Chen Chun-Fan, Chen Fu-An, Lee Tsung-Lun, Liao Li-Feng, Chen Cheng-Yen, Tan Ann Charis, Chan Chia-Hao, Lin Chih-Ching
1 School of Medicine, National Yang-Ming University, Taipei, Taiwan.
2 Division of Nephrology, Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.
J Vasc Access. 2019 Jul;20(4):368-373. doi: 10.1177/1129729818807336. Epub 2018 Oct 25.
Due to the implementation of the National Health Insurance system in 1995, the number of patients receiving maintenance dialysis has increased rapidly. This contributed to Taiwan to be in an unfortunate position of possessing the highest prevalence of end-stage renal disease globally. Although the age-standardized incidence of end-stage renal disease gradually decreased to -1.1% in 2014, the huge economic burden that comes with dialysis is detrimental to the quality of dialysis treatment. To achieve a balance between economy and quality of care requires multidisciplinary cooperation. Through a variety of chronic kidney disease-related care projects, we have gradually reversed this situation and achieved good results. Further promotion of kidney transplantation and hospice care for terminal patients will improve the situation. With respect to vascular access, the "fistula first" policy is carried out and percutaneous transluminal angioplasty is the mainstay of treatment to resolve vascular access dysfunction. The medical expenses for dialysis and vascular access management are both fully paid for by the National Health Insurance, and patients do not have to worry about the medical expenses. However, the statistics and vascular access monitoring are relatively insufficient in the past. The comprehensive integration of vascular access management into public policy related to kidney disease will complete the missing piece of the puzzle of overall care.
由于1995年实施了国民健康保险制度，接受维持性透析的患者数量迅速增加。这使得台湾处于全球终末期肾病患病率最高的不幸境地。尽管终末期肾病的年龄标准化发病率在2014年逐渐降至-1.1%，但透析带来的巨大经济负担不利于透析治疗质量。要在经济与医疗质量之间取得平衡需要多学科合作。通过各种与慢性肾脏病相关的护理项目，我们已逐渐扭转了这种局面并取得了良好成果。进一步推广肾脏移植和为末期患者提供临终关怀将改善这种状况。在血管通路方面，推行“内瘘优先”政策，经皮腔内血管成形术是解决血管通路功能障碍的主要治疗方法。透析和血管通路管理的医疗费用均由国民健康保险全额支付，患者无需担心医疗费用。然而，过去在统计和血管通路监测方面相对不足。将血管通路管理全面纳入与肾病相关的公共政策将补齐整体护理拼图中缺失的一块。
