Guppy Michelle, Glasziou Paul, Jones Mark, Beller Elaine, Shaw Jonathan E, Barr Elizabeth, Doust Jenny
Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
BJGP Open. 2024 Jul 29;8(2). doi: 10.3399/BJGPO.2023.0193. Print 2024 Jul.
The stages of chronic kidney disease (CKD) and estimated glomerular filtration rate (eGFR) reference ranges are currently determined without considering age.
To determine whether a chart that graphs age with eGFR helps GPs make better decisions about managing patients with declining eGFR.
DESIGN & SETTING: A randomised controlled vignette study among Australian GPs using a percentile chart plotting the trajectory of eGFR by age.
Three hundred and seventy-three GPs received two case studies of patients with declining renal function. They were randomised to receive the cases with the chart or without the chart, and asked a series of questions about how they would manage the cases.
In an older female patient with stable but reduced kidney function, use of the chart was associated with GPs in the study recommending a longer follow-up period, and longer time until repeat pathology testing. In a younger male First Nations patient with normal but decreasing kidney function, use of the chart was associated with GPs in the study recommending a shorter follow-up period, shorter time to repeat pathology testing, increased management of blood pressure and lifestyle, and avoidance of nephrotoxic medications. This represents more appropriate care in both cases.
Having access to a chart of percentile eGFR by age was associated with more appropriate management review periods of patients with reduced kidney function, either by greater compliance with current guidelines or greater awareness of a clinically relevant kidney problem.
目前在确定慢性肾脏病（CKD）分期和估算肾小球滤过率（eGFR）参考范围时未考虑年龄因素。
确定一张将年龄与eGFR绘制成图表的工具是否有助于全科医生（GP）在管理eGFR下降的患者时做出更好的决策。
一项针对澳大利亚全科医生的随机对照 vignette 研究，使用百分位数图表绘制按年龄划分的eGFR轨迹。
373名全科医生收到了两份肾功能下降患者的案例研究。他们被随机分配接受带有图表或不带有图表的案例，并被问及一系列关于他们将如何处理这些案例的问题。
在一名肾功能稳定但降低的老年女性患者中，使用图表与研究中的全科医生建议更长的随访期以及更长时间后进行重复病理检查相关。在一名肾功能正常但下降的年轻男性原住民患者中，使用图表与研究中的全科医生建议更短的随访期、更短时间进行重复病理检查、加强血压和生活方式管理以及避免使用肾毒性药物相关。这在两种情况下都代表了更恰当的治疗。
能够获取按年龄划分的eGFR百分位数图表与对肾功能降低患者更恰当的管理复查期相关，这要么是因为更好地遵循了当前指南，要么是因为对临床上相关的肾脏问题有了更强的认识。
