School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Worldviews Evid Based Nurs. 2021 Feb;18(1):33-41. doi: 10.1111/wvn.12483. Epub 2020 Nov 28.
Chronic kidney disease (CKD) is a common chronic disease. As this disease is extremely complex, multidisciplinary care (MDC) is needed to provide complete and continuous care.
A systematic literature review was performed to examine the constituents of MDC, the content of MDC interventions, and the health outcomes in CKD patients receiving MDC.
Searches of five Chinese and English databases for studies of CKD patients who had received MDC from 2007 to 2019 revealed 11 studies, which comprised 16,066 CKD patients. The Physiotherapy Evidence Database scale (Physiotherapy Evidence Database, 2017) was used to appraise study quality for randomized controlled trials, and the Joanna Briggs Institute Critical Appraisal tools (Joanna Briggs Institute, 2017) were for cohort studies.
The MDC teams that provided comprehensive medical care for these patients included nephrologists, nurses, surgeons, general practitioners, pharmacists, psychotherapists, social workers, nutritionists, and other specialists. The literature review revealed that MDC for CKD slows the decline in estimated glomerular filtration rate and decreases patient mortality, the risk of renal replacement therapy, the need for emergent dialysis, and annual medical costs. Analyses of biochemical markers in the CKD patients showed that MDC improves control of serum levels of calcium and phosphate, improves control of parathyroid hormone, and reduces proteinuria and fasting blood glucose values. However, further studies are needed to determine the effects of MDC on all-cause mortality, blood pressure control, hospitalization rate, hospitalization for cardiovascular or infection events, medications use, and other biochemical markers in CKD patients.
Cross-disciplinary collaboration of healthcare professionals is needed to ensure that patients undergo regular follow-up and periodic assessment of clinical status, in addition to ensuring that relevant resources and assistance are provided in a timely manner. A follow-up period of at least 2 years is also needed to ensure sufficient time to observe MDC results.
慢性肾脏病（CKD）是一种常见的慢性疾病。由于该病极其复杂，需要多学科护理（MDC）来提供全面和连续的护理。
系统地回顾文献，以研究 MDC 的组成部分、MDC 干预的内容以及接受 MDC 的 CKD 患者的健康结果。
对 2007 年至 2019 年接受 MDC 的 CKD 患者的中英文数据库进行检索，共检索到 11 项研究，纳入 16066 例 CKD 患者。采用循证医学证据数据库量表（Physiotherapy Evidence Database，2017 年）对随机对照试验进行研究质量评价，采用循证卫生保健中心乔安娜·布里格斯评价工具（Joanna Briggs Institute，2017 年）对队列研究进行研究质量评价。
为这些患者提供全面医疗服务的 MDC 团队包括肾病学家、护士、外科医生、全科医生、药剂师、心理治疗师、社会工作者、营养师和其他专家。文献回顾显示，CKD 的 MDC 可减缓估算肾小球滤过率的下降速度，降低患者死亡率、肾脏替代治疗风险、紧急透析需求和年度医疗费用。对 CKD 患者生化标志物的分析表明，MDC 可改善血清钙磷水平的控制，改善甲状旁腺激素的控制，并减少蛋白尿和空腹血糖值。然而，仍需要进一步研究来确定 MDC 对 CKD 患者全因死亡率、血压控制、住院率、心血管或感染事件住院率、药物使用和其他生化标志物的影响。
需要跨学科的医疗保健专业人员合作，以确保患者定期进行随访和定期评估临床状况，同时确保及时提供相关资源和援助。还需要至少 2 年的随访期，以确保有足够的时间观察 MDC 的结果。
