Division of Pediatric Nephrology, Johns Hopkins University, 200 N. Wolfe St, Baltimore, MD 21287, USA.
Pediatr Nephrol. 2011 Dec;26(12):2219-26. doi: 10.1007/s00467-011-1932-8. Epub 2011 Jun 4.
Published data on the comparative achievement of The Kidney Disease Dialysis Outcome Quality Initiative (KDOQI) recommended clinical performance targets between children and young adults on dialysis are scarce. To characterize the achievement of KDOQI targets among children (<18 years) and young adults (18-24 years) with prevalent end stage renal disease (ESRD), we performed a cross-sectional analysis of data collected by the Mid-Atlantic Renal Coalition, in conjunction with the 2007 and 2008 ESRD Clinical Performance Measures Projects. Data on all enrolled pediatric dialysis patients, categorized into three age groups (0-8, 9-12, 13-17 years), and on a random sample of 5% of patients ≥ 18 years in ESRD Network 5 were examined for two study periods: hemodialysis (HD) data were collected from October to December 2006 and from October to December 2007 and peritoneal dialysis (PD) data were collected from October 2006 to March 2007 and from October 2007 to March 2008. In total, 114 unique patients were enrolled the study, of whom 41.2% (47/114) were on HD and 58.8% (67/114) on PD. Compared to the pediatric patients, young adults were less likely to achieve the KDOQI recommended serum phosphorus levels and serum calcium × phosphorus product values, with less than one-quarter demonstrating values at or below each goal. Multivariate analysis revealed that both young adults and 13- to 17-year-olds were less likely to achieve target values for phosphorus [young adults: odds ratio (OR) 0.04, 95% confidence interval (95% CI) 0.01-0.19, p < 0.001; 13- to 17-year-olds: OR 0.17, 95% CI 0.04-0.77, p = 0.02] and calcium × phosphorus product (young adults: OR 0.01, 95% CI 0.002-0.09, p < 0.001; 13- to 17-year-olds: OR 0.09, 95% CI 0.02-0.56, p = 0.01) than younger children. In summary, there are significant differences in clinical indices between pediatric and young adult ESRD patients.
目前，关于接受透析治疗的儿童和青年患者在肾脏病生存质量倡议（KDOQI）推荐的临床实践目标方面的达成情况，相关数据较为匮乏。为了评估儿童（<18 岁）和青年（18-24 岁）终末期肾病（ESRD）患者的 KDOQI 目标达成情况，我们对 2007 年和 2008 年 ESRD 临床实践指标项目中由中大西洋肾脏联盟（Mid-Atlantic Renal Coalition）收集的数据进行了横断面分析。该研究纳入了所有登记的儿科透析患者，按照年龄分为 3 组（0-8 岁、9-12 岁、13-17 岁），并对 ESRD 网络 5 中 5%的≥18 岁患者进行了随机抽样。该研究的两个观察期分别为：2006 年 10 月至 12 月进行血液透析（HD）数据收集，2007 年 10 月至 12 月进行腹膜透析（PD）数据收集；2006 年 10 月至 2007 年 3 月进行 PD 数据收集，2007 年 10 月至 2008 年 3 月进行 HD 数据收集。共有 114 例患者符合入选标准，其中 41.2%（47/114）患者接受 HD 治疗，58.8%（67/114）患者接受 PD 治疗。与儿科患者相比，青年患者的 KDOQI 推荐的血清磷和血清钙×磷乘积目标值达标率较低，不到四分之一的患者达到了每个目标值。多变量分析显示，青年患者和 13-17 岁患者的磷[青年患者：比值比（OR）0.04，95%置信区间（95%CI）0.01-0.19，p<0.001；13-17 岁患者：OR 0.17，95%CI 0.04-0.77，p=0.02]和钙×磷乘积（青年患者：OR 0.01，95%CI 0.002-0.09，p<0.001；13-17 岁患者：OR 0.09，95%CI 0.02-0.56，p=0.01）达标率均显著低于年龄更小的儿童。综上所述，儿童和青年 ESRD 患者在临床指标上存在显著差异。
