CKD:研究發現都會區之貧困者的ESRD風險最高


  【24drs.com】根據一篇回溯世代研究,運用5個現有之可評估臨床因素建立的新模式,可準確地辨識患有慢性腎臟病(CKD)、居住於都會區的某些貧困者,將會發生末期腎臟病(ESRD)。
  
  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。
  
  研究世代包括28,779名沒有接受透析的CKD成人,在1996-2009年間,於兩所大型安全網絡衛生體系接受照護。
  
  根據這篇線上發表於12月4日美國腎臟學會期刊的研究,在平均追蹤6.6年間,1,730名病患(6%)漸漸發生成為ESRD,相當於每1000人-年發生率為8.7。
  
  這個模式是依據年齡、性別、種族、估計腎絲球過濾速率、試紙檢驗蛋白尿,發現大部分病患逐漸惡化成ESRD。
  
  特別的是,在1年內發生ESRD的病患,91%是那些由這個模式估計風險最高的前10%的患者,同樣地,這個模式估計風險最高的前10%患者,在3年和5年內發生ESRD的風險分別是83%與74%。
  
  在這個模式中,在第1、3、5年時,需要追蹤的病患分別只有5%、8%和13%,發生ESRD的風險達到80%。
  
  這個模式的分析表現,與那些需要更複雜的社會人口統計學及臨床資料的模式一樣。如果將健康保險狀態、共病症、其他檢驗資料加入分析,整體而言,鑑別改善不大。
  
  研究者結論指出,在安全照護網絡中,運用系統性風險預測可以改善現有資源下的CKD相關照護效果,有助於將資源直接運用於發生疾病惡化或失能風險高的相對少數病患。
  
  資料來源:

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.

    
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