在选择肾脏替代治疗方式时进行共同决策，可使透析开始后患者的预后更好。
Shared decision-making in selecting modality of renal replacement therapy confers better patient prognosis after the initiation of dialysis.
作者信息
Kohatsu Kaori, Kojima Shigeki, Shibagaki Yugo, Sakurada Tsutomu
机构信息
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
出版信息
Ther Apher Dial. 2025 Feb;29(1):34-41. doi: 10.1111/1744-9987.14192. Epub 2024 Aug 7.
INTRODUCTION
The effect of shared decision-making (SDM) regarding the choice of renal replacement therapy (RRT) for chronic kidney disease (CKD) patients on their mortality after the induction of dialysis therapy has not been adequately investigated.
METHODS
Patients who initiated dialysis at our hospital were divided into two groups according to whether they participated in SDM in the outpatient clinic, and survival analysis was performed. We also examined the effect of SDM in the outpatient clinic on mortality.
RESULTS
Of the 554 patients, 123 (22.2%) were in the SDM group. The survival rate was significantly higher in the SDM group (p = 0.001, log-rank test). Multivariate analysis excluding ADL, which competed with SDM, showed that SDM was significantly associated with mortality (HR 0.593, 95% CI: 0.353-0.997, p = 0.049).
CONCLUSION
SDM regarding RRT selection in the outpatient clinic may be associated with a better patient prognosis after dialysis induction.
引言
关于慢性肾脏病（CKD）患者肾替代治疗（RRT）选择的共同决策（SDM）对透析治疗开始后患者死亡率的影响尚未得到充分研究。
方法
在我院开始透析的患者根据其在门诊是否参与共同决策分为两组，并进行生存分析。我们还研究了门诊共同决策对死亡率的影响。
结果
554例患者中，123例（22.2%）在共同决策组。共同决策组的生存率显著更高（p = 0.001，对数秩检验）。排除与共同决策相互竞争的日常生活活动能力（ADL）后的多变量分析显示，共同决策与死亡率显著相关（风险比0.593，95%置信区间：0.353 - 0.997，p = 0.049）。
结论
门诊中关于RRT选择的共同决策可能与透析开始后患者更好的预后相关。
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