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【文摘发布】老年CKD患者多学科治疗和生存率之
Association between Multidisciplinary Care and Survival for Elderly Patients with Chronic Kidney Disease
Brenda R. Hemmelgarn*,, Braden J. Manns*,,, Jianguo Zhang*, Marcello Tonelli,, Scott Klarenbach,, Michael Walsh*, Bruce F. Culleton* for the Alberta Kidney Disease Network
departments of * Medicine and Community Health Sciences, University of Calgary, Calgary, and Institute of Health Economics and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
The effectiveness of multidisciplinary care (MDC) in improving health outcomes for patients with chronic kidney disease (CKD) is uncertain. This study sought to determine the association among MDC, survival, and risk for hospitalization among elderly outpatients with CKD. A total of 6978 patients who were 66 yr and older and had CKD were identified between July 1 and December 31, 2001, and followed to December 31, 2004; 187 (2.7%) were followed in an MDC clinic. Logistic regression was used to determine the propensity score (probability of MDC) for each patient, and MDC and non-MDC patients then were matched 1:1 on the basis of their score. A Cox model was used to determine the association between MDC and risk for death and hospitalization. After adjustment for age, gender, baseline GFR, diabetes, and comorbidity score, there was a 50% reduction in the risk for death for the MDC compared with the non-MDC group (hazard ratio [HR] 0.50; 95% confidence interval [CI] 0.35 to 0.71). There was no difference in the risk for all-cause (HR 0.83; 95% CI 0.64 to 1.06) or cardiovascular-specific hospitalization (HR 0.76; 95% CI 0.54 to 1.06) for the MDC compared with the non-MDC group. In conclusion, it was found that MDC was associated with a significant reduction in the risk for all-cause mortality and, although not statistically significant, a trend toward a reduction in risk for all-cause and cardiovascular-specific hospitalizations. The benefits of MDC and an assessment of their economic impact should be tested in a randomized, controlled trial. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 版主对不起，宝马同志被通知明日上班24小时，无法高质完成翻译，请见谅。请其它战友认领。 自产自销了。
Association between Multidisciplinary Care and Survival for Elderly Patients with Chronic Kidney Disease
老年CKD患者多学科治疗和生存率之间的相关性
Brenda R. Hemmelgarn*,, Braden J. Manns*,,, Jianguo Zhang*, Marcello Tonelli,, Scott Klarenbach,, Michael Walsh*, Bruce F. Culleton* for the Alberta Kidney Disease Network
departments of * Medicine and Community Health Sciences, University of Calgary, Calgary, and Institute of Health Economics and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
The effectiveness of multidisciplinary care (MDC) in improving health outcomes for patients with chronic kidney disease (CKD) is uncertain.
多学科治疗（MDC）在改善CKD患者健康预后的有效性尚不肯定。
This study sought to determine the association among MDC, survival, and risk for hospitalization among elderly outpatients with CKD.
该研究试图确定老年CKD患者MDC、生存率和需住院治疗风险率之间的相关性。
A total of 6978 patients who were 66 yr and older and had CKD were identified between July 1 and December 31, 2001, and followed to December 31, 2004; 187 (2.7%) were followed in an MDC clinic.
从2001年7月1日到12月31日选取6978例66岁以上老年CKD患者，并随访至2004年12月31日。其中187例（2.7%）在一家多学科诊所随访。
Logistic regression was used to determine the propensity score (probability of MDC) for each patient, and MDC and non-MDC patients then were matched 1:1 on the basis of their score.
使用逻辑回归方法确定每例患者的趋势积分（多学科治疗的概率），然后将MDC和非MDC患者按照其积分以1:1的比例进行配对。
A Cox model was used to determine the association between MDC and risk for death and hospitalization.
利用Cox模型确定MDC和死亡以及需住院治疗风险之间的相关性。
After adjustment for age, gender, baseline GFR, diabetes, and comorbidity score, there was a 50% reduction in the risk for death for the MDC compared with the non-MDC group (hazard ratio [HR] 0.50; 95% confidence interval [CI] 0.35 to 0.71).
对年龄、性别、基线肾小球滤过率、糖尿病和共病积分进行校正后，MDC患者与非MDC患者相比死亡风险下降50%（风险比HR 0.50, 95%可信区间CI 0.35~ 0.71）。
There was no difference in the risk for all-cause (HR 0.83; 95% CI 0.64 to 1.06) or cardiovascular-specific hospitalization (HR 0.76; 95% CI 0.54 to 1.06) for the MDC compared with the non-MDC group.
两组之间在全因或因心血管疾病住院治疗风险方面没有差异（两者风险比和95%可信区间分别为HR 0.83， CI 0.64 ~ 1.06；HR 0.76; CI 0.54 ~1.06）。
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作者:admin@医学,生命科学 2011-03-01 05:11
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