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Том 22 №2 2020 год - Нефрология и диализ

Начало диализа, выбор метода, доступ и программы лечения: итоги конференции KDIGO (Инициатива по улучшению глобальных исходов заболеваний почек) по спорным вопросам


Т. Чан Кристофер Бланкестин Петер Дж. Дембер Лаура М. Галлиени Маурицио Харрис Дэвид Ч.Х. Лок Шармэн Э. Меторта Ражниш Стивенс Пауль Э. Ванг Анжела Й-М. Чонг Майкл Велер Дэвид К. Винкельмаейр Вольфганг К. Поллок Кэрол А.

DOI: 10.28996/2618-9801-2020-2-152-167

Аннотация: Во всем мире растет число пациентов, получающих постоянное поддерживающее лечение диализом, однако существует значительная вариабельность в практических подходах к его началу. Такие факторы, как доступность ресурсов, причины начала диализа, время его начала, обучение и подготовка пациентов, метод диализа и диализный доступ, а также варьирующие в зависимости от страны специфические факторы значительно влияют на восприятие пациентов и на результаты лечения. По всему миру возросло число пациентов с терминальной стадией болезни почек (ТСБП), в связи с этим все более широко признается важность участия пациента в определении целей медицинской помощи и в принятии решений в отношении лечения. В январе 2018 года была созвана конференция KDIGO (Инициатива по улучшению глобальных исходов заболеваний почек), посвященная спорным вопросам, касающимся начала диализа, в том числе выбору метода лечения, доступу и программам лечения. Здесь представлено краткое содержание дискуссий на конференции, в том числе относительно выявленных пробелов в знаниях, спорных вопросов и приоритетов дальнейших исследований. Одной из новейших главных тем, представленных на конференции, стала необходимость отказаться от унифицированного подхода к диализу в пользу более индивидуального подхода, который включает в себя цели и предпочтения пациента, учитывая при этом наилучшую медицинскую практику, ориентированную на качество лечения и безопасность пациента. Определение и включение ориентированных на пациентов целей, которые могут быть приняты как показатели качества в контексте различных систем здравоохранения для достижения относительного равновесия результатов, потребует согласованности целей и побуждений при взаимодействии между пациентами, поставщиками услуг, регуляторными органами и плательщиками. Степень такой согласованности будет варьировать в зависимости от системы здравоохранения конкретной страны.

Для цитирования: Т. Чан Кристофер, Бланкестин Петер Дж., Дембер Лаура М., Галлиени Маурицио, Харрис Дэвид Ч.Х., Лок Шармэн Э., Меторта Ражниш, Стивенс Пауль Э., Ванг Анжела Й-М., Чонг Майкл, Велер Дэвид К., Винкельмаейр Вольфганг К., Поллок Кэрол А. Начало диализа, выбор метода, доступ и программы лечения: итоги конференции KDIGO (Инициатива по улучшению глобальных исходов заболеваний почек) по спорным вопросам. Нефрология и диализ. 2020. 22(2):152-167. doi: 10.28996/2618-9801-2020-2-152-167


Весь текст



Ключевые слова: целенаправленный диализ, гемодиализ, домашний диализ, начало, метод, перитонеальный диализ, программа лечения, контроль симптомов, сосудистый и перитонеальный диализный доступ, goal-directed dialysis, hemodialysis, home dialysis, initiation, modality, peritoneal dialysis, prescription, symptom control, vascular and peritoneal dialysis access

