介入肾脏病学：日本的现状与临床影响
Interventional nephrology: current status and clinical impact in Japan.
作者信息
Ikeda Masato, Terawaki Hiroyuki, Kanda Eiichiro, Furuya Maiko, Tanno Yudo, Nakao Masatsugu, Maruyama Yukio, Maeda Masutaka, Higuchi Chieko, Sakurada Tsutomu, Kaneko Tomohiro, Io Hiroaki, Hashimoto Koji, Ueda Atsushi, Hirano Keita, Washida Naoki, Yoshida Hiraku, Yoshikawa Kazuhiro, Taniyama Yoshihiro, Harada Kenji, Matsuo Nanae, Okido Ichiro, Yokoo Takashi
机构信息
Division of Nephrology and Hypertension, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan.
Dialysis Center, Fukushima Medical University Hospital, 1 Hikariga-oka, Fukushima, 960-1295, Japan.
出版信息
Clin Exp Nephrol. 2018 Apr;22(2):437-447. doi: 10.1007/s10157-017-1457-y. Epub 2017 Aug 2.
BACKGROUND
Current status and clinical significance of interventional nephrology has not been reported from Japan.
METHODS
Questionnaires were mailed twice to the directors of all 534 Japanese certificated nephrology training institutions in 2014. The main questions were current performance, categorized annual procedure volume and managers of peritoneal dialysis (PD) access, vascular access (VA) surgery, endovascular intervention, and kidney biopsy. Frequencies of nephrologist involvement between high volume center and low volume center and association between the level of nephrologists' involvement to each procedure and annual procedure volume were examined.
RESULTS
332 (62.2%) institutions answered performance of all procedures and 328 (61.4%) institutions answered all procedure volume. Kidney biopsy, VA surgery, endovascular intervention and PD access surgery were performed by any doctors in 94.2, 96.3, 88.4, and 76.2% and each involvement of nephrologist was 93.9, 54.1, 53.1 and 47.6%, respectively. Cochran-Armitage analyses demonstrated significant increases in all 4 procedure volume with greater management by nephrologists (p < 0.01). Nephrologists involvement to VA surgery associated with procedure volume increase in not only VA surgery, but also PD catheter insertion (p < 0.01) and kidney biopsy (p < 0.05). And nephrologists involvement to PD catheter insertion also associated with surgical volume increase in both VA surgery (p < 0.01) and endovascular intervention (p < 0.05).
CONCLUSIONS
Main manager of all 4 procedures was nephrologist in Japan. Each procedure volume increased as nephrologists become more involved. Acquisition of one specific procedure by nephrologist associated with increase not only in this specific procedure volume, but also the other procedure volume.
背景
日本尚未报道介入肾脏病学的现状及临床意义。
方法
2014年，两次向日本所有534家获得认证的肾脏病培训机构的主任邮寄调查问卷。主要问题包括当前的操作情况、按年度分类的手术量以及腹膜透析（PD）通路、血管通路（VA）手术、血管内介入治疗和肾活检的负责人。研究了高手术量中心和低手术量中心肾病专家参与的频率，以及肾病专家对每种手术的参与程度与年度手术量之间的关联。
结果
332家（62.2%）机构回答了所有手术的操作情况，328家（61.4%）机构回答了所有手术的手术量。肾活检、VA手术、血管内介入治疗和PD通路手术分别由94.2%、96.3%、88.4%和76.2%的医生进行，肾病专家的参与率分别为93.9%、54.1%、53.1%和47.6%。 Cochr an-Armitage分析表明，随着肾病专家管理的增加，所有4种手术的手术量均显著增加（p<0.01）。肾病专家参与VA手术不仅与VA手术量增加相关，还与PD导管插入量增加（p<0.01）和肾活检量增加（p<0.05）相关。肾病专家参与PD导管插入也与VA手术量增加（p<0.01）和血管内介入治疗量增加（p<0.05）相关。
结论
在日本，所有这4种手术的主要负责人均为肾病专家。随着肾病专家参与度的提高，每种手术的手术量都有所增加。肾病专家掌握一项特定手术不仅与该特定手术量增加相关，还与其他手术量增加相关。
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