Division of Nephrology, University of Virginia Health Sciences Center, Charlottesville, USA.
Adv Chronic Kidney Dis. 2011 Nov;18(6):420-7. doi: 10.1053/j.ackd.2011.10.006.
CKD is a common condition with well-documented associated morbidity and mortality. Given the substantial disease burden of CKD and the cost of ESRD, interventions to delay progression and decrease comorbidity remain an important part of CKD care. Early referral to nephrologists has been shown to delay progression of CKD. Conversely, late referral has been associated with increased hospitalizations, higher mortality, and worsened secondary outcomes. Late referral to nephrology has been consequent to numerous factors, including the health care system, provider issues, and patient related factors. In addition to timely referral to nephrologists, the optimal modality to provide care for CKD patients has also been evaluated. Multidisciplinary clinics have shown significant improvements in other disease states. Data for the use of these clinics have shown benefit in mortality, progression, and laboratory markers of disease severity. However, studies supporting the use of multidisciplinary clinics in CKD have been mixed. Evidence-based guidelines from groups, including Renal Physicians Association and NKF, provide tools for management of CKD patients by both generalists and nephrologists. Through the use of guidelines, timely referral, and a multidisciplinary approach to care, the ability to provide effective and efficient care for CKD patients can be improved. We present a model to guide a multidisciplinary comanagement approach to providing care to patients with CKD.
CKD 是一种常见病症，其相关发病率和死亡率已有充分记录。鉴于 CKD 疾病负担沉重以及 ESRD 的成本，延缓疾病进展和减少合并症的干预措施仍然是 CKD 护理的重要组成部分。早期转介给肾病学家已被证明可以延缓 CKD 的进展。相反，延迟转介与住院次数增加、死亡率升高和次要结局恶化有关。肾病学的延迟转诊是由许多因素引起的，包括医疗保健系统、提供者问题和患者相关因素。除了及时转介给肾病学家外，还评估了为 CKD 患者提供护理的最佳方式。多学科诊所已在其他疾病状态中显示出显著改善。这些诊所的使用数据显示在死亡率、进展和疾病严重程度的实验室标志物方面有获益。然而，支持在 CKD 中使用多学科诊所的研究结果喜忧参半。包括肾脏医师协会和 NKF 在内的团体的循证指南为内科医生和肾病学家管理 CKD 患者提供了工具。通过使用指南、及时转诊和多学科的护理方法，可以提高为 CKD 患者提供有效和高效护理的能力。我们提出了一个模型，以指导多学科共同管理方法为 CKD 患者提供护理。
