末期腎臟病前期病人照護結果之相關因素探討-以一家區域醫院為例

Abstract

研究背景與目的：台灣的末期腎臟病透析治療發生率與盛行率高於世界各國，台灣全民健康保險辦理「末期腎臟病前期Pre-ESRD (Pre- End Stage Renal Disease)之病人照護與衛教計畫」將近20年，登錄的病患與資料眾多，使用了龐大的醫療人力物力。本研究期望分析台灣北部某區域醫院中的照護計畫資料，找出末期腎臟病前期病患照護結果的相關因子，以利未來做出策略與施行改變，減緩慢性腎臟病的惡化，降低透析治療發生率與盛行率。 研究方法：本研究採用資料庫回溯的研究方法，研究對象為在臺安醫院腎臟科門診就診的病患，疾病診斷為慢性腎臟病，符合「全民健康保險末期腎臟病前期（Pre-ESRD）之病人照護與衛教計畫」的收案條件，腎絲球過濾率(estimated Glomerular filtration rate, eGFR)小於45 mL/min/1.73 m2，經收案後依計畫登錄於「腎臟病整合照護平台」，將其中資料收集統計分析。資料包病患的基本生理與社會經濟狀態、自我照護能力、生理型態等，利用描述性統計、t檢定、卡方檢定與Cox比例風險模型分析統計，整理對進入透析治療、死亡、轉院治療的顯著差異與風險比值，找出影響照護結果的相關因素。 研究結果：研究發現基本生理與社會經濟狀態中年齡為80歲以上、男性，沒有自我照顧能力，以及生理型態中家族病史的糖尿病、致病因子中的高血脂、檢驗檢查值中的收縮壓、血中尿素氮、肌酸酐、腎絲球過濾率與貧血，與本院的照護結果有顯著的相關。 結論： 性別、年齡、自我照顧能力與貧血，是在全民健康保險末期腎臟病前期（Pre-ESRD）之病人照護與衛教計畫中，影響照護結果的相關因素。

Background and Objectives: The incidence and prevalence rates of dialysis treatment for end-stage renal disease (ESRD) in Taiwan are higher than those in other countries. Taiwan's National Health Insurance has been administering the "Pre-ESRD Patient Care and Education Program" for nearly 20 years, with a large number of patients and data registered, utilizing substantial medical resources. This study aims to analyze the data from the care program in a regional hospital in northern Taiwan, identifying the relevant factors affecting care outcomes for pre-ESRD patients. The goal is to develop strategies and implement changes to slow the progression of chronic kidney disease, thereby reducing the incidence and prevalence of dialysis treatment. Methodology: This retrospective study focuses on patients with chronic kidney disease visiting the nephrology outpatient department at Taiwan Adventist Hospital. These patients, with an eGFR below 45 mL/min/1.73 m², were enrolled in the "Pre-ESRD Patient Care and Education Program" and their data were registered on the "Integrated Kidney Disease Care Platform." The analysis included patients' physiological, socioeconomic status, self-care abilities, and other characteristics. Statistical methods such as descriptive analysis, t-tests, chi-square tests, and Cox proportional hazards models were used to identify factors influencing the dialysis treatment, mortality, and transfer to other facilities. Results: The study found significant correlations between the care outcomes and the following factors: age over 80, male gender, lack of self-care ability, family history of diabetes, presence of high cholesterol as a pathogenic factor, and laboratory values such as systolic blood pressure, blood urea nitrogen, creatinine, eGFR, and anemia. These factors were notably associated with the care outcomes at the hospital. Conclusion: Gender, age, self-care ability, and anemia are key factors influencing care outcomes in the Pre-ESRD Patient Care and Education Program under Taiwan's National Health Insurance.