European Renal Association-European Dialysis and Transplant Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Am J Kidney Dis. 2012 Dec;60(6):940-8. doi: 10.1053/j.ajkd.2012.07.015. Epub 2012 Aug 23.
Little is known about the criteria nephrologists use in the decision of when to start renal replacement therapy (RRT) in early referred adult patients. We evaluated opinions of European nephrologists on the decision for when to start RRT.
European web-based survey.
Patient presentations described as uncomplicated patients, patients with unfavorable clinical and unfavorable social conditions, or patients with specific clinical, social, and logistical factors.
SETTING & PARTICIPANTS: Nephrologists from 11 European countries.
OUTCOMES & MEASUREMENTS: We studied opinions of European nephrologists about the influence of clinical, social, and logistical factors on decision making regarding when to start RRT, reflecting practices in place in 2009. Questions included target levels of kidney function at the start of RRT and factors accelerating or postponing RRT initiation. Using linear regression, we studied determinants of target estimated glomerular filtration rate (eGFR) at the start of RRT.
We received 433 completed surveys. The median target eGFR selected to start RRT in uncomplicated patients was 10.0 (25th-75th percentile, 8.0-10.0) mL/min/1.73 m(2). Level of excretory kidney function was considered the most important factor in decision making regarding uncomplicated patients (selected by 54% of respondents); in patients with unfavorable clinical versus social conditions, this factor was selected by 24% versus 32%, respectively. Acute clinical factors such as life-threatening hyperkalemia refractory to medical therapy (100%) and uremic pericarditis (98%) elicited a preference for an immediate start, whereas patient preference (69%) and vascular dementia (66%) postponed the start. Higher target eGFRs were reported by respondents from high- versus low-RRT-incidence countries (10.4 [95% CI, 9.9-10.9] vs 9.1 mL/min/1.73 m(2)) and from for-profit versus not-for-profit centers (10.1 [95% CI, 9.5-10.7] vs 9.5 mL/min/1.73 m(2)).
We were unable to calculate the exact response rate and examined opinions rather than practice for 433 nephrologists.
Only for uncomplicated patients did half the nephrologists consider excretory kidney function as the most important factor. Future studies should assess the weight of each factor affecting decision making.
对于早期转介的成年患者，肾内科医生在决定何时开始肾脏替代治疗（RRT）时使用的标准知之甚少。我们评估了欧洲肾内科医生对开始 RRT 决策的看法。
欧洲网络调查。
描述为无并发症患者、临床和社会预后不良患者或具有特定临床、社会和后勤因素的患者。
来自 11 个欧洲国家的肾内科医生。
我们研究了欧洲肾内科医生对临床、社会和后勤因素对开始 RRT 决策的影响的看法，反映了 2009 年的实际情况。问题包括开始 RRT 时的肾功能目标水平以及加速或推迟 RRT 启动的因素。使用线性回归，我们研究了开始 RRT 时目标估计肾小球滤过率（eGFR）的决定因素。
我们收到了 433 份完整的调查问卷。在无并发症患者中，选择开始 RRT 的中位目标 eGFR 为 10.0（25-75 百分位，8.0-10.0）mL/min/1.73 m2。肾脏功能的排泄水平被认为是决定无并发症患者治疗的最重要因素（54%的受访者选择）；在临床和社会预后不良的患者中，这一因素分别被 24%和 32%的受访者选择。危及生命的抗医学治疗性高钾血症（100%）和尿毒症性心包炎（98%）等急性临床因素需要立即开始治疗，而患者偏好（69%）和血管性痴呆（66%）则会推迟开始治疗。来自高 RRT 发生率国家（10.4[95%CI，9.9-10.9]vs 9.1 mL/min/1.73 m2）和营利性与非营利性中心（10.1[95%CI，9.5-10.7]vs 9.5 mL/min/1.73 m2）的受访者报告了更高的目标 eGFR。
我们无法计算确切的回复率，并针对 433 名肾内科医生的意见进行了调查，而非实际情况。
只有在无并发症患者中，一半的肾内科医生认为排泄功能是最重要的因素。未来的研究应该评估影响决策的每个因素的权重。
