Wong Susan P Y, Hebert Paul L, Laundry Ryan J, Hammond Kenric W, Liu Chuan-Fen, Burrows Nilka R, O'Hare Ann M
Departments of Medicine.
Health Services.
Clin J Am Soc Nephrol. 2016 Oct 7;11(10):1825-1833. doi: 10.2215/CJN.03760416. Epub 2016 Sep 22.
It is not known what proportion of United States patients with advanced CKD go on to receive RRT. In other developed countries, receipt of RRT is highly age dependent and the exception rather than the rule at older ages.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective study of a national cohort of 28,568 adults who were receiving care within the US Department of Veteran Affairs and had a sustained eGFR <15 ml/min per 1.73 m between January 1, 2000 to December 31, 2009. We used linked administrative data from the US Renal Data System, US Department of Veteran Affairs, and Medicare to identify cohort members who received RRT during follow-up through October 1, 2011 (=19,165). For a random 25% sample of the remaining 9403 patients, we performed an in-depth review of their VA-wide electronic medical records to determine the treatment status of their CKD.
Two thirds (67.1%) of cohort members received RRT on the basis of administrative data. On the basis of the results of chart review, we estimate that an additional 7.5% (95% confidence interval, 7.2% to 7.8%) of cohort members had, in fact, received dialysis, that 10.9% (95% confidence interval, 10.6% to 11.3%) were preparing for and/or discussing dialysis but had not started dialysis at most recent follow-up, and that a decision had been made not to pursue dialysis in 14.5% (95% confidence interval, 14.1% to 14.9%). The percentage of cohort members who received or were preparing to receive RRT ranged from 96.2% (95% confidence interval, 94.4% to 97.4%) for those <45 years old to 53.3% (95% confidence interval, 50.7% to 55.9%) for those aged ≥85 years old. Results were similar after stratification by tertile of Gagne comorbidity score.
In this large United States cohort of patients with advanced CKD, the majority received or were preparing to receive RRT. This was true even among the oldest patients with the highest burden of comorbidity.
美国晚期慢性肾脏病（CKD）患者中接受肾脏替代治疗（RRT）的比例尚不清楚。在其他发达国家，RRT的接受情况高度依赖年龄，在老年人群中是例外而非普遍现象。
设计、地点、参与者与测量：我们对28568名成年退伍军人进行了一项回顾性研究，这些人于2000年1月1日至2009年12月31日期间在美国退伍军人事务部接受治疗，且估算肾小球滤过率（eGFR）持续<15 ml/min/1.73 m²。我们使用了来自美国肾脏数据系统、美国退伍军人事务部和医疗保险的关联行政数据，以确定在随访至2011年10月1日期间接受RRT的队列成员（n = 19165）。对于其余9403名患者的25%随机样本，我们对其全退伍军人事务部范围的电子病历进行了深入审查，以确定其CKD的治疗状态。
根据行政数据，队列成员中有三分之二（67.1%）接受了RRT。根据病历审查结果，我们估计实际上另有7.5%（95%置信区间，7.2%至7.8%）的队列成员接受了透析，10.9%（95%置信区间，10.6%至11.3%）正在准备和/或讨论透析，但在最近一次随访时尚未开始透析，14.5%（95%置信区间，14.1%至14.9%）已决定不进行透析。接受或准备接受RRT的队列成员百分比范围为：<45岁者为96.2%（95%置信区间，94.4%至97.4%），≥85岁者为53.3%（95%置信区间，50.7%至55.9%）。按Gagne合并症评分三分位数分层后结果相似。
在这个美国晚期CKD患者的大型队列中，大多数患者接受或准备接受RRT。即使在合并症负担最高的老年患者中也是如此。
