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首页> 外文期刊>Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association >Starting and withdrawing haemodialysis--associations between nephrologists' opinions, patient characteristics and practice patterns (data from the Dialysis Outcomes and Practice Patterns Study).
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Starting and withdrawing haemodialysis--associations between nephrologists' opinions, patient characteristics and practice patterns (data from the Dialysis Outcomes and Practice Patterns Study).

机译：开始和退出血液透析-肾脏科医生的意见，患者特征和实践模式之间的关联（来自透析结果和实践模式研究的数据）。

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摘要

BACKGROUND: The incidence and prevalence of haemodialysis vary widely across countries. The variation may be attributable to differences in the incidence of end-stage renal disease and/or in the availability of haemodialysis. Previous studies have identified differences in nephrologists' opinions about the availability of haemodialysis and its appropriateness for patients with comorbidities. We studied the associations between nephrologists' opinions, availability of haemodialysis, patient characteristics and comorbidities, and facilities' withdrawal rates. METHODS: Most of our analyses used data from 242 haemodialysis units in six countries (France, Germany, Italy, Spain, UK and the USA) in the first phase of the Dialysis Outcomes and Practice Patterns Study (DOPPS I). Opinions about access to and practice patterns in dialysis facilities, measured by the level of agreement with standardized statements, were collected from medical directors and nurse managers. A sub-analysis considered data from corresponding facilities in DOPPS II. RESULTS: We found wide variations in the prevalence of waiting lists for new dialysis patients (UK 60%; USA 25%; Germany 0%; P < 0.05), in agreement with starting haemodialysis for patients with advanced age, dementia and comorbidities (UK, France < USA < other countries; P < 0.05), and in agreement with withdrawing dialysis (other countries < UK/USA; P < 0.05). The estimated glomerular filtration rate at the start of dialysis was not significantly different in units with waiting lists. Significant associations were found between nephrologists' opinions and the odds of patients being > or =80 years old, and between opinions and the rate and relative risk of withdrawal of haemodialysis. No significant associations were found between opinions and patients' comorbidities or dependency. CONCLUSION: Differences within and across countries in nephrologists' opinions regarding starting and withdrawing haemodialysis reflect differences in access to haemodialysis and the practice of withdrawal of haemodialysis in their facilities.
机译：背景：各国之间血液透析的发生率和流行率差异很大。差异可能归因于终末期肾脏疾病的发生率和/或血液透析的可用性。先前的研究已经确定了肾脏科医生对血液透析的有效性及其对合并症患者的适用性的意见分歧。我们研究了肾脏科医生的意见，血液透析的可用性，患者特征和合并症以及设施的退出率之间的关联。方法：在透析结果和实践模式研究（DOPPS I）的第一阶段中，我们的大多数分析使用了来自六个国家（法国，德国，意大利，西班牙，英国和美国）的242个血液透析单位的数据。从医务主任和护士经理那里收集有关透析设施使用和执业方式的意见，这些意见是通过与标准声明达成的协议水平来衡量的。子分析考虑了DOPPS II中相应设施的数据。结果：我们发现新透析患者的等待名单患病率存在​​很大差异（英国为60％;美国为25％;德国为0％; P <0.05），与高龄，痴呆和合并症患者（英国）开始血液透析的结果一致，法国<美国<其他国家; P <0.05），并同意退出透析（其他国家<英国/美国; P <0.05）。透析开始时估计的肾小球滤过率在有等待名单的单位中无显着差异。肾病医生的意见与≥80岁患者的几率之间以及意见与撤回血液透析的发生率和相对风险之间存在显着关联。在意见与患者合并症或依赖性之间未发现显着关联。结论：在肾脏病专家关于开始和撤回血液透析的国家内部和国家之间的差异反映了血液透析的获取途径和在其设施中撤回血液透析的做法的差异。

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