Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Nephrology (Carlton). 2012 Jul;17(5):472-9. doi: 10.1111/j.1440-1797.2012.01598.x.
The mortality and morbidity of end-stage renal failure patients remains high despite recent advances in pre-dialysis care. Previous studies suggesting a positive effect of pre-dialysis education were limited by unmatched comparisons between the recipients and non-recipients of education. The present study aimed to clarify the roles of the multidisciplinary pre-dialysis education (MPE) in chronic kidney disease patients.
We performed a retrospective single centre study, enrolling 1218 consecutive pre-dialysis chronic kidney disease patients, between July 2007 and Feb 2008 and followed them up to 30 months. By using propensity score matching, we matched 149 recipient- and non-recipient pairs from 1218 patients. The incidences of renal replacement therapy, mortality, cardiovascular event and infection were compared between recipients and non-recipients of MPE.
Renal replacement therapy was initiated in 62 and 64 patients in the recipients and non-recipients, respectively (P > 0.05). The MPE reduced unplanned urgent dialysis (8.7% vs 24.2%, P < 0.001) and shortened hospital days (2.16 vs 5.05 days/patient per year). MPE recipients had a better metabolic status at the time of initiating renal replacement therapy. Although no significant survival advantage from MPE was exhibited, MPE recipients had lower incidence of cardiovascular events (adjusted hazard ratio, 0.24; 95% confidence interval (CI), 0.08 to 0.78; P = 0.017), and a tendency toward a lower infection rate (adjusted hazard ratio, 0.44; 95% CI, 0.17 to 1.11; P = 0.083).
MPE was associated with better clinical outcomes in terms of urgent dialysis, cardiovascular events and infection.
尽管在透析前护理方面取得了最近的进展，终末期肾衰竭患者的死亡率和发病率仍然很高。先前的研究表明，透析前教育具有积极影响，但这些研究受到受教育者和未受教育者之间匹配比较的限制。本研究旨在阐明多学科透析前教育（MPE）在慢性肾脏病患者中的作用。
我们进行了一项回顾性单中心研究，纳入了 2007 年 7 月至 2008 年 2 月期间的 1218 例连续透析前慢性肾脏病患者，并对其进行了 30 个月的随访。通过使用倾向评分匹配，我们从 1218 例患者中匹配了 149 对接受者和未接受者。比较了 MPE 的接受者和未接受者之间的肾脏替代治疗、死亡率、心血管事件和感染的发生率。
在接受者和未接受者中，分别有 62 例和 64 例患者开始接受肾脏替代治疗（P>0.05）。MPE 减少了非计划紧急透析（8.7%对 24.2%，P<0.001）和缩短了住院天数（2.16 对 5.05 天/患者/年）。MPE 接受者在开始肾脏替代治疗时的代谢状态更好。尽管 MPE 未显示出显著的生存优势，但 MPE 接受者的心血管事件发生率较低（调整后的危险比为 0.24；95%置信区间为 0.08 至 0.78；P=0.017），感染率也有降低的趋势（调整后的危险比为 0.44；95%置信区间为 0.17 至 1.11；P=0.083）。
MPE 与紧急透析、心血管事件和感染方面的更好临床结局相关。
