在初级保健中管理早期慢性病的整体计划的五年成果
Sky Wei Chee Koh1, Ping Young Ang1,2, Hung Chew Wong3
1National University Polyclinics, National University Health System, Singapore.
Annals of the Academy of Medicine, Singapore
|November 7, 2024
概括
维持血管激素转化酶抑制剂 (ACEi) /血管激素受体阻断剂 (ARB) 剂量对于减缓慢性病 (CKD) 进展至关重要. 早期CKD患者在降低或停止ACEi/ARB剂量时,进展更快到晚期病.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
- 临床研究 临床研究
背景情况:
- 降低和跟踪慢性病 (HALT-CKD) 计划的整体方法于2017年在新加坡建立,以应对慢性病 (CKD) 的患病率上升.
- 早期发现和治疗CKD至关重要,以防止疾病的进展和减少相关的发病率.
研究的目的:
- 评估HALT-CKD计划在治疗早期CKD患者中的有效性.
- 在现实世界,全国范围内确定与CKD进展相关的关键因素.
主要方法:
- 进行了一项回顾性队列研究,涉及3800名在2017年至2018年期间从新加坡多诊所招募的成年患者 (CKD阶段G1-G3A).
- 通过使用血清肌素水平,使用描述性统计数据和Cox回归分析,监测到晚期CKD (G3B-G5) 的进展,直到2023年3月.
- 如果患者转移护理,去世或在没有疾病进展的情况下违约,则会受到审查.
主要成果:
- 在4.7年的中位数随访期间,12.6%的患者进展为晚期CKD,尽管HbA1c,血压和白尿的改善.
- 显著加快CKD进展的因素包括年龄的增长,女性性别,基线肌素,透气血压,HbA1c和宏蛋白尿的存在.
- 减少或停止使用血管激素转化酶抑制剂 (ACEi) /血管激素受体抑制剂 (ARB) 与更快的进展有关 (HR 1.92),而咨询和SGLT2i使用没有显著的保护作用.
结论:
- 维持ACEi/ARB的最佳剂量对于延缓CKD进展至关重要,应避免过早停止治疗.
- 需要进一步研究患者咨询和-葡萄糖共传输体-2抑制剂 (SGLT2i) 治疗在早期CKD管理中的作用.
- 这些发现强调了药物坚持和管理策略在缓解慢性病进展方面的重要性.
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