估计ESKD风险和及时替代疗法教育教育的估计
Lauren E Haggerty1, Dena E Rifkin2,3, Hoang Anh Nguyen4
1Division of Nephrology-Hypertension, University of Washington, Seattle, WA, USA.
BMC nephrology
|September 10, 2024
概括
科医生经常高估功能衰竭的风险,但低估了患者的替代疗法 (KRT) 教育. 衰竭风险方程 (KFRE) 为及时的KRT准备提供了更客观的措施.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗决策的制定 医疗决策的制定
- 医疗保健服务研究 医疗服务研究
背景情况:
- 置换疗法 (KRT) 需要仔细规划,但预测衰竭的时间是具有挑战性的.
- 医生对功能衰竭的风险评估往往比像功能衰竭风险方程 (KFRE) 这样的客观计算更悲观.
研究的目的:
- 为了比较科专家的主观风险估计与客观KFRE在预测需要KRT教育转诊.
- 分析医生预测,KFRE分数和有关功能衰竭的实际患者结果之间的关系.
主要方法:
- 一项前性观察性研究,涉及圣地亚哥VA和UCSD诊所的257名慢性病 (CKD) 患者.
- 科医生提供了KRT在2年内无助风险预测;KFRE是使用临床变量计算的.
- 追踪了90天内转诊到KRT教育和随后的功能衰竭,以评估预测准确性 (灵敏度,特异性).
主要成果:
- 很大一部分患者在90天内被转诊接受KRT教育.
- 科医生的高风险预测 (≥15%) 显示KRT需要71%的灵敏度和76%的特异性.
- 与医生的估计相比,KFRE高风险预测 (≥15%) 显示出更高的灵敏度 (85%),但较低的特异性 (41%).
结论:
- 科医生倾向于高估功能衰竭风险,但他们对KRT教育的推并不总是与这些高风险感知保持一致.
- KFRE提供了一个更敏感的,虽然不那么具体的工具,用于识别可能受益于及时KRT教育的患者.
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