https://scholars.lib.ntu.edu.tw/handle/123456789/514961
標題: | Nephrologist Follow-Up Care of Patients With Acute Kidney Disease Improves Outcomes: Taiwan Experience | 作者: | VIN-CENT WU SHIH-CHIEH CHUEH Huang T.-M. TAO-MIN HUANG TAI-SHUAN LAI Chen Y.-M. YUNG-MING CHEN TZONG-SHINN CHU Chawla L.S. |
公開日期: | 2020 | 出版社: | Elsevier Ltd | 卷: | 23 | 期: | 9 | 起(迄)頁: | 1225-1234 | 來源出版物: | Value in Health | 摘要: | Objectives: Acute kidney injury (AKI) and acute kidney disease (AKD) are a continuum on a disease spectrum and frequently progress to chronic kidney disease. Benefits of nephrologist subspecialty care during the AKD period after AKI are uncertain. Methods: Patients with AKI requiring dialysis who subsequently became dialysis independent and survived for at least 90 days, defined as the AKD period, were identified from the Taiwanese population's health insurance database. Cox proportional hazard models using death as the competing risk before and after propensity-score matching were applied to evaluate various endpoints. Results: Among a total of 20 260 patients with AKI requiring dialysis who became dialysis independent, only 7550 (37.3%) patients were followed up with by a nephrologist (F/Unephrol group) during the AKD period. During a mean 4.04 ± 3.56 years of follow-up, the patients in the F/Unephrol group were more often administered statin, antihypertensives, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), diuretics, antiplatelet agents, and antidiabetic agents. The patients in the F/Unephrol group had a lower mortality rate (hazard ratio [HR] = 0.87, P <.001) and were less likely to have major adverse cardiovascular events (MACE) (subdistribution HR [sHR] = 0.85, P <.001), congestive heart failure (CHF) (sHR = 0.81, P <.001), and severe sepsis (sHR = 0.88, P =.008) according to the Cox proportional model after adjusting for mortality as a competing risk. During the AKD period, an increase in the frequency of nephrology visits was associated with improved outcomes. Conclusions: In this population-based cohort, even after weaning off acute dialysis, only a minority of patients visited a nephrologist during the AKD period. We showed that nephrology follow-up is associated with a decrease in MACE, CHF exacerbations, and sepsis, as well as lower mortality; thus it may improve outcomes in patients with AKD. ? 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85089251674&doi=10.1016%2fj.jval.2020.01.024&partnerID=40&md5=6af18106615d63468ed7dc97f8bbb4d7 https://scholars.lib.ntu.edu.tw/handle/123456789/514961 |
ISSN: | 1098-3015 | DOI: | 10.1016/j.jval.2020.01.024 | SDG/關鍵字: | angiotensin receptor antagonist; antidiabetic agent; antihypertensive agent; antithrombocytic agent; dipeptidyl carboxypeptidase inhibitor; diuretic agent; hydroxymethylglutaryl coenzyme A reductase inhibitor; acute kidney failure; adult; Article; cardiovascular disease; cohort analysis; congestive heart failure; controlled study; dialysis; disease severity; female; follow up; health insurance; human; ICD-9; long term care; major clinical study; male; middle aged; mortality rate; nephrologist; outcome assessment; patient care; patient referral; priority journal; propensity score; retrospective study; sepsis; Taiwan; acute kidney failure; aged; case control study; complication; disease exacerbation; epidemiology; hemodialysis; mortality; nephrology; proportional hazards model; very elderly; Acute Kidney Injury; Aged; Aged, 80 and over; Case-Control Studies; Disease Progression; Female; Humans; Male; Middle Aged; Nephrology; Proportional Hazards Models; Renal Dialysis; Taiwan |
顯示於: | 醫學系 |
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