偏鄉地區醫院末期腎臟病前期病程變化與相關因子探討

背景：臺灣透析發生率及盛行率高居不下，目前國內腎臟透析的病患約有8萬多人，由於健保提供完整的醫療照護，國內洗腎人數逐年增加，2015年每位洗腎病患一年約需要近50萬元的健保醫療支出，8萬多人一年花健保約400多億元，末期腎臟病患者接受透析治療的醫療資源耗用已造成國家經濟財政沉重且無法忽視的負擔了。目的：旨在瞭解台灣偏鄉地區末期腎臟病前期個案收案期間腎功能變化成效與相關因子。這些因子的辨認有助於偏鄉地區慢性腎臟病的早期監測與治療，並且期望建構相關照護模式提供臨床與實務面一個重要的參考依據。方法：收集台灣中部某偏鄉教學醫院腎臟疾病共同照護網2014年至2016年個案共398名，根據病患人口學特徵、臨床特性、伴隨症狀、危險因子與疾病病程進行分析。結果：研究發現398位病人中CKD Stage 3b的病人占59%，固定回診追蹤衛教者僅占41％。t檢定、ANOVA及逐步複迴歸分析結果顯示在GFR下降速率方面，離婚、喪偶或分居者、有職業者以及有運動習慣者顯著較慢，年齡75-84歲比64歲以下病人顯著較快，有高血壓家族史及高血脂危險因子者顯著較慢，伴隨自體免疫疾病與長期服用處方藥者顯著較快。另外Cr上升速率方面，伴隨自體免疫疾病者與有糖尿病家族史者顯著較快。結論：偏鄉地區腎臟病個案之保護因子：罹患慢性病或血壓升高不適之有症狀者、固定運動、離婚、喪偶、分居、有職業者。危險因子：大於65歲、家族慢性病患、高血糖、高血脂、自體免疫疾病、使用長期處方用藥者。

關鍵字

偏鄉； CKD ；健保Pre-ESRD計畫；相關因子

並列摘要

Background: The prevalence and incidence of end stage renal disease (ESRD) in Taiwan is among the highest in the world. Each year, about 80 thousand patients are under maintenance hemodialysis national wide, costing 40 billion NT dollars paid by The Taiwanese National Health Insurance. In other words, each hemodialysis patient spent about 500 thousand NT dollars in one year, causing major financial burden to the country. Objective: The objective of this study is to investigate the efficacy and associated factors of the changes in renal function of pre-ESRD (End stage Renal Disease) cases in remote area of Taiwan. Identifying these factors will help to early monitoring and treatment and build effective care model to provide the important reference in clinical and practical. Method: 398 pre-ESRD patients were collected from kidney disease collaborative care network in a remote teaching hospital of central Taiwan during 2014 to 2016. The associations were analyzed between demographic characteristics, clinical characteristics, accompanied symptoms, risk factors and disease progression. Result: The result of this study showed 59% of 398 cases were in CKD stage 3b and only 41% cases have regular follow up with health education. The results by t-test, ANOVA and Stepwise multiple regression procedure revealed (1) the cases of divorced, widowed or separation, being employed, and having exercise habits had slower descent rate in GFR (glomerular filtration rate); (2) ages between 75-84 years old had faster descent rate than the ages under 64 years old in GFR; (3) family history with hypertension and risk factor with hyperlipidemia had slower descent rate in GFR; (4) accompanied with autoimmune disease and long-term prescription taking cases have faster descent rate in GFR; (5) accompanied with autoimmune disease and family history with diabetes cases have faster rising rate in creatinine. Conclusion: In remote area of Taiwan, the protective factors of chronic kidney disease are chronic disease or symptoms of hypertension , regular exercise, divorced, widowed, separation and being employed. The risk factors are ages over 65, family chronic disease history, diabetes , hyperlipidemia, autoimmune disease and long-term prescription taking.