Comisión Asesora de Programa de Salud Renal, Fondo Nacional de Recursos, Montevideo, Uruguay.
Departamento de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
PLoS One. 2022 Oct 14;17(10):e0266617. doi: 10.1371/journal.pone.0266617. eCollection 2022.
The Renal Healthcare Program Uruguay (NRHP-UY) is a national, multidisciplinary program that provides care to chronic kidney disease (CKD) patients. In this study, we report the global results of CKD patient outcomes and a comparison between those treated at the NRHP-UY Units, with those patients who were initially included in the program but did not adhere to follow up.
A cohort of not-on dialysis CKD patients included prospectively in the NRHP-UY between October 1st 2004 and September 30th 2017 was followed-up until September 30th 2019. Two groups were compared: a) Nephrocare Group: Patients who had at least one clinic visit during the first year on NRHP-UY (n = 11174) and b) Non-adherent Group: Patients who were informed and accepted to be included but had no subsequent data registered after admission (n = 3485). The study was approved by the Ethics Committee and all patients signed an informed consent. Outcomes were studied with Logistic and Cox´s regression analysis, Fine and Gray competitive risk and propensity-score matching tests.
14659 patients were analyzed, median age 70 (60-77) years, 56.9% male. The Nephrocare Group showed improved achievement of therapeutic goals, ESKD was more frequent (HR 2.081, CI 95%1.722-2.514) as planned kidney replacement therapy (KRT) start (OR 2.494, CI95% 1.591-3.910), but mortality and the combined event (death and ESKD) were less frequent (HR 0.671, CI95% 0.628-0.717 and 0.777, CI95% 0.731-0.827) (p = 0.000) compared to the Non-adherent group. Results were similar in the propensity-matched group: ESKD (HR 2.041, CI95% 1.643-2.534); planned kidney replacement therapy (KRT) start (OR 2.191, CI95% 1.322-3.631) death (HR 0.692, CI95% 0.637-0.753); combined event (HR 0.801, CI95% 0.742-0.865) (p = 0.000).
Multidisciplinary care within the NRHP-UY is associated with timely initiation of KRT and lower mortality in single outcomes, combined analysis, and propensity-matched analysis.
乌拉圭肾脏保健计划（NRHP-UY）是一个全国性的多学科项目，为慢性肾脏病（CKD）患者提供护理。在这项研究中，我们报告了 CKD 患者结局的全球结果，并比较了在 NRHP-UY 单位接受治疗的患者与最初纳入该计划但未坚持随访的患者。
2004 年 10 月 1 日至 2017 年 9 月 30 日期间，前瞻性纳入 NRHP-UY 的非透析 CKD 患者队列进行随访，直至 2019 年 9 月 30 日。比较了两组：a）肾保健组：至少有一次在 NRHP-UY 第一年就诊的患者（n=11174）和 b）不依从组：已告知并接受纳入但入院后无后续数据登记的患者（n=3485）。该研究得到了伦理委员会的批准，所有患者均签署了知情同意书。使用 Logistic 和 Cox 回归分析、Fine 和 Gray 竞争风险和倾向评分匹配检验研究了结局。
分析了 14659 名患者，中位年龄为 70（60-77）岁，56.9%为男性。肾保健组实现治疗目标的情况有所改善，计划肾脏替代治疗（KRT）开始时更频繁地发生终末期肾病（ESKD）（HR 2.081，95%CI 1.722-2.514）（OR 2.494，95%CI 1.591-3.910），但死亡率和复合事件（死亡和 ESKD）的发生率较低（HR 0.671，95%CI 0.628-0.717 和 0.777，95%CI 0.731-0.827）（p=0.000）与不依从组相比。在倾向评分匹配组中，结果相似：ESKD（HR 2.041，95%CI 1.643-2.534）；计划肾脏替代治疗（KRT）开始（OR 2.191，95%CI 1.322-3.631）死亡（HR 0.692，95%CI 1.637-0.753）；复合事件（HR 0.801，95%CI 1.742-0.865）（p=0.000）。
NRHP-UY 内的多学科护理与及时启动 KRT 相关，并降低单结局、综合分析和倾向评分匹配分析中的死亡率。
