透析前慢性肾脏病管理对血液透析患者的影响

The effects of predialysis CKD management on hemodialysis patients

目的:分析透析前慢性肾脏病(CKD)管理对于血液透析患者预后的影响。方法:本研究为回顾性队列研究。研究对象为2006年1月至2009年12月开始在我科维持性血液透析患者,按照患者透析前是、否接受过我科CKD门诊规范化的教育和管理分为管理组和非管理组。2010年3月,收集患者的临床结局、透析间期体重增加值(IDWG)、血压、化验结果、活动能力和康复状况,并对两组进行比较。结果:共88例患者纳入本研究,其中管理组29例,非管理组59例。截至研究结束,管理组1例死亡,3例肾移植,3例转出;非管理组11例死亡,2例肾移植,3例转出。管理组患者(22例)平均IDWG(1.58±0.77)kg,非管理组(42例)平均IDWG(2.14±0.99)kg,前者较低,差异有统计学意义(t=2.317,P<0.05);管理组患者贫血控制更好(t=2.185,P<0.05),康复回归也更好(z=2.423,P=0.015)。结论:系统的透析前慢性肾脏病管理和教育可以提高患者治疗的依从性及疾病的自我管理能力,从而使患者在进入透析后仍能够有较好的临床结局。

Objective： To explore the effects of pre-dialysis Chronic Kidney Disease Management Clinic （CKDMC） on patients with maintenance hemodialysis. Methods： It was a retrospective cohort study. All patients who began maintenance hemodialysis in our hospital from January, 2006 to December, 2009 were included in this study. We divided them into two groups, namely management group （MG） and non-management group （NMG）, based on whether they came from our CKDMC. We collected their interdialysis weight gain （IDWG）, blood pressure, lab test result, activity index, rehabilitation status and clinical outcome in March, 2010. Results： A total of 88 patients were included in this study, with 29 cases in MG group and 59 in NMG group. Until March,2010, 1 patient died, 3 got transplantation and 3 transferred to other center in MG group, while 11 died, 1 changed to peritoneal dialysis, 2 got transplantation and 3 went to other program in NMG group. The average IDWG was lower in MG （22 cases） group than NMG （42cases） group at the end of the study （t=-2.317, P〈0.05 ）. They also had higher hemoglobin level （t=-2.185, P〈0.05 ）, and better rehabilitation status （z=2.423, P=-0.015 ）.Conclusions： Pre-dialysis CKDMC may increase patients＇ self management ability, and then improve patients＇ clinical outcome and health status even after they got hemodialysis.