Kurtin P, Nissenson A R
J Am Soc Nephrol. 1993 May;3(11):1738-47. doi: 10.1681/ASN.V3111738.
The size and expense of the ESRD program exceed all predictions made when the program was first initiated. Although the effectiveness of dialytic therapy is unquestioned, its value (quality/cost) is actively debated in this era of constricting resources. To better evaluate the quality of the ESRD program, it is essential to first define and quantitate the outcomes of dialytic care. Although mortality is a convenient outcome measure, it may be affected by many patient-specific as well as other factors that must be considered when evaluating and comparing new and existing technologies or advances. Quality of life is only beginning to be used in depth as an outcome measure, and much work is needed to standardize research methodology and thus move this area forward. The following review describes the current state of knowledge regarding outcomes of ESRD patients and proposes areas for future investigation, which should help increase the understanding of the value of the ESRD program to patients, providers, and payors.
终末期肾病项目的规模和费用超出了该项目最初启动时所做的所有预测。尽管透析疗法的有效性毋庸置疑，但在资源紧缩的这个时代，其价值（质量/成本）仍存在激烈争论。为了更好地评估终末期肾病项目的质量，首先必须定义并量化透析治疗的结果。虽然死亡率是一个便捷的结果衡量指标，但在评估和比较新技术及现有技术或进展时，它可能会受到许多患者特异性因素以及其他因素的影响。生活质量作为一种结果衡量指标才刚刚开始被深入使用，需要做大量工作来规范研究方法，从而推动这一领域的发展。以下综述描述了关于终末期肾病患者治疗结果的当前知识状态，并提出了未来研究的领域，这应有助于增进对终末期肾病项目对患者、医疗服务提供者和支付方价值的理解。
