Janus Nicolas, Launay-Vacher Vincent, Juillard Laurent, Deray Gilbert, Hannedouche Thierry, Isnard-Rouchon Myriam, Burtey Stéphane, Vanhille Philippe, Ortiz Jean-Paul, Janin Gérard, Nicoud Philippe, Touam Malik, Laville Maurice
Service ICAR, Néphrologie, Hôpital Pitié-Salpêtrière, Paris, France.
Néphrologie, Hôpital Pitié-Salpêtrière, Paris, France.
Clin Kidney J. 2017 Feb;10(1):74-78. doi: 10.1093/ckj/sfw092. Epub 2016 Sep 23.
In 1998, a French survey showed that the referral of patients with chronic kidney disease to a nephrologist was delayed, resulting in many emergency initiations of dialysis. In 2009, the ORACLE study aimed to describe the renal course of dialysis patients from their first nephrology visit to their first dialysis session.
The ORACLE study was a multicentre retrospective study of all patients who started chronic dialysis. Data were collected at the first nephrology visit and at the first dialysis session.
In total, 720 patients were included (69 centres). At the first nephrology visit, the mean Cockcroft-Gault (CG) indicator was 31.8 mL/min (22.7 in 1998) and 52.4% of patients (73% in 1998) had a CG <30. The mean time between the first nephrology visit and the first dialysis session was 48 months (35 months in 1998).
In 2009, most patients were referred a long time before dialysis initiation, which likely allowed them to benefit from the impact of nephrology care on early outcomes when on dialysis. However, 34.2% of the dialysis sessions were still initiated under emergency conditions.
1998年，一项法国调查显示，慢性肾病患者转诊至肾病科的时间有所延迟，导致许多患者紧急开始透析治疗。2009年，ORACLE研究旨在描述透析患者从首次肾病科就诊到首次透析治疗期间的肾脏病程。
ORACLE研究是一项针对所有开始慢性透析治疗患者的多中心回顾性研究。在首次肾病科就诊和首次透析治疗时收集数据。
共纳入720例患者（69个中心）。首次肾病科就诊时，Cockcroft-Gault（CG）指标的平均值为31.8 mL/分钟（1998年为22.7），52.4%的患者（1998年为73%）CG<30。首次肾病科就诊与首次透析治疗之间的平均时间为48个月（1998年为35个月）。
2009年，大多数患者在开始透析治疗前很久就已转诊，这可能使他们在透析时能够受益于肾病护理对早期结局的影响。然而，仍有34.2%的透析治疗是在紧急情况下开始的。
