如何阻断终末期肾病

正说到终末期肾病,可能许多人一下子不甚了了。但若是说起肾功能衰竭、尿毒症,以及由此而来的肾透析,大家可能会恍然大悟。其实,终末期肾病和肾功能衰竭、尿毒症是既相似又有区别的三个关联概念。在因病致贫、因病返贫的严重疾病中,终末期肾病可能是人们谈论最多的疾病之一。终末期肾病的替代治疗,即大家俗话所说的肾透析,实际上包括了血液透析和腹膜透析。终末期肾病患者丧失基本的劳动能力,再加上透析治疗需要定期进行,犹如一个吸金的"黑洞",把患者及其家庭的资产吸干耗净,不要说是农村贫困家庭,即使是城市工薪族也难以承受。有关资料显示,     

血液透析与腹膜透析的费用及疾病经济负担分析

终末期肾病给社会带来的经济负担十分沉重。我国经济水平不高,人均占有的卫生经费很少,而终末期肾病患者众多,疾病对我国患者及其家庭、社会保障部门乃至整个社会造成的影响远甚于发达国     

关于终末期糖尿病肾病的医疗保险研究

目的探索终末期肾病的保险精算方法,为终末期肾病以及其他重大疾病的保险研究方法提供参考和借鉴。为完善我国终末期肾病的医疗保障提供理论依据。方法拟和糖尿病病人终末期肾病发病概率模型、生存概率模型,采用寿险精算的思想,考虑长期保险过程中利率因素的影响,建立终末期糖尿病肾病的保险方案。结果糖尿病患者终末期肾病的发病率随年龄增加而上升。保费与投保时年龄有关。对于终身长期疾病保险,利率的变化对保费的影响较大。结论将寿险精算的方法应用到糖尿病终末期肾病保险中具有可行性,随着糖尿病的发病率迅速上升,终末期肾病造成的经济负担需要健全和完善的社会医疗保障体系。     

我国终末期肾病现状及透析技术的应用、费用及支付情况分析

终末期肾病是世界范围的重大公共卫生问题。近年来我国终末期肾病发病率增幅较大,给国家、社会和患者个人带来了较大的经济负担。本文对中国终末期肾病流行现状及两种透析治疗方法（即血液透析和腹膜透析）的技术应用、费用和支付情况做出分析,并提出相关政策建议：建立全国或地方肾病登记制度,进行终末期肾病的流行病学监测;规范两种透析治疗的临床应用;鼓励研究机构开展两种透析治疗的经济学评价和技术评估研究,为协助医保部门制定适宜的支付方式提供实证基础,同时也为卫生部门制定有关政策提供证据。     

终末期肾病患者血清蛋白质组二维电泳图像与正常血清蛋白图谱比较研究

目的建立和优化终末期肾病患者血清蛋白质组研究的双向电泳及相关技术,并与正常血清蛋白图谱比较。方法以固相pH梯度等电聚焦为第一向和垂直SDS-聚丙烯酰胺凝胶电泳为第二向,对终末期肾病患者血清蛋白质样品制备、上样量、IPG胶条、等电聚焦等进行条件优化。质谱鉴定有差异表达的其中4个蛋白点。结果成功获得终末期肾病患者血清蛋白质组电泳图谱,与正常者相比存在表达有明显差异的蛋白点。结论成功建立了终末期肾病患者血清蛋白质组研究的双向电泳技术平台。     

终末期肾病治疗病人的社会学特征

终末期肾病是一种费用巨大的灾难性疾病。公费、劳保单位不堪负担,自费病人更是不敢问津,患者治疗无门,供需矛盾十分突出,社会舆论反响极大。在上海市科委的支持下,我们成立了“终末期肾病治疗的成本效果分析及建立医疗基金”课题组,对终末期肾病治疗病人的社会学特征作了专题调查。     

