Wikström Bjorn, Jacobson Stefan H, Bragg-Gresham Jennifer, Eichleay Margaret, Pisoni Ron, Port Friedrich
Department of Nephrology, Uppsala University Hospital, Uppsala, Sweden.
Scand J Urol Nephrol. 2010 Mar;44(2):113-20. doi: 10.3109/00365590903490047.
To examine the association of adherence to Swedish Society of Nephrology guidelines on haemodialysis treatment and patient outcomes in Sweden.
A prevalent cross-sectional sample of Swedish haemodialysis patients was obtained from the Dialysis Outcomes and Practice Patterns Study (DOPPS II, 2002-2004), an international, prospective, cohort study that investigates relationships between patient outcomes and haemodialysis practices. The sample was used to estimate life-years gained through adherence to six potentially modifiable practice patterns: dialysis dose, anaemia, serum phosphorus, serum calcium, serum albumin and catheter use for vascular access. Cox proportional hazards regression models were used to calculate the relative risk of mortality for all patients outside each guideline.
The practices resulting in the largest patient-year gains were increasing patient albumin above 35 g/l and reducing facility catheter use to below 10%. Compliance with the albumin target levels could save approximately 441 life-years (or as many as 904 years). Similarly, by 2010, 409 life-years (or as many as 837 years) could be saved if vascular access target levels were achieved.
The analysis suggests potential opportunities to improve haemodialysis patient care in Sweden. Estimates of life-years saved may serve as motivation for the improvement of patient care through adherence to published guidelines supported by international data from the DOPPS.
研究瑞典肾脏病学会血液透析治疗指南的依从性与瑞典患者预后之间的关联。
从透析结局和实践模式研究（DOPPS II，2002 - 2004年）中获取瑞典血液透析患者的现患横断面样本，这是一项国际性、前瞻性队列研究，旨在调查患者预后与血液透析实践之间的关系。该样本用于估计通过遵循六种可能可改变的实践模式所获得的生命年数：透析剂量、贫血、血清磷、血清钙、血清白蛋白以及用于血管通路的导管使用情况。采用Cox比例风险回归模型计算各指南之外所有患者的死亡相对风险。
导致患者生命年数增加最多的实践模式是将患者白蛋白水平提高至35 g/l以上，并将医疗机构导管使用率降低至10%以下。达到白蛋白目标水平可节省约441个生命年（或多达904年）。同样，到2010年，如果达到血管通路目标水平，可节省409个生命年（或多达837年）。
该分析表明在瑞典改善血液透析患者护理存在潜在机会。节省生命年数的估计值可作为通过遵循DOPPS国际数据支持的已发表指南来改善患者护理的动力。
