Tuppin Philippe, Cuerq Anne, Torre Sylvie, Couchoud Cécile, Fagot-Campagna Anne
Caisse nationale de l'Assurance maladie des travailleurs salariés, direction de la stratégie des études et des statistiques, 26-50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France.
Caisse nationale de l'Assurance maladie des travailleurs salariés, direction de la stratégie des études et des statistiques, 26-50, avenue du Pr-André-Lemierre, 75986 Paris cedex 20, France.
Nephrol Ther. 2017 Apr;13(2):76-86. doi: 10.1016/j.nephro.2016.07.446. Epub 2016 Nov 10.
This study evaluated the management of patients with end-stage renal disease prior to initiation of renal replacement therapy. Among the 51 million national health insurance general scheme beneficiaries (77% of the population), persons 18 years and older, starting dialysis or undergoing preemptive renal transplantation in 2013, were included in this study. Data were derived from the French national health insurance system (SNIIRAM). In this population of 6674 patients (median age: 68 years), 88% initiated renal replacement therapy by haemodialysis, 8% by peritoneal dialysis, and 4% by renal transplantation. During the year preceding initiation of dialysis, 76% of patients had been hospitalised with at least one diagnostic code for renal disease in 83% of cases, 16% had not received any reimbursements for serum creatinine assay and 32% had not seen a nephrologist; 87% were taking at least one antihypertensive drug (60% were taking at least a renin-angiotensin system inhibitor) and 30% were taking a combination of 4 or more classes of antihypertensive drugs. For patients initiating haemodialysis in a haemodialysis centre, 39% had undergone a procedure related to arteriovenous fistula and 10% had been admitted to an intensive care unit. This study, based on the available reimbursement data, shows that, despite frequent use of the health care system by this population, there is still room for improvement of screening and management of patients with end-stage renal disease and preparation for renal replacement therapy.
本研究评估了终末期肾病患者在开始肾脏替代治疗之前的管理情况。在5100万国家健康保险一般计划受益人（占人口的77%）中，纳入了2013年开始透析或接受抢先肾移植的18岁及以上人群。数据来源于法国国家健康保险系统（SNIIRAM）。在这6674名患者（中位年龄：68岁）中，88%通过血液透析开始肾脏替代治疗，8%通过腹膜透析，4%通过肾移植。在开始透析前的一年中，76%的患者因至少一项肾病诊断编码而住院（83%的病例），16%未获得血清肌酐检测报销，32%未看过肾病专科医生；87%的患者至少服用一种降压药（60%至少服用一种肾素 - 血管紧张素系统抑制剂），30%服用4种或更多类降压药的组合。对于在血液透析中心开始血液透析的患者，39%接受了与动静脉内瘘相关的手术，10%曾入住重症监护病房。这项基于现有报销数据的研究表明，尽管该人群频繁使用医疗保健系统，但终末期肾病患者的筛查、管理以及肾脏替代治疗的准备工作仍有改进空间。
