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一家健康维护组织开展的每日家庭血液透析:三年经验

Daily home hemodialysis at a health maintenance organization: three-year experience.

作者信息

Kumar Victoria A, Ledezma Mateo L, Rasgon Scott A

机构信息

Southern California Permanente Medical Group, Center for Medical Education, Los Angeles, California 91602, USA.

出版信息

Hemodial Int. 2007 Apr;11(2):225-30. doi: 10.1111/j.1542-4758.2007.00173.x.

Abstract

Daily home hemodialysis (DHD), 5 to 7 short-duration hemodialysis treatments per week, promotes self-care and has beneficial effects on a number of clinical outcomes including blood pressure and volume control, electrolyte balance, uremic symptoms and sequelae, and quality of life. We sought to demonstrate that DHD is feasible and confers clinical benefits that permit savings in overall healthcare costs despite expenditures on program infrastructure and supplies. We examined the following outcomes monthly for all patients: laboratory values, dialysis adequacy, hospital admission records, surgical and interventional radiology records, and prescription medication usage. Twelve patients completed training in our home hemodialysis unit between April 2003 and April 2006. The mean age at the time of training was 58 years and mean vintage was 62 months. The mean treatment time was 147 min, and the mean number of treatments performed was 5.3 per week. When 1 patient with morbid obesity was excluded due to intentional weight loss, the mean dry weight at initiation of training was 71.9+/-12.4 kg and increased to 74.3+/-12.4 kg by the end of the study (p=0.66). The mean albumin increased from a baseline of 3.9+/-0.3 to 4.3+/-1.1 gm/dL during DHD (p=0.0015). The mean serum phosphorus levels were 5.4+/-1.4 mg/dL. Phosphate binder usage increased from a mean baseline of 2.6+/-1.4 to 4.2+/-2.6 tablets per meal during DHD (p=0.08). The mean delivered single pool Kt/V was 0.87 per treatment. During the 234 months studied, there were 11 hospital admissions (0.56 admissions per patient per year), with a mean length of stay of 3.7 days. Our results demonstrate that DHD improves nutritional status and decreases hospital admissions for dialysis-dependent patients.

摘要

每日家庭血液透析(DHD),即每周进行5至7次短疗程血液透析治疗,可促进自我护理,并对包括血压和容量控制、电解质平衡、尿毒症症状及后遗症以及生活质量在内的多项临床结局产生有益影响。我们试图证明,尽管在项目基础设施和耗材方面有支出,但DHD是可行的,并能带来临床益处,从而节省总体医疗成本。我们每月对所有患者检查以下结局:实验室检查值、透析充分性、住院记录、外科手术和介入放射学记录以及处方药使用情况。2003年4月至2006年4月期间有12名患者在我们的家庭血液透析单元完成了培训。培训时的平均年龄为58岁,平均透析时间为62个月。平均治疗时间为147分钟,每周平均治疗次数为5.3次。当1名病态肥胖患者因故意减重被排除后,培训开始时的平均干体重为71.9±12.4千克,到研究结束时增至74.3±12.4千克(p = 0.66)。在DHD期间,平均白蛋白从基线的3.9±0.3克/分升增至4.3±1.1克/分升(p = 0.0015)。平均血清磷水平为5.4±1.4毫克/分升。在DHD期间,每餐磷酸盐结合剂的使用量从平均基线的2.6±1.4片增至4.2±2.6片(p = 0.08)。每次治疗的平均单池Kt/V为0.87。在研究的234个月期间,共有11次住院(每位患者每年0.56次住院),平均住院时间为3.7天。我们的结果表明,DHD可改善依赖透析患者的营养状况并减少住院次数。

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