慢性腎臟病完整照護計畫介入可延緩腎功能惡化

Slowing Progression of Chronic Kidney Disease by CKD Integrated Program

慢性腎臟病為全世界逐漸增加的公共健康議題，並成為財務上沉重的負擔。這個研究的目的主要是探討是否慢性腎臟病照護計畫可延緩慢性腎臟病病患腎功能的惡化。我們從93年2月至94年7月收集了一間區域醫院慢性腎臟病第三期至第五期病人，共242個病人。使用簡易MDRD公式推估腎絲球過濾率並根據2002年美國腎臟基金會(NKF)發展之腎臟疾病療效品質指引[NKF-K/DOQI]來設定慢性腎臟病分級。慢性腎臟病照護介入前其腎絲球過濾率下降速率為每年下降4.2±0.4ml/min/1.73平方公尺，而在慢性腎臟病照護介入後其腎絲球過濾率下降速率為每年下降2.8±0.3ml/min/1.73平方公尺，有明顯的下降(p=0.005)。且病患在腎臟病照護介入後其血壓、血糖和血脂肪獲得較佳的控制。另外病患在腎臟病照護介入後也較多使用廔管收縮素轉化抑制劑，廔管收縮素Ⅱ接受器阻斷劑及statin類的藥物。慢性腎臟病照護計畫的介入的確可延緩慢性腎臟病病患腎功能的惡化。為了降低台灣末期腎臟疾病的發生率和盛行率，應加強及推廣慢性腎臟病照護計畫。

Background: Chronic kidney disease (CKD) is an increasing worldwide public health problem and global burden. This aim of this study is to evaluate whether the decline in renal function can be slowed down by CKD integrated program. Methods: The study included 242 subjects with CKD stage 3 to 5 in one regional hospital between Feb 2004 and Jul 2005. The simplified Modification of Diet in Renal Disease equation was used to define estimated glomerular filtration rate (eGFR) and CKD stage according to the criteria of the United States National Kidney Foundation. Results: The rates of eGFR declining slowed significantly from -4.2±0.4 before intervention to -2.8±0.3 ml/min/1.73m^2/year after intervention (mean±standard error of mean, p=0.005). Patients had better control of blood pressure, sugar and lipids, and more frequent use of angiotensin converting enzyme inhibitors, angiotensin Ⅱ receptor blockers and statins. Conclusions: CKD program intervention slows down the renal function deterioration. To decrease the prevalence and incidence of ESRD in Taiwan, the CKD integrated program should be strengthened and propagated.