腎代替療法選択時の多職種介入がrrt導入後の生命予後に及ぼす影響

Abstract

Keywords： multidisciplinary team care, pre dialysis education, renal replacement therapy, shared decision making 〈Abstract〉 ［Background］ To determine the association between multidisciplinary intervention in the renal replacement therapy (RRT) selection phase and life expectancy after the initiation of RRT. ［Methods］ A total of 365 patients who started RRT between April 1, 2011 and March 31, 2021 were divided into two groups based on the presence or absence of multidisciplinary intervention. ［Results］ The median observation period for eligible patients was 1,147 (514 1,933) days, median age at the time of RRT introduction was 65 (55 73) years, and median eGFR was 6.55 (7 13) mL/min/1.73m 2 . The PD selection rate was higher in the multidisciplinary than nonmultidisciplinary intervention group. Emergency dialysis was more frequent in the nonmultidisciplinary than multidisciplinary intervention group. Eighty seven patients died during the observation period, and the survival rate was significantly higher in the multidisciplinary intervention group (log rank test, p＜0.05). Based on Cox proportional hazards analysis, the risk of death was reduced with multidisciplinary intervention (HR： 0.52, 95％CI ： 0.30 0.88, p＜ 0.05). ［Conclusion］ Multidisciplinary intervention during the RRT selection phase may improve the prognosis after RRT initiation.