Список литературы:
  1. Thomas B, Wulf S, Bikbov B, et al. Maintenance dialysis throughout the world in years 1990 and 2010. J Am Soc Nephrol. 2015; 26: 2621-2633.
  2. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015; 385:1975- 1982.
  3. Locatelli F, Del Vecchio L, Pozzoni P, et al. Nephrology: main advances in the last 40 years. J Nephrol. 2006; 19:6-11.
  4. Robinson BM, Akizawa T, Jager KJ, et al. Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. Lancet. 2016; 388:294-306.
  5. Foster BJ, Mitsnefes MM, Dahhou M, et al. Changes in excess mortality from end stage renal disease in the United States from 1995 to 2013. Clin J Am Soc Nephrol. 2018;13:91-99.
  6. Hasegawa T, Bragg-Gresham JL, Yamazaki S, et al. Greater first-year survival on hemodialysis in facilities in which patients are provided earlier and more frequent pre-nephrology visits. Clin J Am Soc Nephrol. 2009;4:595-602.
  7. Tennankore KK, Soroka SD, Kiberd BA. The impact of an "acute dialysis start" on the mortality attributed to the use of central venous catheters: a retrospective cohort study. BMC Nephrol. 2012;13:72.
  8. Walker RC, Hanson CS, Palmer SC, et al. Patient and caregiver perspectives on home hemodialysis: a systematic review. Am J Kidney Dis. 2015;65:451-463.
  9. Evangelidis N, Tong A, Manns B, et al. Developing a set of core outcomes for trials in hemodialysis: An international Delphi survey. Am J Kidney Dis. 2017;70:464-475.
  10. Morton RL, Snelling P, Webster AC, et al. Dialysis modality preference of patients with CKD and family caregivers: a discrete-choice study. Am J Kidney Dis. 2012;60:102-111.
  11. Ronco C, Mason G, Nayak Karopadi A, et al. Healthcare systems and chronic kidney disease: putting the patient in control. Nephrol Dial Transplant. 2014;29:958-963.
  12. Dahlerus C, Quinn M, Messersmith E, et al. Patient perspectives on the choice of dialysis modality: results from the Empowering Patients on Choices for Renal Replacement Therapy (EPOCH-RRT) study. Am J Kidney Dis. 2016;68:901-910.
  13. Morton RL, Tong A, Howard K, et al. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ. 2010;340:c112.
  14. Winterbottom AE, Gavaruzzi T, Mooney A, et al. Patient acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) booklet: a prospective non-randomized comparison study across 6 predialysis services. Perit Dial Int. 2016;36:374-381.
  15. Lacson E Jr, Wang W, DeVries C, et al. Effects of a nationwide predialysis educational program on modality choice, vascular access, and patient outcomes. Am J Kidney Dis. 2011;58:235-242.
  16. Manera KE, Tong A, Craig JC, et al. Standardized Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD): study protocol for establishing a core outcome set in PD. Perit Dial Int. 2017;37:639-647.
  17. Finkelstein FO, Finkelstein SH. Time to rethink our approach to patient-reported outcome measures for ESRD. Clin J Am Soc Nephrol. 2017;12: 1885-1888.
  18. Perl J, Dember LM, Bargman JM, et al. The use of a multidimensional measure of dialysis adequacy-Moving beyond small solute kinetics. Clin J Am Soc Nephrol. 2017;12:839-847.
  19. Pike E, Hamidi V, Ringerike T, et al. More use of peritoneal dialysis gives significant savings: A systematic review and health economic decision model. J Clin Med Res. 2017;9:104-116.
  20. van de Luijtgaarden MW, Jager KJ, Stel VS, et al. Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicators. Nephrol Dial Transplant. 2013;28:1264-1275.
  21. Karopadi AN, Mason G, Rettore E, et al. Cost of peritoneal dialysis and haemodialysis across the world. Nephrol Dial Transplant. 2013;28:2553- 2569.
  22. Jaar BG. The Achilles heel of mortality risk by dialysis modality is selection bias. J Am Soc Nephrol. 2011;22:1398-1400.
  23. Piccoli GB, Alrukhaimi M, Liu ZH, et al. Women and kidney disease: reflections on World Kidney Day 2018: kidney health and women’s health: a case for optimizing outcomes for present and future generations. Nephrol Dial Transplant. 2018;33:189-193.
  24. United States Renal Data System. Annual Data Report 2017: End-stage Renal Disease in the United States: Chapter 1: Incidence, Prevalence, Patient Characteristics, and Treatment Modality. Available at: https:// www.usrds.org/2017/download/v2_c01_IncPrev_17.pdf. Accessed February 13, 2018.
