2020年7月
Quality of Care in Chronic Kidney Disease and Incidence of End-stage Renal Disease in Older Patients A Cohort Study
MEDICAL CARE
- 巻
- 58
- 号
- 7
- 開始ページ
- 625
- 終了ページ
- 631
- 記述言語
- 英語
- 掲載種別
- 研究論文(学術雑誌)
- DOI
- 10.1097/MLR.0000000000001301
- 出版者・発行元
- LIPPINCOTT WILLIAMS & WILKINS
Background: The quality of care received by a growing number of older patients with chronic kidney disease (CKD) has not been adequately examined. Objective: The objective of this study was to assess the quality of CKD care among older patients and to clarify its association with the incidence of end-stage renal disease (ESRD). Research Design: This was a population-based cohort study. Subjects: Older (65 y and above) CKD patients diagnosed between October 2010 and September 2014 from the National Database of Health Insurance Claims of Japan. Measures: A composite quality score (QS) of 3 quality measures for CKD care during the 6 months after CKD diagnosis was computed. The validated quality measures included urine testing for proteinuria, nutritional guidance, and nonsteroidal anti-inflammatory drugs avoidance. To assess the association between the QS and ESRD incidence, we used instrumental variable analysis after stratification for the history of diabetes. Results: Among the 890,773 older CKD patients, 2.9% progressed to ESRD (incidence rate of 12.5 per thousand person-years). In total, 59.9% underwent urine testing, 4.5% received nutritional guidance, and 91.2% avoided regular use of nonsteroidal anti-inflammatory drugs. An instrumental variable analysis revealed that a higher QS was associated with-lower ESRD incidence in patients diagnosed with diabetes (hazard ratio: 0.25, 95% confidence interval: 0.24-0.27 for each point higher score) but not in patients without a diagnosis of diabetes (hazard ratio: 0.99, 95% confidence interval: 0.92-1.05). Conclusion: Among older CKD patients, quality of CKD care varied between patients, and better quality of CKD care was associated with a lower ESRD incidence in patients with diabetes but not in nondiabetic patients.
- リンク情報
- ID情報
-
- DOI : 10.1097/MLR.0000000000001301
- ISSN : 0025-7079
- eISSN : 1537-1948
- Web of Science ID : WOS:000542994100008