糖尿病肾病终末期肾衰患者高血压控制的临床分析

目的研究并发高血压的糖尿病肾病终末期肾衰患者的降压药使用和血压控制情况,以及其相关因素。方法对象为于本院住院的并发高血压的糖尿病肾病终末期肾衰患者共55例,记录其基本资料、血糖、血压、降压药使用及其他生化资料,分析其血压控制率及用药方案。结果糖尿病肾病终末期肾衰患者总体高血压控制率为21.8%,糖尿病肾病终末期透析组高血压控制率显著高于非透析组(P0.05)。应用可乐定在两组中所占比例差异有统计学意义(P0.05)。透析组患者的舒张压与尿白蛋白呈正相关(P0.05);使用1、2、3、≥4种降压药的患者血压控制率各组间差异无统计学意义。结论住院DN终末期肾衰患者并高血压的控制率低,且控制率与所应用降压药数无相关。透析、应用可乐定片均是其血压控制的有利因素。降低糖尿病肾病终末期肾衰透析患者的尿白蛋白有助于控制其舒张压。     

重视终末期肾病患者常见的心理问题

正终末期肾病患者长期忍受着慢性疾病的煎熬,严重威胁生命,给患者的身心带来巨大的痛苦。资料显示,全球每年死于终末期肾病的人数高达73万人,而在我国,终末期肾病患者超过了100万。据国外报道,12%～40%的终末期肾病患者存在不同程度的心理问题,如焦虑、抑郁等;而这些心理问题造成的危害有时甚至比疾病本身带来的损害还要严重。因此,终末期肾病患者常见的心理问题必须引起重视。     

浅谈终末期肾病的一体化治疗

随着高血压、动脉粥样硬化、糖尿病等疾病发病率的升高,以及人口老龄化,终末期肾病的发病率也明显升高.据有关资料不全统计,目前全国每百万人口中约有终末期肾病患者150-200例."终末期肾病一体化治疗"是指及时、早期诊断终末期肾病,适时开始肾替代治疗,保护残余肾功能,延缓病情发展,预防和治疗并发症,同时进行相关疾病知识的指导,让患者获得最佳的生活质量和尽可能恢复劳动能力.     

基于蒙医特色护理干预对终末期肾病透析患者不良情绪及营养状况的影响

目的探讨基于蒙医特色护理干预对终末期肾病透析患者不良情绪及其营养状况的影响。方法选择2013年6月—2015年6月期间在内蒙古民族大学附属医院住院的266例终末期肾病透析患者为研究对象,根据入院时间分为观察组和对照组各133例,对照组给予常规护理,观察组给予基于蒙医特色护理干预,比较两组患者焦虑抑郁情绪、营养状况、护理满意度。结果 266例终末期肾病透析患者中,124例患者发生焦虑、抑郁等不良情绪,发生率为46.62%。家庭经济条件差、透析时间1 a、无医疗保险、社会及家庭情感支持差是影响终末期肾病透析患者发生不良情绪的主要因素(均P0.05)。观察组焦虑评分、抑郁评分均低于对照组,血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、血红总蛋白(Hb)均高于对照组,患者满意度(94.74%)亦高于对照组(87.97%)(均P0.05)。结论终末期肾病血液透析患者不良情绪发生率高,影响因素多。基于蒙医特色的护理干预有助于缓解终末期肾病血液透析患者的焦虑抑郁情绪,改善营养不良状况,提高患者满意度。     

Excessive burden of end-state renal disease among Canadian Indians: a national survey.

Analysis of data from the Canadian National Renal Failure Register indicates that Canadian Natives are at much higher risk for end-stage renal disease (ESRD) than the Canadian population in general. Using two population estimates for the total Native population, the age-standardized incidence rate of newly registered ESRD cases between 1981 and 1986 among Natives was at least 2.5 times (and may be as high as four times) the national rate. Natives were particularly at higher risk for ESRD to diabetes, glomerulonephritis, and pyelonephritis, whereas for the other causes the risk was no different from that of other Canadians. As technologically sophisticated treatment facilities are only available in major urban centers, Native ESRD patients and their families living in remote areas of Canada are faced with major psychosocial disruptions of relocation.     

