初级保健医生与肾病专家合作与5期慢性肾脏病患者临床结局之间的关联：一项JOINT-KD队列研究

Association between primary care physician-nephrologist collaboration and clinical outcomes in patients with stage 5 chronic kidney disease: a JOINT-KD cohort study.

作者信息

Murakami Minoru, Aoki Takuya, Sugiyama Yoshifumi, Sasaki Sho, Nishiwaki Hiroki, Yazawa Masahiko, Raita Yoshihiko, Kawarazaki Hiroo, Shimizu Hideaki, Nakamura Yoshihiro, Saka Yosuke, Matsushima Masato

机构信息

Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan.

Department of Nephrology, Saku Central Hospital, 197 Usuda, Saku-shi, Nagano, 384-0301, Japan.

出版信息

J Nephrol. 2025 May 8. doi: 10.1007/s40620-025-02299-1.

DOI:10.1007/s40620-025-02299-1

PMID:40338420

Abstract

BACKGROUND

Primary care physician-nephrologist collaboration plays an important role in the management of chronic kidney disease (CKD). However, the benefits of such collaboration in patients with stage 5 CKD remain unclear.

METHODS

We conducted a retrospective cohort study of adult outpatients with stage 5 CKD across nine nephrology centers in Japan. The exposure of interest was primary care physician-nephrologist collaboration. We examined the association between primary care physician-nephrologist collaboration and clinical outcomes in adult outpatients with stage 5 CKD: dialysis initiation and cause-specific hospitalizations using the Fine-Gray models, which treat death and preemptive kidney transplantation and death and kidney replacement therapy as competing risk events, respectively.

RESULTS

Of the 570 patients included in the analysis, 91 (16.0%) received primary care physician-nephrologist collaboration, whereas the remaining patients were treated by nephrologists alone. During a median follow-up of 1.4 years, 399 (70.0%) patients started dialysis, 11 (1.9%) received preemptive kidney transplantation, and 53 (9.3%) died. There were no significant between-group differences in dialysis initiation and CKD- and cardiovascular-related hospitalizations (adjusted subdistribution hazard ratio [SHR] [95% confidence interval], 0.89 [0.64-1.23], 1.22 [0.78-1.90], and 0.95 [0.46-1.98], respectively). However, primary care physician-nephrologist collaboration was associated with a lower risk of infection-related hospitalization (adjusted SHR [95% confidence interval], 0.36 [0.15-0.87]).

CONCLUSIONS

Our findings suggest that primary care physician-nephrologist collaboration in the management of stage 5 CKD is not associated with delayed dialysis initiation but is associated with a lower risk of infection-related hospitalization, indicating the potential benefits of primary care physician-nephrologist collaboration in stage 5 CKD.

摘要

背景

基层医疗医生与肾病专家的合作在慢性肾脏病（CKD）管理中发挥着重要作用。然而，这种合作对5期CKD患者的益处仍不明确。

方法

我们对日本9个肾病中心的成年5期CKD门诊患者进行了一项回顾性队列研究。感兴趣的暴露因素是基层医疗医生与肾病专家的合作。我们使用Fine-Gray模型研究了基层医疗医生与肾病专家的合作与成年5期CKD门诊患者临床结局之间的关联：透析开始和特定病因住院，该模型分别将死亡与抢先肾移植以及死亡与肾脏替代治疗视为竞争风险事件。

结果

纳入分析的570例患者中，91例（16.0%）接受了基层医疗医生与肾病专家的合作，其余患者仅由肾病专家治疗。在中位随访1.4年期间，399例（70.0%）患者开始透析，11例（1.9%）接受了抢先肾移植，53例（9.3%）死亡。透析开始以及CKD和心血管相关住院方面，组间无显著差异（调整后的亚分布风险比[SHR][95%置信区间]分别为0.89[0.64 - 1.23]、1.22[0.78 - 1.90]和0.95[0.46 - 1.98]）。然而，基层医疗医生与肾病专家的合作与感染相关住院风险较低相关（调整后的SHR[95%置信区间]，0.36[0.15 - 0.87]）。