Division of Nephrology, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Quality Management Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Am J Kidney Dis. 2017 Aug;70(2):164-172. doi: 10.1053/j.ajkd.2016.12.018. Epub 2017 Mar 3.
Patients with kidney failure are at a high risk for cardiovascular events. Predialysis nephrology care has been reported to improve postdialysis survival, but its effects on postdialysis major adverse cardiovascular events (MACEs) have not been comprehensively studied.
Observational cohort study.
SETTING & PARTICIPANTS: We used data from the National Health Insurance Research Database in Taiwan. Adult patients who initiated maintenance dialysis therapy in 1999 to 2010 were enrolled.
We created 3 subtypes of predialysis nephrology care based on the time between the first nephrology visit and the initiation of dialysis therapy: early frequent (duration ≥ 6 months; at least 1 nephrology visit every 3 months), early infrequent (duration ≥ 6 months, <1 nephrology visit every 3 months), and late (duration < 6 months).
MACE was defined using the primary diagnosis in hospitalization records of acute myocardial infarction, acute heart failure, acute stroke, or sudden death.
We investigated the associations of different subtypes of nephrology care with postdialysis 1-year MACEs.
Among the 60,329 eligible patients, 24,477 (40.6%) had early frequent, 12,763 (21.2%) had early infrequent, and 23,089 (38.3%) had late nephrology care. Compared to the late-nephrology-care group, the early-frequent group was associated with an ∼10% lower risk for 1-year MACEs (HR of 0.89 [95% CI, 0.82-0.96] for first MACE and relative risk of 0.91 [95% CI, 0.84-0.98] for recurrent MACEs). However, the early-infrequent-care group had similar risks for MACEs as the late group (HR of 0.95 [95% CI, 0.86-1.05] for first MACE and relative risk of 0.94 [95% CI, 0.86-1.02] for recurrent MACEs).
Lack of physical and biochemical information because of inherent limitations from administrative claims data.
Early frequent nephrology care for 6 or more months before the initiation of long-term dialysis therapy may improve 1-year postdialysis major cardiovascular outcomes.
肾衰竭患者发生心血管事件的风险较高。已有研究报道，透析前肾脏科护理可改善透析后的生存情况，但尚未对其对透析后主要不良心血管事件（MACE）的影响进行全面研究。
观察性队列研究。
我们使用了来自中国台湾地区全民健康保险研究数据库的数据。1999 年至 2010 年间开始维持性透析治疗的成年患者被纳入研究。
我们根据首次肾脏科就诊与开始透析治疗之间的时间，创建了 3 种透析前肾脏科护理亚类：早期频繁（持续时间≥6 个月；至少每 3 个月进行 1 次肾脏科就诊）、早期不频繁（持续时间≥6 个月，＜1 次/3 个月）和晚期（持续时间＜6 个月）。
MACE 定义为急性心肌梗死、急性心力衰竭、急性卒中和猝死住院记录中的主要诊断。
我们研究了不同类型的肾脏科护理与透析后 1 年 MACE 的相关性。
在 60329 名符合条件的患者中，24477 名（40.6%）接受了早期频繁护理，12763 名（21.2%）接受了早期不频繁护理，23089 名（38.3%）接受了晚期肾脏科护理。与晚期肾脏科护理组相比，早期频繁护理组发生 1 年 MACE 的风险降低约 10%（首次 MACE 的 HR 为 0.89[95%CI，0.82-0.96]，复发性 MACE 的相对风险为 0.91[95%CI，0.84-0.98]）。然而，早期不频繁护理组发生 MACE 的风险与晚期组相似（首次 MACE 的 HR 为 0.95[95%CI，0.86-1.05]，复发性 MACE 的相对风险为 0.94[95%CI，0.86-1.02]）。
由于行政索赔数据的固有局限性，缺乏身体和生化信息。
在开始长期透析治疗前 6 个月或更长时间内进行早期频繁的肾脏科护理，可能会改善透析后 1 年的主要心血管结局。