End-stage renal disease and economic incentives: the International Study of Health Care Organization and Financing (ISHCOF)

End-stage renal disease (ESRD) is a debilitating, costly, and increasingly common condition. Little is known about how different financing approaches affect ESRD outcomes and delivery of care. This paper presents results from a comparative review of 12 countries with alternative models of incentives and benefits, collected under the International Study of Health Care Organization and Financing, a substudy within the Dialysis Outcomes and Practice Patterns Study. Variation in spending per ESRD patient is relatively small, but correlated with overall per capita health care spending. Remaining differences in costs and outcomes do not seem strongly linked to differences in incentives.      

终末期肾病患者血清氨基酸水平的变化

目的用高效毛细管电泳法分析终末期肾病（ESRD）患者与正常人血清游离氨基酸水平的变化，并探讨氨基酸与患者血白蛋白、血红蛋白和转铁蛋白的相互关系。方法选择ESRD（内生肌酐清除率〈0．25ml／s）尚未开始透析的患者共40例，除外活动性肝脏疾病、急性感染、慢性特异性感染和肿瘤患者；健康对照者24例。常规检测血白蛋白、转铁蛋白、血红蛋白和肌酐的水平，用高效毛细管电泳仪检测血清氨基酸水平。结果与正常人相比，ESRD患者血清非必需氨基酸中酪氨酸浓度显著降低，而半胱氨酸、脯氨酸浓度显著升高（P〈0．05）；缬氨酸／甘氨酸、丝氨酸／甘氨酸比值显著降低（P〈0．05）；血清必需氨基酸中色氨酸、缬氨酸、苏氨酸浓度显著降低（P〈0．05）。甘氨酸与红细胞压积、丝氨酸／甘氨酸比值与红细胞压积和血红蛋白值呈显著正相关，半胱氨酸、缬氨酸和缬氨酸／甘氨酸比值与白蛋白（ALB）呈显著正相关。进一步将ALB按ALB〉30g／L、20g／L≤ALB≤30g／L、ALB〈20g／L分层分析，结果显示3组间缬氨酸浓度差异具有显著性（P=0．029）。酪氨酸、脯氨酸、甘氨酸、缬氨酸与转铁蛋白呈显著正相关（P=0．007，P=0．046，P=0．008，P=0．009）。结论ESRD患者血清游离氨基酸代谢与正常人相比，差异具有显著性；必需氨基酸普遍下降；非必需氨基酸高低不一。部分氨基酸的代谢可能影响患者白蛋白、血红蛋白和转铁蛋白的合成。     

End stage renal disease and the marital dyad: an empirical investigation

The psychological well-being of end stage renal disease (ESRD) patients and spouses was investigated from a dyadic perspective. The responses of patients and spouses from five groups of couples--illustrating different points in the progression and treatment of ESRD--were compared both across ESRD groups and between patients and spouses. Despite the fact that the ESRD groups reflected differences in illness/treatment intrusiveness, no significant differences were found between the ESRD groups, or between patients and spouses, in either marital relations or psychological well-being. However, while for all the participants marital role strain was a significant predictor of psychological well-being, the two dialysis groups evidenced significantly greater correlations between marital role strain and psychological distress than the nondialysis groups. These findings are interpreted as being consistent with a general systems theory approach to the conceptualization and treatment of chronic illness.     

Evaluation of the ESRD managed care demonstration operations

Individuals with end stage renal disease (ESRD), most of whom are insured by Medicare, are generally prohibited from enrolling in Medicare managed care plans (MCPs). CMS offered ESRD patients the opportunity to participate in an ESRD managed care demonstration mandated by Congress. The demonstration tested whether managed care systems would be of interest to ESRD patients and whether these approaches would be operationally feasible and efficient for treating ESRD patients. This article examines the structure, implementation, and operational outcomes of the three demonstration sites, focusing on: the structure of these managed care programs for ESRD patients, requirements needed to attract and enroll patients, and the challenges of introducing managed care programs in the ESRD arena.     

