Lerner Blake, Desrochers Sean, Tangri Navdeep
Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Division of Nephrology, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Chronic Disease Innovation Center, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
Semin Nephrol. 2017 Mar;37(2):144-150. doi: 10.1016/j.semnephrol.2016.12.004.
Chronic kidney disease (CKD) currently affects 20 million Americans and is associated with increased morbidity and mortality. Resource-efficient and appropriate treatment of CKD benefits the patient and provides improved resource allocation for the health care system. Prediction models can be useful in efficiently allocating resources, and currently are being used at the bedside for several important clinical decisions. There is a paucity of prediction models in use in nephrology, but one such model, the Kidney Failure Risk Equation, uses routinely collected laboratory values and can inform clinical decisions related to the following: (1) triage of nephrology referrals, (2) evaluating the need for more intensive interdisciplinary clinic care, (3) determining the timing of modality education, and (4) dialysis access planning. The development of new models that predict survival and quality of life on dialysis, success on home modalities, failure of arteriovenous fistulas, and risk of cardiovascular disease in patients with CKD is needed.
慢性肾脏病(CKD)目前影响着2000万美国人,且与发病率和死亡率的增加相关。对CKD进行资源高效且恰当的治疗有利于患者,并能改善医疗保健系统的资源分配。预测模型有助于有效分配资源,目前正用于床边的多项重要临床决策。肾脏病学领域使用的预测模型较少,但有一种这样的模型,即肾衰竭风险方程,它利用常规收集的实验室值,可为以下相关临床决策提供依据:(1)肾脏病转诊的分诊,(2)评估是否需要更强化的多学科门诊护理,(3)确定开始透析方式教育的时机,以及(4)透析通路规划。需要开发新的模型,以预测CKD患者的透析生存率和生活质量、家庭透析方式的成功率、动静脉内瘘失败情况以及心血管疾病风险。