Department of Nephrology, Omihachiman Community Medical Center, 1379 Tsuchida-Cho, Omihachiman, Shiga, Japan.
Department of Nephrology, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kamigyo-Ku, Kyoto, Japan.
Clin Exp Nephrol. 2024 Sep;28(9):910-916. doi: 10.1007/s10157-024-02496-5. Epub 2024 Apr 20.
Multidisciplinary care for Chronic Kidney Disease (CKD) has been reported to be effective in preventing deterioration of renal function and avoiding hemodialysis induction using a central venous catheter.
We included 171 patients who received dialysis at our department between October 2014 and June 2017. Patients were divided into two groups: an inpatient group who received inpatient multidisciplinary care for CKD (educational hospitalization) prior to outpatient collaborative care from their family physician and nephrologist, and a non-inpatient group who did not receive such care. We compared factors related to dialysis induction.
There was no significant difference in eGFR between the groups at the start of observation. The mean time from the start of observation to dialysis induction (inpatient group vs. non-inpatient group; 40.8 ± 2.8 vs. 23.9 ± 3.0 months, respectively; P < 0.001) and the rate of hemodialysis induction using a central venous catheter (22.5 vs. 47.1%, respectively; P = 0.002) were significantly different between the groups. Survival analysis showed that the time to dialysis induction was significantly longer in the inpatient group (P = 0.0001). Multivariate analysis revealed that educational hospitalization (odds ratio = 0.30 [95% CI 0.13, 0.67]) was significantly associated with hemodialysis induction using a central venous catheter.
Educational hospitalization prior to outpatient collaborative care is beneficial for preventing hemodialysis induction using a central venous catheter and postponing dialysis induction.
多学科治疗慢性肾脏病（CKD）已被报道可有效预防肾功能恶化和避免使用中心静脉导管进行血液透析诱导。
我们纳入了 2014 年 10 月至 2017 年 6 月期间在我院接受透析的 171 例患者。患者分为两组：一组为住院组，在接受家庭医生和肾病医生的门诊协作治疗之前接受了 CKD 的住院多学科治疗（教育住院），另一组为非住院组，未接受这种治疗。我们比较了与透析诱导相关的因素。
在观察开始时，两组的 eGFR 没有显著差异。从观察开始到透析诱导的平均时间（住院组与非住院组分别为 40.8±2.8 个月和 23.9±3.0 个月，P<0.001）和使用中心静脉导管进行血液透析诱导的比例（分别为 22.5%和 47.1%，P=0.002）在两组之间有显著差异。生存分析显示住院组的透析诱导时间明显更长（P=0.0001）。多变量分析显示，教育住院（比值比=0.30[95%CI 0.13, 0.67]）与使用中心静脉导管进行血液透析诱导显著相关。
在门诊协作治疗之前进行教育住院有助于预防使用中心静脉导管进行血液透析诱导，并推迟透析诱导。
