臺灣地區八十八至八十九年度透析評估工作報告

1999 National Dialysis Surveillance in Taiwan

黃尚志(Shang-Jyh Hwang) ； 楊五常(Wu-Chang Yang) ； 陳秀熙 ； 台灣腎臟醫學會透析評估委員(The Dialysis Surveillance Committee TSN)

《Acta Nephrologica》 14卷4期 (2000/10) Pp. 139-228

摘要

本科劃藉資料收集與實地評鑑，以普查式的調查工作，研究分析台灣地區透析病患與院所之醫療資源現況、透析醫療品質、與評鑑結果。同時以腎臟醫學會資料庫與外部資料庫進行比對，建構完成台灣透析病患資料庫與登錄系統。
八十八年度共有333家血液透析院所及35家腹膜透析院所參與透析評鑑，至民國88年12月31日止台灣地區共有27,143名未期腎衰竭病患(ESRD)正接受長期透析治療，盛行率為每百萬人口1,241人; 其中血液透析病患有25,438名(93.7%); 腹膜透析病患有1,705名(6.3%)。27,143名病患中男性有12,827名(47.3%)盛行率1,134人，女性有14, 315名(52.7%)，盛行率1,311人。全體病患平均年齡為57.5±14.8歲，男性平均年齡為57.0±15.3歲，女性平均年齡為58.1±14.3歲。原發病因中粒尿病高達24.8%，死亡率以老年人較高，死亡至主因可能心肺系統。
88年全年新進入長期透析患者有5,010名，粗發生率227(人/每百萬人口)，其中男性有2,386名(47.6%)，粗發生率211(人/每百萬人口)，女性有2,624名(52.4%)，粗發生率243(人/每百萬人口)。全體新病患平均年齡為59.5±14.2歲(男性平均年齡為85.4±15.1歲，女性平均年齡為58.9±14.3歲)。新透析病患中糖尿病更達32.6%，為單一疾病佔率最高者。
參與評鑑之透析院所，其硬體設備、醫師與護理人員素質、醫師照顧品質等絕大部分院所皆合乎要求。88年透析醫療品指標受檢率與成績已較過去提高，以各項醫療品質中適當透析指標、貧血處理情況、肝炎及傳染疾病管制，尤為明顯改進; 心臟血管併發症的防治、腎性病變防治與處理、病患復健情況雖已不錯但仍有改進空間。評鑑所訂定的醫療品質指標，在適當透析方面以URR; Kt/V、Albumin受檢率與執行成果皆較理想; 心臟血管併發症的預防方面CTR受檢率偏低平均值亦較高，膽固醇值、降膽固醇治療、與高血壓藥物治療等方面則良好。血管通路處置、罹病情況、住院率等指標可列入下年度評鑑計分項目。
以學會資料庫與外部資料庫(中央健保局重大傷病證明資料庫、慢性腎衰竭病患費用申報檔案、及衛生署全國死亡資料)進行資料比對，已整合完成國內透析病患資料庫。未來完整而長久的透析病患登錄制度，必須結合台灣腎臟醫學會的專業與健保局行政資源。尿毒症接受透析患者申請重大傷病作的新流程與新申請書內容，可作為其他重大疾病登錄的借鏡。
結論：隨著台灣地區醫療與公共衛生的進步、國人平均餘命的延長，台灣地區接受透析治療的患者人數逐年提高，醫療支出大幅增加，建議應建立國家級腎臟疾病防治計劃，積極尋找造成未期腎臟病的原因，擬定全盤性的防治對策，才能降低我國未期腎疾病之發生率，達成腎臟疾病防治的目標。

並列摘要

We performed this plan by collecting data, on-the-spot rating and general survey to analyze the current medical resources status, dialysis quality and rating results of dialysis patients and centers in Taiwan. In addition, we compare TSN database with database outside to construct and complete database and registration system of Taiwna dialysis patients.
In 1999, there are totally 333 HD centers and 38 PD centers participating in annual dialysis rating. Until Dec. 31st 1999, there are 27143 ESRD patients patients undergoing long-term dialysis therapy. The prevalence rate is 1241 per million populations. Among these patients, 25348993.7%) are HD patients, 1750(6.3%) are PD patients. 12827 (47.3%) are male, with yearly incidence of 1134 men. 14315(52.7%) are female, with yearly incidence of 1311 women. Average age is 57.5±14.8 year old. Male average age is 57.1±15.3 years old. Female average age is 58.7±14.7years old. Diabetes mellitus occupies 24.8% among primary causes of ESRD. Death rate is higher in elderly people. The main causes of death are still due to cardio-pulmonary diseases.
There are 5010 people entering long-term dialysis in the year of 1999. Incidence is 227 per million population 2386 are male, with incidence of 211/million population. 2624 are female, with incidence 243/million population. Average age of total fresh dialysis cases is 58.7±14.7 years old (male average 58.4±15.1, female average 58.9±14.3). Diabetes mellitus predominates in the diseases causing fresh ESRD by reaching 32.6%. DM is also the top cause among individual disease. Most Dialysis centers participating in the rating meet our demands on hardware equipment, qualification and caring quality provided by medical memberships. In 1999, there is promotion in medical quality indices, especially improvement in dialysis adequacy, anemia management, hepatitis, and contagion control. Concerning prevention for cardiovascular complications, renal osteodystrophy and patient rehabilitation, we also make big progress, although there still need more endeavors. Among the medical quality indices, we have better performance on the examination rate and result of URR, Kt/V and serum albumin values. As to cardiovascular complications prevention, we have lower CTR examination rates, with higher CTR values. Serum cholesterol, cholesterol lower and anti-hypertensive therapies are quite well done. The indices of vascular access, morbidity, and hospirtal-ization rate should be included in the next year’s items.
Comparing TSN database with database outside (Database for certification of serious diseases in Bureau of National Health Insurance, Files for chronic renal failure patients payments, and Total mortality published by Department of Health), we have successfully integrated national dialysis database in Taiwan. In the long-term future, we have to connect TSN speciality and BNHI executive resources to complete dialysis patients registration system. The New flow-chart and contents of application form for dialysis patient applying “serious disease card” can be lessons for registration of other serious diseases.
Conclusion: In Taiwan, with the progress of medicines and public health, lengthening of life expectancy, numbers of patients undergoing dialysis and their medical payments increase year by years. We recommend that national prevention project for renal diseases should be established. As a result we can aggressively search for causes of end-stage renal diseases, and set up wholesome prevention strategies. Thus the ESRD incidence can be lowered significantly to achieve goalso of primary prevention of renal diseases.