基于血液透析实时登记微管理系统改善肾性贫血的多中心临床研究

Telehealth- based dialysis registration system for the improvement of renal anemia in maintenance hemodialysis： multicenter experiences

目的通过分析基于移动信息技术的透析登记微管理系统在实时、动态反映透析患者肾性贫血中的作用，探讨其应用于透析登记管理的前景。方法“红遍中国”项目是基于手机微信端开发的透析登记微管理系统。通过微管理系统录入年龄、性别、原发病、透析龄、肌酐等人口统计学、基线实验室指标及患者每月的血红蛋白（Hb）水平。微管理系统每月为每个血液透析（HD）中心生成月度Hb统计报告，内容包括该HD中心当月透析患者Hb检测率、达标率和Hb分布水平，并通过手机微信端推送至该HD中心临床医师，临床医师通过微管理系统在手机微信端实时查看并及时个体化调整治疗方案。统计“红遍中国”项目自2015年6月上线至2017年10月人组患者的人口统计学和基线实验室指标，每月Hb检测率、达标率、平均Hb水平和Hb分布情况。结果2015年6月上线至2017年10月“红遍中国”项目共人组上海市28个HD中心的8392例MHD患者，平均年龄（60．5±13．7）岁，其中男性5059例（60．3％），基线Hb水平为（108．3±16．0）g/L，基线Hh的检测率、达标率分别为54．2％和47．5％。随访28个月时，MHD患者每月Hh检测率由54．2％上升至73．6％（P〈0．001）；每月Hb达标率由47．5％上升至56．1％（P〈0．001）；平均Hb水平由（108．3±16．0）g，L上升至（110．7±16．0）g／L（P〈0．001）；相邻两月平均Hh波动均差值不超过1．3g／L。结论透析登记微管理系统能够实时、动态反映MHD患者的贫血情况，提高对贫血的知晓率、重视程度和对贫血监测依从性，从而提高Hb检测率、改善H1）达标率、减少Hb的波动，有利于MHD患者及时、稳定、长期地纠正贫血，其作为一种优化的透析登记管理模式具有应用前景。

Objective To analyze the role of telehealth-based dialysis registration systems in real-time and dynamic reflection of renal anemia in hemodialysis （HD） patients, and discuss the prospect of its application in dialysis registration management. Methods The Red China project was to build up a dialysis registration system based on the WeChat mobile terminal platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, creatinine were recorded in this system. Hemoglobin （Hb） level was monthly recorded. The platform generated Hb statistics report for each HD center monthly, including the detection rate, target rate and the distribution level of Hb, and released it to physicians through the WeChat terminal of mobile phone. After that, physicialas could change the treatment of anemia individually on basis of this report. Here the demographic and baseline laboratory parameters, the detection rate, target rate, the average level and the distribution of Hb from June 2015 to October 2017 after the project launched were analyzed. Results From June 2015 to October 2017, 8392 maintenance HD patients from 28 HD centers in Shanghai were enrolled, of whom 5059（60.3%） were male.The average rate age was （60.5±13.7） years old. Baseline average Hb was （108.3±16.0） g/L. Baseline detection rate and target rate were 54.2% and 47.5%, respectively. After 28 months follow- up, the detection rate of Hb increased from 54.2% to 73.6% （P 〈 0.001）, the target rate of Hb increased from 47.5% to 56.1% （P 〈 0,001）, and the level of average Hb rose from （108.3±16.0） g/L to （110.7±16.0） g/L. The difference between average Hb in two consecutive months was less than 1.3 g/L. Conclusions The telehealth-based dialysis registration system can timely report the anemia situation of HD patients, which may improve the awareness rate of anemia, the degree of attention and the compliance of anemia monitoring, so as to improve the detection rate and target rate of Hb and reduce the fluctuation of Hb, which helps to maintain the HD patients to correct anemia in a timely, stable and long-term way. The telehealth-based dialysis registration system, as an improved mode of dialysis registration is a promising way for long- term management of renal anemia in dialysis patients.