School of Public Health, The University of Sydney, Australia.
Am J Kidney Dis. 2012 Mar;59(3):419-27. doi: 10.1053/j.ajkd.2011.08.024. Epub 2011 Oct 20.
It is unclear how many incident patients with stage 5 chronic kidney disease (CKD) referred to nephrologists are presented with information about conservative care as a treatment option and how many plan not to dialyze.
National observational survey study with random-effects logistic regression.
SETTING & PARTICIPANTS: Incident adult and pediatric pre-emptive transplant, dialysis, and conservative-care patients from public and private renal units in Australia, July to September 2009.
Age, sex, health insurance status, language, time known to nephrologist, timing of information, presence of caregiver, unit conservative care pathway, and size of unit.
OUTCOMES & MEASUREMENTS: The 2 main outcome measures were information provision to incident patients about conservative care and initial treatment regardless of planned conservative care.
66 of 73 renal units (90%) participated. 10 (15%) had a formal conservative-care pathway. Of 721 incident patients with stage 5 CKD, 470 (65%) were presented with conservative care as a treatment option and 102 (14%) planned not to dialyze; median age was 80 years. Multivariate analysis for information provision showed that patients older than 65 years (OR, 3.40; 95% CI, 1.97-5.87) and those known to a nephrologist for more than 3 months (OR, 6.50; 95% CI, 3.18-13.30) were more likely to receive information about conservative care. Patients with conservative care as planned initial treatment were more likely to be older than 65 years (OR, 4.71; 95% CI, 1.77-12.49) and women (OR, 2.23; 95% CI, 1.23-4.02) than those who started dialysis therapy. Those with private health insurance were less likely to forgo dialysis therapy (OR, 0.40; 95% CI, 0.17-0.98).
Cross-sectional design prohibited longer term outcome measurement. Excluded patients with stage 5 CKD managed in the community.
1 in 7 patients with stage 5 CKD referred to nephrologists plans not to dialyze. Comprehensive service provision with integrated palliative care needs to be improved to meet the demands of the aging population.
目前尚不清楚有多少被转诊给肾脏科医生的 5 期慢性肾脏病（CKD）新发病例患者获得了关于保守治疗作为治疗选择的信息，以及有多少患者计划不进行透析。
全国观察性调查研究，采用随机效应逻辑回归。
2009 年 7 月至 9 月，来自澳大利亚公立和私立肾脏单位的新发病例成人和儿科患者，包括接受预先移植、透析和保守治疗的患者。
年龄、性别、医疗保险状况、语言、被肾脏科医生了解的时间、信息提供时间、是否有护理人员、单位保守治疗途径以及单位规模。
2 个主要结局测量指标是向新发病例患者提供有关保守治疗的信息，以及无论是否计划进行保守治疗，都提供初始治疗。
73 个肾脏单位中有 66 个（90%）参与了研究。其中 10 个（15%）有正式的保守治疗途径。在 721 名患有 5 期 CKD 的新发病例患者中，470 名（65%）接受了保守治疗作为治疗选择，102 名（14%）计划不进行透析；中位年龄为 80 岁。多变量分析显示，年龄大于 65 岁的患者（OR，3.40；95%CI，1.97-5.87）和被肾脏科医生了解超过 3 个月的患者（OR，6.50；95%CI，3.18-13.30）更有可能获得有关保守治疗的信息。计划进行保守治疗作为初始治疗的患者年龄大于 65 岁的可能性更大（OR，4.71；95%CI，1.77-12.49），女性（OR，2.23；95%CI，1.23-4.02）也更有可能接受保守治疗。而那些有私人医疗保险的患者更不可能选择透析治疗（OR，0.40；95%CI，0.17-0.98）。
横断面设计禁止进行更长期的结局测量。排除了在社区接受管理的 5 期 CKD 患者。
被转诊给肾脏科医生的 5 期 CKD 患者中，每 7 例就有 1 例计划不进行透析。需要改善全面的服务提供，包括综合姑息治疗，以满足老龄化人口的需求。
Zotero 插件