Lin Ming-Yen, Lee Charles Tzu-Chi, Kuo Mei-Chuan, Hwang Shang-Jyh, Chen Hung-Chun, Chiu Yi-Wen
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
Medicine (Baltimore). 2018 Jun;97(26):e11317. doi: 10.1097/MD.0000000000011317.
Late referral in chronic kidney disease (CKD) is associated with irregular care and poor prognosis. How the specialty of healthcare provider affect late referral and irregular CKD care remain unclear.We conducted a population-based cross-sectional study to include incident dialysis patients from 2002 to 2007 in Taiwan and observed for 1, 2, and 3 years before dialysis. The medical visits-related information was evaluated every 3 months, retrospectively. Irregular follow-up was defined as missing a follow-up during more than one interval every year.A total of 46,626 patients were included. At 1, 2, and 3 years prior to maintenance dialysis, 87%, 66%, and 50% of patients had regular medical visits; however, only 49%, 23%, and 12% had estimated glomerular filtration rate (eGFR) regularly monitored, respectively. Independent factors of less regular eGFR follow-up included age (adjusted odds ratio (OR) 0.995, 95% confidence interval 0.993-0.998), cardiac disorder (0.90, 0.82-0.99), and stroke (0.76, 0.69-0.84), as well as regular visits at some other specialties (adjusted OR range: from 0.77 to 0.88); whereas, independent factors of less regular visits at nephrology included diabetes mellitus (0.48, 0.46-0.51), cardiac disorder (0.61, 0.56-0.66), stroke (0.53, 0.48-0.58), and regular visits at any other specialty (adjusted OR range: from 0.22 to 0.78).Regular medical visits were quite common in late CKD patients, but they received regular eGFR measurement and visit at nephrology much less frequently. Physicians play a major role in the late referrals in CKD and its irregular care.
慢性肾脏病（CKD）患者转诊延迟与治疗不规范及预后不良相关。医疗服务提供者的专业领域如何影响转诊延迟及CKD治疗不规范尚不清楚。我们进行了一项基于人群的横断面研究，纳入了2002年至2007年台湾地区的新发透析患者，并在透析前观察1年、2年和3年。回顾性评估每3个月的就诊相关信息。将每年超过一个时间间隔未进行随访定义为随访不规范。
共纳入46626例患者。在维持性透析前1年、2年和3年，分别有87%、66%和50%的患者进行了定期就诊；然而，分别只有49%、23%和12%的患者定期监测了估算肾小球滤过率（eGFR）。eGFR随访不太规律的独立因素包括年龄（调整后的比值比（OR）为0.995，95%置信区间为0.993 - 0.998）、心脏疾病（0.90，0.82 - 0.99）和中风（0.76，0.69 - 0.84），以及在其他一些专科的定期就诊（调整后的OR范围：从0.77到0.88）；而在肾脏病专科就诊不太规律的独立因素包括糖尿病（0.48，0.46 - 0.51）、心脏疾病（0.61，0.56 - 0.66）、中风（0.53，0.48 - 0.58），以及在任何其他专科的定期就诊（调整后的OR范围：从0.22到0.78）。
定期就诊在晚期CKD患者中相当常见，但他们接受eGFR定期测量和肾脏病专科就诊的频率要低得多。医生在CKD患者的晚期转诊及其不规范治疗中起主要作用。