The impact of birth weight on the racial disparity of end-stage renal disease

PURPOSE: Blacks have a high rate of end-stage renal disease (ESRD) and low birthweight (LBW) than whites. LBW has been associated with ESRD. The purpose of this study was to assess impact of LBW on the racial difference in ESRD.METHODS: Patients born in SC after 1950 and diagnosed with ESRD between 1991-1996 were identified from the ESRD registry. Birth weight was compared for 858 black and 372 white patients and 2460 controls matched for age, sex, and race. LBW was defined as birthweight <2500 g.RESULTS: Among patients with ESRD, mean birthweight was lower in blacks than whites (3179 vs 3367 g, p < 0.001). LBW was more common in blacks than whites with ESRD (13.9 vs 7.5%, p = 0.02). The risk ratio for LBW among ESRD patients was 1.4 (95% C.I. 1.1 to 1.8) for blacks and 1.5 (95% C.I. 0.9 to 2.5) for whites. The population attributable risk (PAR) for ESRD due to LBW was greater for blacks than whites (33.6 vs 4.2 per 100,000).CONCLUSIONS: Birthweights were lower and LBW was more common among blacks than whites with ESRD. Moreover, LBW contributed more to the PAR of ESRD in blacks than whites. Thus, LBW may contribute to the greater risk for ESRD in African Americans than Caucasians. This preliminary study indicates that further research on the link between LBW and ESRD could be instructive in understanding the racial health disparities.     

Improving the care of ESRD patients: a success story

Medicare's health care quality improvement program (HCQIP) is a national effort to improve beneficiaries' quality of care. The end stage renal disease (ESRD) HCQIP was implemented in 1994 in response to criticism about the poor quality of care received by ESRD patients. Quality improvement efforts initiated by the ESRD Networks and dialysis providers in response to the HCQIP have demonstrated substantial improvement in care for dialysis patients. This article describes the evolution of the ESRD HCQIP and its successful application in the ESRD program.     

The economics of end-stage renal disease care in Canada: incentives and impact on delivery of care

Examining international differences in health outcomes for end-stage renal disease (ESRD) patients requires an understanding of ESRD funding structures. In Canada, funding for all aspects of dialysis and transplant care, with the exception of drugs (for which supplementary insurance can be purchased), is provided for all citizens. Although ESRD programs across Canada’s 10 provinces differ in funding structure, they share important economic characteristics, including being publicly funded and universal, and providing most facets of ESRD care for free. This paper explains how ESRD care fits into the Canadian health care system, describes the epidemiology of ESRD in Canada, and offers economic explanations for international discrepancies.      

Assessment of costs of health insurance, substitution therapy in chronic renal insufficiency]

The authors have studied the cost of the different treatments proposed in ESRD to patients attended by the same nephrologic team. For each patient they have isolated two consecutive periods of treatment, each six months apart. Treatment modifications noted between the two periods allowed the patient to be used as his own control. The results show that the costs are essentially composed of the dialysis sessions, hospitalisations and transport, and that their level and composition differ significantly between the different treatments. They derive a typology composed of three groups of patients, which differ in their treatment, age, duration of ESRD, complications, and total cost of treatment. They conclude that services should be organised in such a way that a range of different treatments can reasonably be provided, according to patient needs.     

A data-driven approach to improving the care of in-center hemodialysis patients

Health care providers, patients, the end stage renal disease (ESRD) networks, and HCFA have developed the ESRD Health Care Quality Improvement Program (HCQIP) in an effort to assess and improve care provided to ESRD patients. Currently, the ESRD HCQIP focuses on collecting information on quality indicators (QIs) for treatment of anemia, delivery of adequate dialysis, nutritional status, and blood pressure control for adult in-center hemodialysis patients. QIs were measured in a national probability sample of ESRD patients, and interventions and evaluations of the interventions are beginning. The ESRD HCQIP illustrates a way to mobilize the strengths of the public and private sectors to achieve improved care for special populations.