Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan.
Department of Health Care Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan.
J Formos Med Assoc. 2019 Dec;118(12):1652-1660. doi: 10.1016/j.jfma.2019.01.007. Epub 2019 Jan 31.
End-stage renal disease (ESRD) is a growing global health concern with increased disease burden and high medical costs. Utilization of the emergency department (ED) among dialyzed patients and the associated risk factors remain unknown.
Participants of this study, selected from the National Health Insurance Database in Taiwan, were aged 19-90 years and received maintenance hemodialysis from January 1, 2010, to December 31, 2010. A control group consisting of individuals who did not receive dialysis, selected from the same data source, were matched for age, sex, and the Charlson Comorbidity Index (CCI). Subgroup analysis with hemodialysis frequency was also performed. ED utilization among enrolled individuals was assessed in 2012. Generalized estimating equations with multiple variable adjustments were used to identify risk factors associated with resuscitation during ED visits.
One group of 2985 individuals who received maintenance hemodialysis, and another group of 2985 patients that did not receive hemodialysis, between January 1, 2010, and December 31, 2010, were included in this study. There were 4822 ED visits in the hemodialysis group, and 1755 ED visits in the non-dialysis group between January 1, 2012, and December 31, 2012. Analysis of multivariable generalized estimating equations identified the risk associated with resuscitation during ED visits to be greater in individuals who were receiving maintenance hemodialysis, aged older than 55 years, hospitalized in the past year, and assigned first and second degree of triage.
Patients receiving maintenance hemodialysis had higher ED utilization and a significantly higher risk of resuscitation during ED visits than those without hemodialysis.
终末期肾病（ESRD）是一个日益严重的全球健康问题，其疾病负担加重，医疗费用高昂。接受透析治疗的患者使用急诊部（ED）的情况及其相关的危险因素仍不清楚。
本研究的参与者选自中国台湾的国家健康保险数据库，年龄在 19-90 岁之间，于 2010 年 1 月 1 日至 12 月 31 日期间接受维持性血液透析。从同一数据源中选择未接受透析的个体作为对照组，匹配年龄、性别和 Charlson 合并症指数（CCI）。还进行了血液透析频率的亚组分析。在 2012 年评估了入组个体的 ED 使用情况。使用多变量调整的广义估计方程来确定与 ED 就诊期间复苏相关的危险因素。
本研究纳入了一组于 2010 年 1 月 1 日至 12 月 31 日期间接受维持性血液透析的 2985 名个体，和另一组于同一时期未接受血液透析的 2985 名患者。在 2012 年 1 月 1 日至 12 月 31 日期间，血液透析组有 4822 次 ED 就诊，非透析组有 1755 次 ED 就诊。多变量广义估计方程分析确定，在接受维持性血液透析、年龄大于 55 岁、过去一年住院和被分配第一和第二级分诊的个体中，ED 就诊时复苏的风险更高。
与未接受血液透析的患者相比，接受维持性血液透析的患者 ED 使用频率更高，ED 就诊时复苏的风险显著更高。
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