/min/1.73 m2.的时间.
- 通过积发病率曲线和替代疗法 (KRT) 或6个月,12个月和2年死亡的决定曲线分析评估KFRE/eGFR效用.
主要成果:
- 对于KRT启动,KFRE>50%显示了最高的12个月特异性 (94.5%);KFRE>30%和eGFR<15显示了最高的灵敏度.
- 两年的积极预测值为KFRE>50的71.5%,KFRE>40%的61.7%,eGFR<15.2的47.2%.
- 决策曲线分析表明,KFRE>40% (2年) 和KFRE>50% (12个月) 提供了最大的净益,特别是在避免不必要的手术时.
结论:
- 与标准EGFR<15 mL/min/1.73 m2的门相比,KFRE,特别是>40%和>50%的门,在血管接入规划方面表现出优越的效用.
- 这些发现支持将KFRE纳入临床实践,以便在CKD管理中更准确地做出AV接入转诊决策.
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