國家衛生研究院 NHRI:Item 3990099045/10411
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    題名: Frequency of early predialysis nephrology care and postdialysis cardiovascular events
    作者: Yang, JY;Huang, JW;Chen, L;Chen, YY;Pai, MF;Tung, KT;Peng, YS;Hung, KY
    貢獻者: Division of Health Services and Preventive Medicine
    摘要: BACKGROUND: Patients with kidney failure are at a high risk for cardiovascular events. Predialysis nephrology care has been reported to improve postdialysis survival, but its effects on postdialysis major adverse cardiovascular events (MACEs) have not been comprehensively studied. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: We used data from the National Health Insurance Research Database in Taiwan. Adult patients who initiated maintenance dialysis therapy in 1999 to 2010 were enrolled. PREDICTOR: We created 3 subtypes of predialysis nephrology care based on the time between the first nephrology visit and the initiation of dialysis therapy: early frequent (duration >/= 6 months; at least 1 nephrology visit every 3 months), early infrequent (duration >/= 6 months, <1 nephrology visit every 3 months), and late (duration < 6 months). OUTCOMES: MACE was defined using the primary diagnosis in hospitalization records of acute myocardial infarction, acute heart failure, acute stroke, or sudden death. MEASUREMENTS: We investigated the associations of different subtypes of nephrology care with postdialysis 1-year MACEs. RESULTS: Among the 60,329 eligible patients, 24,477 (40.6%) had early frequent, 12,763 (21.2%) had early infrequent, and 23,089 (38.3%) had late nephrology care. Compared to the late-nephrology-care group, the early-frequent group was associated with an approximately 10% lower risk for 1-year MACEs (HR of 0.89 [95% CI, 0.82-0.96] for first MACE and relative risk of 0.91 [95% CI, 0.84-0.98] for recurrent MACEs). However, the early-infrequent-care group had similar risks for MACEs as the late group (HR of 0.95 [95% CI, 0.86-1.05] for first MACE and relative risk of 0.94 [95% CI, 0.86-1.02] for recurrent MACEs). LIMITATIONS: Lack of physical and biochemical information because of inherent limitations from administrative claims data. CONCLUSIONS: Early frequent nephrology care for 6 or more months before the initiation of long-term dialysis therapy may improve 1-year postdialysis major cardiovascular outcomes.
    日期: 2017-08
    關聯: American Journal of Kidney Diseases. 2017 Aug;70(2):164-172.
    Link to: http://dx.doi.org/10.1053/j.ajkd.2016.12.018
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0272-6386&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000406047500009
    Cited Times(Scopus): http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85014061251
    顯示於類別:[陳麗光] 期刊論文

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