華盛頓大學醫學系、腎臟研究院的Marlena Maziarz醫師等人寫道,我們的研究方法可以幫助公衛系統辨識高風險族群,然後,可進行更密切的監控、管理風險因素,必要時,則準備進行ESRD照護。

CKD: Model Identifies Urban Poor at Greatest Risk for ESRD

By Susan London
Medscape Medical News

A new model based on five readily assessed clinical factors accurately identifies the small subset of urban poor patients with chronic kidney disease (CKD) who will go on to develop end-stage renal disease (ESRD), according to a retrospective cohort study.

"Our study approach may help to guide public health systems in identifying a high-risk subcohort that might, for example, undergo more intensive surveillance, risk factor management, and when necessary, preparation for ESRD care," write Marlena Maziarz, MSc, from the Kidney Research Institute, Department of Medicine, University of Washington, Seattle, and colleagues.

The study cohort consisted of 28,779 adults with CKD who were not receiving dialysis and who were receiving care in two large safety net health systems between 1996 and 2009.

During a median follow-up of 6.6 years, 1730 of the patients (6%) experienced progression to ESRD, according to the study, which was published online December 4 in the Journal of the American Society of Nephrology. This corresponded to an incidence rate of 8.7 per 1000 person-years.

The model, based on age, sex, race, estimated glomerular filtration rate, and dipstick proteinuria, identified the large majority of patients having progression to ESRD.

Specifically, "91% of patients who developed ESRD within 1 year were included among the 10% of patients having the highest model-estimated risk. Similarly, the top 10% of model-estimated risk included 83% and 74%, respectively, of the patients who developed ESRD within 3 and 5 years.

With the model, only 5%, 8%, and 13% of patients would need follow-up to catch 80% of those with progression to ESRD at 1, 3, and 5 years, respectively.

The model performed about the same as more complex models that require more detailed sociodemographic and clinical data. Its discrimination improved little, if at all, with the further addition of health insurance status, comorbidities, and other laboratory data.

"Application of risk prediction at the system level in the health care safety net may improve the effectiveness of CKD-related care delivery by allowing resources to be directed to a relatively small subcohort of patients who are at highest risk for developing progressive disease and disability," the investigators conclude.

One coauthor served as a consultant for Biogen Idec and has ownership interest in Thrasos Innovations, Inc. Another coauthor serves on the board of directors of Satellite HealthCare and PuraCath; reports serving as a consultant for Amgen, AstraZeneca, Gilead, Otsuka, and ZS; and has ownership interest in Ardelyx, Allocure, HD+, PuraCath, and Thrasos. Another coauthor previously received research funding from Satellite HealthCare's Norman S. Coplon Extramural Grant Program. The other authors have disclosed no relevant financial relationships.

J Am Soc Nephrol. Published online December 4, 2014.

2016/1/29 下午 01:44:56
2015/3/23 下午 03:07:21
2014/11/28 上午 11:15:44

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