Chao Chia-Ter, Tang Chao-Hsiun, Cheng Rhoda Wen-Yi, Wang Michael Yao-Hsien, Hung Kuan-Yu
a Department of Medicine , National Taiwan University Hospital Jin-Shan branch , Wuhu Village, Jinshan Dist. , New Taipei City , Taiwan.
b Department of Internal Medicine , National Taiwan University Hospital , Taipei , Taiwan.
Curr Med Res Opin. 2017 Sep;33(9):1705-1713. doi: 10.1080/03007995.2017.1354823. Epub 2017 Jul 31.
Disease-related malnutrition is highly prevalent, and has prognostic implications for patients with chronic kidney disease (CKD); however, few studies have investigated the impact of malnutrition, or protein-energy wasting (PEW), on healthcare utilization and medical expenditure among CKD patients.
Using claim data from the National Health Insurance in Taiwan, this study identified patients with CKD between 2009-2013 and categorized them into those with mild, moderate, or severe CKD. Cases with PEW after CKD was diagnosed were propensity-score matched with controls in a 1:4 ratio. Healthcare resource utilization metrics were compared, including outpatient and emergency department visits, frequency and duration of hospitalization, and the cumulative costs associated with different CKD severity.
From among 347,501 CKD patients, eligible cohorts of 66,872 with mild CKD (49.2%), 27,122 with moderate CKD (19.9%), and 42,013 with severe CKD (30.9%) were selected. Malnourished CKD patients had significantly higher rates of hospitalization (p < .001 for all severities) and re-admission (p = .015 for mild CKD, p = .002 for severe CKD) than non-malnourished controls. Cumulative medical costs for outpatient and emergency visits, and hospitalization, were significantly higher among all malnourished CKD patients than non-malnourished ones (p < .001); total medical costs were also higher among malnourished patients with mild (62.9%), moderate (59.6%), or severe (43.6%) CKD compared to non-malnourished patients (p < .001).
In a nationally-representative cohort, CKD patients with PEW had significantly more healthcare resource utilization and higher aggregate medical costs than those without, across the spectrum of CKD: preventing PEW in CKD patients should receive high priority if we would like to reduce medical costs.
疾病相关营养不良极为普遍，对慢性肾脏病（CKD）患者的预后有影响；然而，很少有研究调查营养不良或蛋白质能量消耗（PEW）对CKD患者医疗资源利用和医疗支出的影响。
利用台湾国民健康保险的理赔数据，本研究确定了2009 - 2013年间的CKD患者，并将他们分为轻度、中度或重度CKD患者。CKD确诊后发生PEW的病例与对照组按1:4的比例进行倾向得分匹配。比较了医疗资源利用指标，包括门诊和急诊科就诊次数、住院频率和时长，以及不同CKD严重程度相关的累计费用。
从347,501例CKD患者中，选取了符合条件的队列，其中轻度CKD患者66,872例（49.2%），中度CKD患者27,122例（19.9%），重度CKD患者42,013例（30.9%）。营养不良的CKD患者的住院率（所有严重程度均p <.001）和再入院率（轻度CKD患者p =.015，重度CKD患者p =.002）显著高于非营养不良对照组。所有营养不良的CKD患者门诊和急诊就诊以及住院的累计医疗费用显著高于非营养不良患者（p <.001）；与非营养不良患者相比，轻度（62.9%）、中度（59.6%）或重度（43.6%）CKD的营养不良患者的总医疗费用也更高（p <.001）。
在一个具有全国代表性的队列中，患有PEW的CKD患者在整个CKD范围内比未患PEW的患者有显著更多的医疗资源利用和更高的总医疗费用：如果我们想降低医疗成本，预防CKD患者的PEW应得到高度重视。
