Kuo Hsin-Wei, Tsai Shang-Shyue, Tiao Mao-Meng, Liu Yi-Chun, Yang Chun-Yuh
Division of Nephrology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan.
J Nephrol. 2009 Sep-Oct;22(5):654-61.
End-stage renal disease is epidemic in Taiwan. Although early intervention in chronic kidney disease (CKD) has proven to be effective in modifying its clinical course, little is known about the quality and trend of CKD care in Taiwan.
From a nationally representative database of 200,000 individuals, CKD patients were identified by diagnostic codes, and their medical interventions were extracted from service claims. The predictors for care delivery were analyzed in a logistic regression model.
Of the 7,740 patients with CKD, only 54.8% had follow-up of renal function. Tests for anemia, calcium/ phosphorus and lipid profile were performed in 34.5%, 5.2% and 40.9% of patients, respectively. Most hypertensive CKD patients have used antihypertensive agents, but only 58.1% of them received angiotensinconverting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). Of CKD patients with diabetes, less than half had glycosylated hemoglobin measured, and only 49.7% received ACEIs/ARBs. We observed an encouraging trend in the use of ACEIs/ ARBs and in most aspects of laboratory monitoring.
Management of CKD patients is suboptimal, and lack of awareness is common. Further work is needed to evaluate the impact of educational initiatives and multidisciplinary teams on outcomes in CKD patients.
终末期肾病在台湾呈流行态势。尽管对慢性肾脏病（CKD）的早期干预已被证明可有效改变其临床病程，但台湾CKD护理的质量和趋势却鲜为人知。
从一个具有全国代表性的20万人数据库中，通过诊断编码识别出CKD患者，并从服务理赔中提取他们的医疗干预措施。在逻辑回归模型中分析护理提供的预测因素。
在7740例CKD患者中，仅有54.8%的患者进行了肾功能随访。分别有34.5%、5.2%和40.9%的患者进行了贫血、钙/磷和血脂检测。大多数高血压CKD患者使用了抗高血压药物，但其中只有58.1%的患者接受了血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）。在患有糖尿病的CKD患者中，不到一半的患者检测了糖化血红蛋白，只有49.7%的患者接受了ACEI/ARB治疗。我们观察到在ACEI/ARB的使用以及大多数实验室监测方面呈现出令人鼓舞的趋势。
CKD患者的管理并不理想，认识不足的情况很常见。需要进一步开展工作来评估教育举措和多学科团队对CKD患者治疗结果的影响。
