5-13
Comparisons of the Results of Integrated CKD Care Program from a Single
CKD Health Promotion Hospital to the National CKD Prevention Project
Shih-Ming Hsiao, Shu-Li Wang, Jer-Ming Chang, Shang-Jyh Hwang, Hung-Chun
Chen
Kaohsiung Medical University Hospital and Faculty of Renal Care, Kaohsiung
Medical University, Kaohsiung, Taiwan.
Background: The incidence and prevalence of
ESRD in Taiwan ranked at the first and second places globally since year
of 2002. To provide better care of the pre-ESRD patients and to slow the
progression of ESRD, Bureau of Health Promotion, Department of Health,
and Taiwan Society of Nephrology (TSN) cooperated to set up Organizations
of CKD Health Promotion since 2003. Kaohsiung Medical University Hospital
(KMUH) was one of the pioneer organizations with full experience. The
aim of this study is to compare the results of CKD integrated care program
in KMUH to the national data.
Method:
From 2005 to 2006, there were 12,051 recruited patients reported to TSN
from 17 organizations that were qualified and granted by the CKD Preventive
Project. Among them, 1,692 cases reached ESRD and entered renal replacement
therapy. At KMUH, the numbers of cases were 1394 and 218, respectively.
The effectiveness of care program on the adequate preparation for renal
replacement therapy was evaluated by indicators as: 1) percentage of patients
choosing CAPD, 2) percentage of hematocrit above 27%, 3) percentage of
EPO used, 4) percentage of HD patients with arteriovenous shunt created
before first HD, 5) percentage of HD patients receiving first HD without
hospitalization. Chi-square test for comparisons between groups with p
value less than 0.05 was considered as significant.
Results:
The data reported to TSN showed 24.7% patients chose CAPD in contrast
to 12.3% in KMUH (p<0.001). Percentage of patients with hematocrit
over 27% at initiation of dialysis were 51.7% at KMUH and 47.9% in TSN
data (p=0.27). The percentage of patients treated with EPO was 81.3% in
KMUH, higher than the 70.8% in TSN data (p=0.001). Among HD patients,
the percentage of patients using arteriovenous shunt for the first HD
was 63.4% in KMUH compared with that of 55.5% in TSN data (p=0.05), and
the percentage of patients initiation of HD through outpatient service
was 41.9% in KMUH, which was significantly higher than that of 26.4% in
TSN data (p<0.001).
Conclusion: The integrated CKD care program
for the pre-ESRD patients in KMUH has better results than the national
data, except a lower penetration rate of PD. It can not only act as benchmark
hospital but also providing the valuable experience for promotion on CKD
prevention in Taiwan.
Corresponding author: Prof. Hung-Chun Chen
Address: Department of Nephrology, Kaohsiung Medical University, 100 Tzyou
First Road, Kaohsiung, Taiwan.
E mail: chenhc@kmu.edu.tw
Fax: +886-7-3228721
Travel grant required for: Shih-Ming Hsiao & Jer-Ming Chang
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