Division of Nephrology and Hypertension, Fletcher Allen Health Care, Burlington, VT 05401, USA.
Am J Kidney Dis. 2012 Mar;59(3 Suppl 2):S5-15. doi: 10.1053/j.ajkd.2011.10.043.
Data are scant regarding access to health care in patients with chronic kidney disease (CKD). We performed descriptive analyses using data from the National Kidney Foundation's Kidney Early Evaluation Program (KEEP), a nationwide health screening program for adults at high risk of CKD.
From 2000-2010, a total of 122,502 adults without end-stage renal disease completed KEEP screenings; 27,927 (22.8%) met criteria for CKD (10,082, stages 1-2; 16,684, stage 3; and 1,161, stages 4-5). CKD awareness, self-rated health status, frequency of physician visits, difficulty obtaining medical care, types of caregivers, insurance status, and medication coverage and estimated costs were assessed.
Participants with CKD were more likely to report fair/poor health status than those without CKD. Health care utilization increased at later CKD stages; ~95% of participants at stages 3-5 had visited a physician during the preceding year compared with 83.7% of participants without CKD. More Hispanic and African American than white participants at all CKD stages reported not having a physician. Approximately 40% of participants younger than 65 years reported fair/poor health status at stages 4-5 compared with ~30% who were 65 years and older. Younger participants at all stages were more likely to report extreme or somewhat/moderate difficulty obtaining medical care. Comorbid conditions (diabetes, hypertension, and prior cardiovascular events) were associated with increased utilization of care. Utilization of nephrology care was poor at all CKD stages; <6% of participants at stage 3 and <30% at stages 4-5 reported ever seeing a nephrologist.
Lack of health insurance and perceived difficulty obtaining medical care with lower health care utilization, both of which are consistent with inadequate access to health care, are more likely for KEEP participants who are younger than 65 years, nonwhite, and without previously diagnosed comorbid conditions. Nephrology care is infrequent in elderly participants with advanced CKD who are nonwhite, have comorbid disease, and have high-risk states for cardiovascular disease.
有关慢性肾脏病（CKD）患者获得医疗保健的资料很少。我们使用全国肾脏基金会的肾脏病早期评估计划（KEEP）的数据进行了描述性分析，该计划是一项针对有发生 CKD 高危人群的全国性成人健康筛查计划。
2000 年至 2010 年期间，共有 122502 名无终末期肾病的成年人完成了 KEEP 筛查；27927 人（22.8%）符合 CKD 标准（10082 人处于 1-2 期；16684 人处于 3 期；1161 人处于 4-5 期）。评估了 CKD 意识、自我评估的健康状况、医生就诊频率、获得医疗保健的困难程度、护理人员类型、保险状况以及药物覆盖范围和估计费用。
与无 CKD 的参与者相比，CKD 患者更有可能报告健康状况不佳/较差。随着 CKD 阶段的进展，医疗保健的利用率增加；与无 CKD 的参与者相比，大约 95%的 3-5 期参与者在过去一年中看过医生。与所有 CKD 阶段的白人参与者相比，更多的西班牙裔和非裔美国人报告没有医生。所有 CKD 阶段中，约 40%的 65 岁以下参与者报告在 4-5 期时健康状况不佳/较差，而 65 岁及以上的参与者中约有 30%报告健康状况不佳/较差。所有阶段的年轻参与者更有可能报告获得医疗保健的极端或某些/中度困难。合并症（糖尿病、高血压和既往心血管事件）与医疗保健利用率的增加相关。在所有 CKD 阶段，肾脏病学护理的利用率都很低；3 期参与者中不到 6%，4-5 期参与者中不到 30%报告曾见过肾病医生。
缺乏健康保险和感知到获得医疗保健的困难与较低的医疗保健利用率相关，这在年龄小于 65 岁、非裔和没有先前诊断出的合并症的 KEEP 参与者中更常见。在患有晚期 CKD 的老年非裔参与者中，合并症和心血管疾病高危状态，肾脏病学护理也很少见。
