透析前诊所患者的结果以及对共享决策的影响
Hannah O'Keeffe1,2, Rosemary Donne1, Philip A Kalra1,2
1Renal Department, Salford Royal Hospital, Northern Care Alliance, Manchester, United Kingdom.
Clinical kidney journal
|August 4, 2025
概括
晚期慢性病 (CKD) 患者面临高死亡率. 一个高级护理服务 (AKCS) 策略改善了预防性移植和腹腔透析的结果,尽管老年患者 (≥80岁) 的预后不好.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 老年医学 老年医学
- 公共卫生 公共卫生
背景情况:
- 末期病 (ESKD) 与显著的发病率和死亡率有关.
- 患者教育和共享决策对于管理晚期慢性病 (CKD) 至关重要.
研究的目的:
- 评估由高级脏护理服务 (AKCS) 管理的患者的结果.
- 评估AKCS对置换疗法 (RRT) 模式和存活率的影响.
- 分析基于晚期CKD患者的年龄和治疗选择的生存差异.
主要方法:
- 对1957名患者的纵向随访,这些患者参加了英国第三级脏中心的AKCS.
- 纳入标准:估计的淋巴膜过率 (eGFR) <20 mL/min/1.73 m2.
- 至少5年后续数据收集到2023年9月.
主要成果:
- 55.7%的患者启动了RRT; 17.9%选择了保守的治疗.
- 预防性移植 (15.5%) 和腹腔透析 (27.3%) 是重要的RRT方式.
- 总体而言,五年生存率为49.6%,随着年龄的增长而显著下降 (例如,≥80岁的22.3%).
- 80岁以上的患者在RRT (17.4个月) 和保守治疗 (11.8个月) 之间显示出适度的生存益处.
结论:
- 先进的CKD队列经历了高竞争性死亡率.
- 结构化的AKCS促进了更高的预防性移植和腹膜透析率.
- 患有ESKD的老年患者 (≥80岁) 无论是RRT还是保守管理,结果都不好.
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