Yu Yu-Jen, Wu I-Wen, Huang Chun-Yu, Hsu Kuang-Hung, Lee Chin-Chan, Sun Chio-Yin, Hsu Heng-Jung, Wu Mai-Szu
Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
Laboratory for Epidemiology, Department of Health Care Management, Chang Gung University, Tao-Yuan, Taiwan.
PLoS One. 2014 Nov 14;9(11):e112820. doi: 10.1371/journal.pone.0112820. eCollection 2014.
The multidisciplinary pre-dialysis education (MPE) retards renal progression, reduce incidence of dialysis and mortality of CKD patients. However, the financial benefit of this intervention on patients starting hemodialysis has not yet been evaluated in prospective and randomized trial.
We studied the medical expenditure and utilization incurred in the first 6 months of dialysis initiation in 425 incident hemodialysis patients who were randomized into MPE and non-MPE groups before reaching end-stage renal disease. The content of the MPE was standardized in accordance with the National Kidney Foundation Dialysis Outcomes Quality Initiative guidelines.
The mean age of study patients was 63.8±13.2 years, and 221 (49.7%) of them were men. The mean serum creatinine level and estimated glomerular filtration rate was 6.1±4.0 mg/dL and 7.6±2.9 mL⋅min(-1)⋅1.73 m(-2), respectively, at dialysis initiation. MPE patients tended to have lower total medical cost in the first 6 months after hemodialysis initiation (9147.6±0.1 USD/patient vs. 11190.6±0.1 USD/patient, p = 0.003), fewer in numbers [0 (1) vs. 1 (2), p<0.001] and length of hospitalization [0 (15) vs. 8 (27) days, p<0.001], and also lower inpatient cost [0 (2617.4) vs. 1559,4 (5019.6) USD/patient, p<0.001] than non-MPE patients, principally owing to reduced cardiovascular hospitalization and vascular access-related surgeries. The decreased inpatient and total medical cost associated with MPE were independent of patients' demographic characteristics, concomitant disease, baseline biochemistry and use of double-lumen catheter at initiation of hemodialysis.
Participation of multidisciplinary education in pre-dialysis period was independently associated with reduction in the inpatient and total medical expenditures of the first 6 months post-dialysis owing to decreased inpatient service utilization secondary to cardiovascular causes and vascular access-related surgeries.
ClinicalTrials.gov NCT00644046.
多学科透析前教育（MPE）可延缓肾脏疾病进展，降低慢性肾脏病（CKD）患者的透析发生率和死亡率。然而，尚未通过前瞻性随机试验评估这种干预措施对开始血液透析的患者的经济效益。
我们研究了425例新接受血液透析的患者在开始透析的前6个月的医疗支出和医疗服务利用情况，这些患者在进入终末期肾病之前被随机分为MPE组和非MPE组。MPE的内容根据美国国家肾脏基金会透析预后质量倡议指南进行了标准化。
研究患者的平均年龄为63.8±13.2岁，其中221例（49.7%）为男性。透析开始时，患者的平均血清肌酐水平和估计肾小球滤过率分别为6.1±4.0mg/dL和7.6±2.9mL·min⁻¹·1.73m⁻²。MPE组患者在开始血液透析后的前6个月总医疗费用往往较低（9147.6±0.1美元/患者 vs. 11190.6±0.1美元/患者，p = 0.003），住院次数[0（1）次 vs. 1（2）次，p<0.001]和住院天数[0（15）天 vs. 8（27）天，p<0.001]也较少，住院费用也较低[0（261..）美元/患者 vs. 1559.4（5019.6）美元/患者，p<0.001]，主要原因是心血管疾病住院和血管通路相关手术减少。与MPE相关的住院费用和总医疗费用的降低与患者的人口统计学特征、合并疾病、基线生化指标以及血液透析开始时双腔导管的使用无关。
由于心血管疾病原因和血管通路相关手术导致的住院服务利用减少，透析前多学科教育的参与与透析后前6个月住院费用和总医疗费用的降低独立相关。
ClinicalTrials.gov NCT00644046。