  25. Kjaergaard KD, Jensen JD, Peters CD, et al. Preserving residual renal function in dialysis patients: an update on evidence to assist clinical decision making. NDT Plus. 2011;4:225-230.
  26. Mathew AT, Obi Y, Rhee CM, et al. Incremental dialysis for preserving residual kidney function-Does one size fit all when initiating dialysis? Semin Dial. 2018;31:343-352.
  27. Ghaffari A. Urgent-start peritoneal dialysis: a quality improvement report. Am J Kidney Dis. 2012;59:400-408.
  28. Levin A, Stevens PA, Bilous RW, et al. Kidney Disease: Improving Global Outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guidelines for the evaluation and managment of chronic kidney disease. Kidney Int Suppl. 2013;3:1-150.
  29. Goovaerts T, Jadoul M, Goffin E. Influence of a pre-dialysis education programme (PDEP) on the mode of renal replacement therapy. Nephrol Dial Transplant. 2005;20:1842-1847.
  30. See EJ, Johnson DW, Hawley CM, et al. Risk predictors and causes of technique failure within the first year of peritoneal dialysis: an Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) study. Am J Kidney Dis. 2018;72:188-197.
  31. Wong MG, Pollock CA, Cooper BA, et al. Association between GFR estimated by multiple methods at dialysis commencement and patient survival. Clin J Am Soc Nephrol. 2014;9:135-142.
  32. Sood MM, Manns B, Dart A, et al. Variation in the level of eGFR at dialysis initiation across dialysis facilities and geographic regions. Clin J Am Soc Nephrol. 2014;9:1747-1756.
  33. Gilg J, Pruthi R, Fogarty D. UK Renal Registry 17th Annual Report: Chapter 1 UK Renal Replacement Therapy Incidence in 2013: National and Centre-specific Analyses. Nephron. 2015;129(Suppl 1):1-29.
  34. United States Renal Data System. Annual Data Report 2017: Chronic Kidney Disease (CKD) in the United States: Chapter 8: Transition of Care in Chronic Kidney Disease. Available at: https://www.usrds.org/2017/ view/v1_08.aspx. Accessed February 8, 2018.
  35. ANZDATA Registry. 39th Report, Chapter 1: Incidence of End Stage Kidney Disease. Adelaide, Australia: Australia and New Zealand Dialysis and Transplant Registry; 2017. http://www.anzdata.org.au.
  36. National Kidney Foundation. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis. 2015;66:884-930.
  37. Nesrallah GE, Mustafa RA, Clark WF, et al. Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis. CMAJ. 2014;186:112-117.
  38. Watanabe Y, Yamagata K, Nishi S, et al. Japanese society for dialysis therapy clinical guideline for "hemodialysis initiation for maintenance hemodialysis. Ther Apher Dial. 2015;19(Suppl 1):93-107.
  39. Tattersall J, Dekker F, Heimburger O, et al. When to start dialysis: updated guidance following publication of the Initiating Dialysis Early and Late (IDEAL) study. Nephrol Dial Transplant. 2011;26:2082-2086.
  40. Heaf J, Petersons A, Vernere B, et al. Why do physicians prescribe dialysis? A prospective questionnaire study. PLoS One. 2017;12:e0188309.
  41. United States Renal Data System. Annual Data Report 2017: End-stage
  42. Renal Disease in the United States: Chapter 5: Mortality. Available at: https://www.usrds.org/2017/view/v2_05.aspx. Accessed February 8, 2018.
  43. Chan KE, Maddux FW, Tolkoff-Rubin N, et al. Early outcomes among those initiating chronic dialysis in the United States. Clin J Am Soc Nephrol. 2011;6:2642-2649.
  44. Couchoud CG, Beuscart JB, Aldigier JC, et al. Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int. 2015;88:1178-1186.
  45. Bansal N, Katz R, De Boer IH, et al. Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD. Clin J Am Soc Nephrol. 2015;10:363-371.
  46. Ivory SE, Polkinghorne KR, Khandakar Y, et al. Predicting 6-month mortality risk of patients commencing dialysis treatment for end-stage kidney disease. Nephrol Dial Transplant. 2017;32:1558-1565.
  47. Davis JL, Davison SN. Hard choices, better outcomes: a review of shared decision-making and patient decision aids around dialysis initiation and conservative kidney management. Curr Opin Nephrol Hypertens. 2017;26: 205-213.
  48. Sellars M, Clayton JM, Morton RL, et al. An interview sudy of patient and caregiver perspectives on advance care planning in ESRD. Am J Kidney Dis. 2018;71:216-224.
  49. Ladin K, Pandya R, Kannam A, et al. Discussing conservative management with older patients with CKD: An interview study of nephrologists. Am J Kidney Dis. 2018;71:627-635.
