Kim Laura H, Catapang Marisa, Polderman Nonnie, Humphreys Robert, Mammen Cherry, Jugnauth Eleonora, Matsell Douglas G
Division of Nephrology, BC Children's Hospital, Vancouver, Canada.
Can J Kidney Health Dis. 2024 Dec 25;11:20543581241304505. doi: 10.1177/20543581241304505. eCollection 2024.
In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children's Hospital (BCCH) and multiple regional clinics.
The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP.
This was a retrospective cohort study of children with NS in BC.
We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna).
Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m vs 3492, IQR 3397-3644 mg/m, = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, = .575), or development of frequently relapsing courses (50% vs 62%, = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, = .655) and dietitian-reviewed food records (67% vs 47%, = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, = .01, BCCH vs regional).
Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance).
Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation.
2013年，不列颠哥伦比亚省（BC）儿童肾病综合征临床路径（CNSCP）得以制定，旨在规范肾病综合征（NS）患儿的护理。在BC省，儿童可在BC儿童医院（BCCH）及多个地区诊所接受肾病学护理。
主要目的是比较自CNSCP实施以来，BCCH与地区诊所之间的诱导治疗及临床结局。
设计、地点与患者：这是一项针对BC省NS患儿的回顾性队列研究。
我们对2013年至2019年（含）新诊断为NS且年龄在1至17岁之间、随访至少12个月的患儿进行了回顾性队列研究。排除患有非微小病变性疾病、激素抵抗、诱导治疗不完全或诊断后第一年内接受路径治疗少于6个月的患儿。诊所分为BCCH或地区诊所（萨里、乔治王子城或基洛纳）。
纳入69例患者，其中52例（75%）在BCCH，17例（25%）在地区诊所。诊断时，两组在年龄、性别或临床特征方面无显著差异。比较BCCH与地区诊所，诱导期泼尼松暴露量无差异（中位数3400，四分位数间距[IQR] 3331 - 3585 mg/m² 对比3492，IQR 3397 - 3644 mg/m²，P = 0.167），年化复发率无差异（中位数3.3，IQR 1.1 - 5.3对比2.3，IQR 0.5 - 4.2，P = 0.575），或频繁复发病程的发生率无差异（50%对比62%，P = 0.475）。第一年的门诊就诊次数相似（4.2 ± 1.2对比4.0 ± 1.8，P = 0.655），营养师审核的饮食记录也相似（67%对比47%，P = 0.135，BCCH对比地区诊所）。BCCH有更多患儿接受了推荐的眼科监测就诊（87%对比59%，P = 0.01，BCCH对比地区诊所）。
研究局限性包括样本量小以及排除了患有复杂NS的患儿（即诱导期复发、激素抵抗）。
自我们实施CNSCP以来，NS患儿在BCCH和地区诊所接受了可比的护理，且结局相似，实践差异不显著。
