■保守性肾脏管理(CKM)是许多慢性肾脏疾病患者的可行治疗选择。然而,美国的CKM实践和资源没有得到很好的描述。我们进行了这项研究,以更好地了解影响CKM摄取的因素,通过描述:(1)选择CKM的患者的特征,(2)与CKM相关的提供者实践模式,和(3)提供商可用的CKM资源。
■横断面研究。
■这项研究是对2014年至2020年慢性肾脏病预后和实践模式研究(CKDopps)中美国肾脏病诊所数据的横断面分析。本研究的数据包括估计肾小球滤过率≤30mL/min/1.73m2(n=1018)的患者的图表抽象特征,以及有关肾衰竭时是否已决定进行CKM的可用信息。患者(n=407)关于放弃透析的讨论报告,和提供者(n=26)对CKM交付和卫生系统中可用资源的回应。
■使用描述性统计来报告患者的人口统计信息,临床信息,提供者人口统计,和临床特点。
■在1018名患者的数据中,68(7%)被记录为CKM计划。这些病人年龄较大,有更多的合并症,更有可能需要转移援助。在407项病人调查中,18%的人报告说与他们的肾脏科医生进行了有关放弃透析的对话。大多数提供商对讨论CKM感到满意;但是,没有诊所有专门的CKM诊所或方案.
■调查术语不一致,患者和提供者的反应不相关。
■很少有患者报告与他们的提供者讨论放弃透析,甚至更少的患者预期在达到肾衰竭时选择CKM。大多数提供者都乐于讨论CKM,但在缺乏专用资源的诊所中实践。需要进一步的研究来改善CKM途径的实施。
■对于患有肾衰竭的老年共病成年人,保守肾脏管理(CKM)可能是一个合适的治疗选择。CKM是一种整体方法,其治疗目标是在不开始透析的情况下最大限度地提高生活质量和预防慢性肾脏疾病(CKD)的进展。我们调查了美国的CKM实践,发现在1018名CKD患者中,只有7%的人计划进行CKM。在接受调查的407名患者中,18%的人报告与他们的提供者进行了有关放弃透析的对话。相比之下,大多数提供者觉得讨论CKM很舒服;然而,没有人报告在有专用CKM诊所或方案的环境中工作。我们的数据表明,在美国需要进一步的CKM教育以及提供专用资源。
UNASSIGNED: Conservative kidney management (CKM) is a viable treatment option for many patients with chronic kidney disease. However, CKM practices and resources in the United States are not well described. We undertook this
study to gain a better understanding of factors influencing uptake of CKM by describing: (1) characteristics of patients who choose CKM, (2) provider practice patterns relevant to CKM, and (3) CKM resources available to providers.
UNASSIGNED: Cross-sectional
study.
UNASSIGNED: This
study is a cross-sectional analysis of data from US nephrology clinics enrolled in the chronic kidney disease Outcomes and Practice Patterns
Study (CKDopps) collected between 2014 and 2020. Data for this
study includes chart-abstracted characteristics of patients with an estimated glomerular filtration rate ≤30mL/min/1.73m2 (n=1018) and available information on whether a decision had been made to pursue CKM at the time of kidney failure, patient (n=407) reports of discussions about forgoing dialysis, and provider (n=26) responses about CKM delivery and available resources in their health systems.
UNASSIGNED: Descriptive statistics were used to report patient demographics, clinical information, provider demographics, and clinic characteristics.
UNASSIGNED: Among data from 1018 patients, 68 (7%) were recorded as planning for CKM. These patients were older, had more comorbidities, and were more likely to require assistance with transfers. Of the 407 patient surveys, 18% reported a conversation about forgoing dialysis with their nephrologist. A majority of providers felt comfortable discussing CKM; however, no clinics had a dedicated clinic or protocol for CKM.
UNASSIGNED: Inconsistent survey terminology and unlinked patient and provider responses.
UNASSIGNED: Few patients reported discussion of forgoing dialysis with their providers and even fewer anticipated a choice of CKM on reaching kidney failure. Most providers were comfortable discussing CKM, but practiced in clinics that lacked dedicated resources. Further research is needed to improve the implementation of a CKM pathway.
UNASSIGNED: For older comorbid adults with kidney failure, conservative kidney management (CKM) can be an appropriate treatment choice. CKM is a holistic approach with treatment goals of maximizing quality of life and preventing progression of chronic kidney disease (CKD) without initiation of dialysis. We investigated US CKM practices and found that among 1018 people with CKD, only 7% were planning for CKM. Of 407 surveyed patients, 18% reported a conversation with their provider about forgoing dialysis. In contrast, most providers felt comfortable discussing CKM; however, none reported working in an environment with a dedicated CKM clinic or protocol. Our data show the need for further CKM education in the United States as well as dedicated resources for its delivery.