  50. van Loon IN, Goto NA, Boereboom FTJ, et al. Frailty screening tools for elderly patients incident to dialysis. Clin J Am Soc Nephrol. 2017;12:1480- 1488.
  51. Silver SA, Bell CM, Chertow GM, et al. Effectiveness of quality improvement strategies for the management of CKD: a meta-analysis. Clin J Am Soc Nephrol. 2017;12:1601-1614.
  52. Ruggenenti P, Perticucci E, Cravedi P, et al. Role of remission clinics in the longitudinal treatment of CKD. J Am Soc Nephrol. 2008;19:1213-1224.
  53. Tangri N, Grams ME, Levey AS, et al. Multinational assessment of accuracy of equations for predicting risk of kidney failure: A meta-analysis. JAMA. 2016;315:164-174.
  54. Chan MR, Oza-Gajera B, Chapla K, et al. Initial vascular access type in patients with a failed renal transplant. Clin J Am Soc Nephrol. 2014;9: 1225-1231.
  55. Woo K, Lok CE. New insights into dialysis vascular access: What is the optimal vascular access type and timing of access creation in CKD and dialysis patients? Clin J Am Soc Nephrol. 2016;11:1487-1494.
  56. Pulliam J, Li NC, Maddux F, et al. First-year outcomes of incident peritoneal dialysis patients in the United States. Am J Kidney Dis. 2014;64:761-769.
  57. Chiarelli G, Beaulieu M, Cozzolino M, et al. Vascular access planning in peritoneal dialysis patients. Perit Dial Int. 2008;28:585-590.
  58. Gallieni M, Giordano A, Ricchiuto A, et al. Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa. J Vasc Access. 2017;18(Suppl 1):41-46.
  59. Winnicki E, McCulloch CE, Mitsnefes MM, et al. Use of the Kidney Failure Risk Equation to determine the risk of progression to end-stage renal disease in children with chronic kidney disease. JAMA Pediatr. 2018;172:174-180.
  60. Cooper BA, Branley P, Bulfone L, et al. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med. 2010;363:609-619.
  61. Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis. 1999;33:235-252.
  62. Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients. Am J Kidney Dis. 1998;31:766-773.
  63. Hladunewich MA, Hou S, Odutayo A, et al. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J Am Soc Nephrol. 2014;25:1103-1109.
  64. Asamiya Y, Otsubo S, Matsuda Y, et al. The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney Int. 2009;75:1217- 1222.
  65. Lopez-Vargas PA, Craig JC, Gallagher MP, et al. Barriers to timely arteriovenous fistula creation: a study of providers and patients. Am J Kidney Dis. 2011;57:873-882.
  66. Donca IZ, Wish JB. Systemic barriers to optimal hemodialysis access. Semin Nephrol. 2012;32:519-529.
  67. Lok CE, Oliver MJ, Su J, et al. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int. 2005;67:2462-2469.
  68. Xi W, MacNab J, Lok CE, et al. Who should be referred for a fistula? A survey of nephrologists. Nephrol Dial Transplant. 2010;25:2644-2651.
  69. Xi W, Harwood L, Diamant MJ, et al. Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making. Nephrol Dial Transplant. 2011;26:3302-3308.
  70. Chaudhry M, Bhola C, Joarder M, et al. Seeing eye to eye: the key to reducing catheter use. J Vasc Access. 2011;12:120-126.
  71. Pisoni RL, Zepel L, Port FK, et al. Trends in US vascular access use, patient preferences, and related practices: An update from the US DOPPS Practice Monitor with international comparisons. Am J Kidney Dis. 2015;65:905-915.
  72. Figueiredo A, Goh BL, Jenkins S, et al. Clinical practice guidelines for peritoneal access. Perit Dial Int. 2010;30:424-429.
  73. Woodrow G, Fan SL, Reid C, et al. Renal Association Clinical Practice Guideline on peritoneal dialysis in adults and children. BMC Nephrol. 2017;18:333.
  74. See EJ, Cho Y, Hawley CM, et al. Early and late patient outcomes in urgent-start peritoneal dialysis. Perit Dial Int. 2017;37:414-419.
  75. Lomonte C, Basile C. Preoperative assessment and planning of haemodialysis vascular access. Clin Kidney J. 2015;8:278-281.
  76. Letachowicz K, Szyber P, Golebiowski T, et al. Vascular access should be tailored to the patient. Semin Vasc Surg. 2016;29:146-152.
  77. Vanholder R, Glorieux G, Eloot S. Once upon a time in dialysis: the last days of Kt/V? Kidney Int. 2015;88:460-465.
  78. Schroeder EB, Yang X, Thorp ML, et al. Predicting 5-year risk of RRT in stage 3 or 4 CKD: development and external validation. Clin J Am Soc Nephrol. 2017;12:87-94.

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