St Peter Wendy L, Khan Samina S, Ebben James P, Pereira Brian J G, Collins Allan J
Nephrology Analytical Services, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA.
Kidney Int. 2004 Jul;66(1):313-21. doi: 10.1111/j.1523-1755.2004.00733.x.
The cost of care for end-stage renal disease (ESRD) is known to be high. The factors responsible for higher ESRD cost develop during chronic kidney disease (CKD), where the data on distribution of cost are limited.
This retrospective cohort study of 1995 through 1998 incident dialysis patients was performed to study the distribution of costs during the 24 months prior to initiation of dialysis. Patient data were obtained from the Centers for Medicare and Medicaid Services (CMS). Patients who were Medicare eligible for at least 2 years prior to initiation of dialysis were included in the study. Financial data were obtained from Medicare Part A and Part B claims and inflationary adjustments were made. The study period was divided into four segments based on overall distribution of cost.
The mean age was 75 years, 51% were males, 73% were white, and 22% were black. Overall, patient comorbidity increased significantly during the study years. Cost showed a sharp increase in the last 6 months prior to initiation of dialysis. Hospitalization was the major component of cost throughout study period. Patients who initiated hemodialysis incurred a higher cost compared to patients who initiated other modes of kidney replacement therapy. Patients with diabetes or cardiovascular disease incurred higher cost compared to those who had no diabetes or cardiovascular disease, respectively.
These data showed that hospitalization was the major component of the sharp increase in cost around the initiation of dialysis. Increased comorbidity was associated with higher cost. A focus on timely management of CKD may prevent future morbidity and costs.
已知终末期肾病（ESRD）的护理成本很高。导致ESRD成本较高的因素在慢性肾脏病（CKD）期间就已出现，而关于成本分布的数据有限。
对1995年至1998年开始透析的患者进行了这项回顾性队列研究，以研究开始透析前24个月内的成本分布情况。患者数据来自医疗保险和医疗补助服务中心（CMS）。研究纳入了在开始透析前至少有2年符合医疗保险资格的患者。财务数据来自医疗保险A部分和B部分的索赔，并进行了通货膨胀调整。根据成本的总体分布，将研究期分为四个阶段。
平均年龄为75岁，51%为男性，73%为白人，22%为黑人。总体而言，在研究期间患者的合并症显著增加。成本在开始透析前的最后6个月急剧上升。在整个研究期间，住院是成本的主要组成部分。开始血液透析的患者比开始其他肾脏替代治疗模式的患者花费更高。患有糖尿病或心血管疾病的患者分别比没有糖尿病或心血管疾病的患者花费更高。
这些数据表明，住院是透析开始前后成本急剧增加的主要组成部分。合并症增加与成本较高相关。关注CKD的及时管理可能会预防未来的发病和成本。
