Thilly Nathalie, Boini Stéphanie, Kessler Michèle, Briançon Serge, Frimat Luc
Department of Clinical Epidemiology and Evaluation, CEC-CIE6 Inserm, University Hospital of Nancy, Nancy, France.
J Eval Clin Pract. 2009 Feb;15(1):121-8. doi: 10.1111/j.1365-2753.2008.00965.x.
RATIONALE, AIMS AND OBJECTIVES: The nephrology literature contains little information about the global patterns of medication used in the management of patients with chronic kidney disease (CKD). This study aims to evaluate the appropriateness of nephrological therapeutic management of CKD patients compared with current guidelines and to investigate associations between patient characteristics and the quality of therapeutic management.
All adult CKD patients who were starting dialysis in Lorraine (France) between 1 January 2005 and 31 December 2006 and who had been referred to a nephrologist no less than 1 month previously were enrolled. Demographic, clinical, biological and therapeutic data were collected retrospectively from medical records covering the period from the first nephrology consultation to initiation of dialysis. Outcomes of interest were the appropriateness of the therapeutic management of five aspects of CKD: hypertension/proteinuria, anaemia, bone disease, metabolic acidosis and dyslipidemia. Therapeutic care was given a global rating (high, moderate or poor), depending on the number of aspects being managed appropriately. Relationships between the global rating and demographic and clinical characteristics of patients were explored.
During predialysis nephrology follow-up, 93.1% of the 420 patients enrolled were receiving antihypertensive therapy; 67.1% were taking a renin-angiotensin system inhibitor. Other prescriptions included: erythropoiesis-stimulating agents (67.4%), iron (48.3%), phosphate binders (38.1%), vitamin D (21.1%), bicarbonates (15.5%) and statins (36.2%). Hypertension/proteinuria was managed appropriately in 72.4% of cases, anaemia in 56.2%, bone disease in 16.7%, metabolic acidosis in 60.2% and dyslipidemia in 61.4%. The global quality of care was high in 22.1% of cases, moderate in 65.7% and poor in 12.2%. After adjustment, the more nephrology consultations a patient had before dialysis, the higher the quality of his or her care.
The quality of therapeutic care delivered to CKD patients in nephrology setting was suboptimal when assessed in terms of adherence to guidelines.
原理、目的和目标：肾脏病学文献中关于慢性肾脏病（CKD）患者管理中用药的全球模式信息很少。本研究旨在评估CKD患者肾脏科治疗管理与现行指南相比的适宜性，并调查患者特征与治疗管理质量之间的关联。
纳入2005年1月1日至2006年12月31日在洛林（法国）开始透析、且在至少提前1个月被转诊至肾脏科医生处的所有成年CKD患者。从涵盖首次肾脏科会诊至透析开始期间的医疗记录中回顾性收集人口统计学、临床、生物学和治疗数据。感兴趣的结果是CKD五个方面治疗管理的适宜性：高血压/蛋白尿、贫血、骨病、代谢性酸中毒和血脂异常。根据适当管理的方面数量，给予治疗护理一个总体评分（高、中或差）。探讨了总体评分与患者人口统计学和临床特征之间的关系。
在透析前肾脏科随访期间，纳入的420例患者中有93.1%接受抗高血压治疗；67.1%服用肾素 - 血管紧张素系统抑制剂。其他处方包括：促红细胞生成素（67.4%）、铁剂（48.3%）、磷结合剂（38.1%）、维生素D（21.1%）、碳酸氢盐（15.5%）和他汀类药物（36.2%）。高血压/蛋白尿在72.4%的病例中得到适当管理，贫血为56.2%，骨病为16.7%，代谢性酸中毒为60.2%，血脂异常为61.4%。22.1%的病例护理总体质量高，65.7%为中等，12.2%为差。调整后，患者在透析前进行的肾脏科会诊越多，其护理质量越高。
从遵循指南的角度评估，肾脏科为CKD患者提供的治疗护理质量欠佳。
