初期慢性腎臟疾病病程變化與相關因子之研究：以中部某偏鄉醫院為例

背景：慢性腎臟病一直是全世界關注的話題，隨著人口老化程度與三高(高血壓、高血糖及高血脂)罹患人數的增加，慢性腎臟病患者的數量正持續增加中，造成醫療財政上沉重的負擔，是全球公共衛生的一大挑戰。目的：本研究探討初期慢性腎臟疾病病程變化，及其相關影響因子。方法：本研究為回溯性(Retrospective)的縱貫研究，以中部某地區醫院2013-2016年間進入慢性腎臟病衛教計畫之慢性腎臟病病患為研究母群體(N=1,027)。應用推論性統計中的獨立樣本t檢定、單因子變項分析以及多元複迴歸分析，探討病患基本資料、伴隨疾病、固定回診與GFR、Cr變化速率之關係。結果：影響慢性腎臟疾病病程因素包含性別、年齡、腎臟分期，伴隨疾病。在GFR下降速率方面，男性顯著高於女性；年齡部分，年齡<65歲者顯著低於≥75歲者；慢性腎臟病分期部分，第一期慢性腎臟病患GFR下降速率最快，其次為第二期病患，第三期病患下降速率最慢；有糖尿病者GFR下降速率顯著低於無糖尿病者。在Cr上升速率中，僅有糖尿病之病人顯著低於無糖尿病者。結論：本研究對象年齡部分≥65歲者占69.5%，教育程度部分≤國中教育程度者占71%，顯示偏鄉地區以老年人居多，大多屬低教育程度，對慢性腎臟疾病認知情形，可能來自非正規醫療資訊，可藉由照護計畫，鼓勵民眾進行篩檢，加強衛教，讓民眾了解慢性腎臟病，進而改變行為及態度，以延緩慢性腎臟病之惡化。本研究結果顯示慢性腎臟病第一期病程變差最快，因初期慢性腎臟疾病，大部分無明顯症狀，需靠抽血、驗尿等實驗室檢驗，才能知道腎臟已有損傷，故應加強在慢性腎臟病衛教照護部分，讓民眾知道如果危險因子一直存在，會加速腎臟病的病程變化，導致後續可能洗腎的嚴重性。關鍵詞：CKD，相關因子，病程變化

關鍵字

初期慢性腎臟病；病程變化；相關因子

並列摘要

Background: Chronic kidney disease (CKD) has been a major issue around the world. As increasing of aging population and prevalence of metabolic syndrome (hypertension, high blood sugar and hyperlipidemia), chronic kidney disease patients is growing in numbers, which cause financial burden and become public health challenge worldwide. Purpose: The purpose of this study is to investigate the disease progression and associated factors of early chronic kidney disease. Methods: This study is a retrospective longitudinal research. Patients who were jointed the integrated CKD care program from 2013 to 2016 in local hospital of central Taiwan were included in this study (N=1,027). The independent sample t test, ANOVA, and multiple regression analysis were used to investigate the association factors (demographic characteristics ,accompanying disease and regular visits) with change rate of GFR & Cr. Result: Gender, age, stage of CKD, and accompanying disease were associated factors with progression of CKD. The results indicated that GFR decline rate of male patients was significantly higher than female. Patients under 65 years old was significantly lower than those more than 75 years old. Among patients in CKD stage 1 to stage 3, the GFR decline rate of patients with stage 1 was the highest, and decline rate of stage 2 was secondary, while decline rate of stage 3 was lowest. Patients with diabetes were significantly lower than those without diabetes. In Cr increasing rate, patients only with diabetes were significantly lower than those without diabetes. Conclusion: In this study, patients aged over 65 years old accounted for 62.1%, and 71% of patients educated less than junior high school indicating that among the investigated group, the elder and low-educated population is the majority and awareness of chronic kidney disease may come frominformal health information. Through the care program could encourage people to screen and strengthen health education so that people understand chronic kidney disease, and then change the behavior and attitude to delay the deterioration of chronic kidney disease. The results of this study indicated that the dramatic change of chronic kidney disease progression in early stage (stage1). This might due to no obvious symptoms in this stage of chronic kidney disease, blood, urine and other laboratory tests is needed to evaluated kidney damage. Health education programs are needed to inform patients the exist of risk factor which could speed the progress of CKD and lead to severe kidney damage . dialysis treatment, health education should be strengthened. Key Words: CKD, association factors, disease progression