Mendelssohn David C, Toffelmire Edwin B, Levin Adeera
Department of Nephrology, Humber River Regional Hospital, University of Toronto, Weston, Canada.
Am J Kidney Dis. 2006 Feb;47(2):277-84. doi: 10.1053/j.ajkd.2005.10.019.
Although evidence supporting the advantages of multidisciplinary team-based chronic kidney disease (CKD) care is not well developed, many groups are advocating increased availability of this model.
The research design is a mailed survey sent to 523 members of the Canadian and Quebec Societies of Nephrology.
After excluding 113 respondents who declared themselves to be ineligible, the response rate was 54%. Ninety-one percent of nephrologists reported that they usually or always use a CKD clinic. Decisions about when to perform CKD-related tasks were based mainly on an estimate of glomerular filtration rate, rather than time remaining before end-stage renal disease (ESRD). The ideal creatinine clearance for referral to a CKD clinic was 30 to 59 mL/min (0.50 to 0.98 mL/s), but the usual level was 20 to 29 mL/min (0.33 to 0.44 mL/s). The ideal time for referral was more than 12 months before ESRD. Renal replacement therapy discussions were initiated at a creatinine clearance of 20 to 29 mL/min (57%). Nephrologists supported promotion of home dialysis for suitable patients, but not mandating this. Nephrologists did not provide a blunt prognosis to patients who did not specifically ask. Late referral based on adequate time for ESRD preparation was reported to be 4 to 6 months (27%), 7 to 9 months (26%), or 10 to 12 months (30%). Thirty-eight percent said that optimal preparation takes 13 months or longer.
The literature's common definition of less than 3 months as a cutoff value between late and early referral is not endorsed. Given that multidisciplinary team-based care is widely available in Canada, this study might inform other jurisdictions about the merits and problems associated with multidisciplinary team-based care and might shape the agenda for future empirical research.
尽管支持多学科团队式慢性肾脏病（CKD）护理优势的证据并不充分，但许多团体仍主张增加这种模式的可及性。
研究设计为向加拿大和魁北克肾脏病学会的523名成员邮寄调查问卷。
排除113名自称不符合条件的受访者后，回复率为54%。91%的肾病学家报告称他们通常或总是使用CKD诊所。关于何时开展与CKD相关任务的决策主要基于对肾小球滤过率的估计，而非终末期肾病（ESRD）前剩余的时间。转诊至CKD诊所的理想肌酐清除率为30至59 mL/ min（0.50至0.98 mL/s），但通常水平为20至29 mL/ min（0.33至0.44 mL/s）。理想的转诊时间是在ESRD前12个月以上。在肌酐清除率为20至29 mL/ min时开始进行肾脏替代治疗的讨论（57%）。肾病学家支持为合适的患者推广家庭透析，但不强制要求。对于未特别询问的患者，肾病学家不会给出直接的预后。据报告，基于有足够时间为ESRD做准备的延迟转诊时间为4至6个月（27%）、7至9个月（26%）或10至12个月（30%）。38%的人表示最佳准备需要13个月或更长时间。
文献中普遍将少于3个月作为延迟转诊和早期转诊的分界值这一定义未得到认可。鉴于多学科团队式护理在加拿大广泛可用，本研究可能会让其他司法管辖区了解与多学科团队式护理相关的优点和问题，并可能为未来的实证研究制定议程。
