Department of Nephrology, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.
Sci Rep. 2020 Nov 12;10(1):19638. doi: 10.1038/s41598-020-76765-0.
The number of patients with end-stage renal disease (ESRD) has been increasing, with dialysis treatment being a serious economic problem. To date, no report in Japan considered medical costs spent at the initiation of dialysis treatment, although some reports in other countries described high medical costs in the first year. This study focused on patient status at the time of initiation of dialysis and examined how it affects prognosis and the medical costs. As a result, all patients dying within 4 months experienced emergent dialysis initiation. Emergent dialysis initiation and high medical costs were risk factors for death within 2 years. High C-reactive protein levels and emergent dialysis initiation were associated with increasing medical costs. Acute kidney injury (AKI) contributed most to emergent dialysis initiation followed by stroke, diabetes, heart failure, and short-term care by nephrologists. Therefore, emergent dialysis initiation was a contributing factor to both death and increasing medical costs. To avoid the requirement for emergent dialysis initiation, patients with ESRD should be referred to nephrologists earlier. Furthermore, ESRD patients with clinical histories of AKI, stroke, diabetes, or heart failure should be observed carefully and provided pre-planned initiation of dialysis.
终末期肾病（ESRD）患者人数不断增加，透析治疗是一个严重的经济问题。迄今为止，日本尚无报告考虑透析治疗开始时的医疗费用，尽管其他国家的一些报告描述了第一年的高额医疗费用。本研究关注透析开始时的患者状况，并研究其如何影响预后和医疗费用。结果，所有在 4 个月内死亡的患者均接受了紧急透析治疗。紧急透析开始和高医疗费用是 2 年内死亡的危险因素。高 C 反应蛋白水平和紧急透析开始与医疗费用的增加有关。急性肾损伤（AKI）是导致紧急透析开始的主要原因，其次是中风、糖尿病、心力衰竭和肾病医生的短期护理。因此，紧急透析开始是导致死亡和医疗费用增加的一个因素。为避免需要紧急透析治疗，应尽早将 ESRD 患者转介给肾病医生。此外，患有 AKI、中风、糖尿病或心力衰竭临床病史的 ESRD 患者应密切观察，并预先计划开始透析。
