Objective To explore the medical insurance quota payment of dialysis treatment for outpatients with end-stage renal disease in Chengdu from following aspects, evaluation indexes and reasonable amount, so as to provide scientific basis for the payment of single disease. Methods A questionnaire survey was conducted to collect the cost information of patients, and to formulate the assignment of evaluation indexes according to the therapeutic principles and statistical results; Delphi method was adopted to determine the assignment and the standard of quota payment. Results A total of 17 dialysis organizations approved by Chengdu municipal medical insurance were involved in this study. Of 700 questionnaires distributed, 686 were retrieved. After excluding 26 questionnaires for incomplete filling and incorrect treatment information, a total of 660 questionnaires were included actually, accounted for 94.28% of all informants. The results of survey showed that, the hemodialysis treatment rate accounted for 84% (555/660) of all informants, while the peritoneal dialysis treatment rate accounted for 16% (105/660). By assessing the project assignment of outpatient dialysis treatment, the minimum annual payment of hemodialysis was RMB 118 242.75 yuan, while that of peritoneal dialysis was RMB 96 498.00 yuan. Conclusion The quota payment of outpatient dialysis shows b evidence after adopting the treatment project assignment. The grading quota payment of outpatient dialysis enables the medical insurance fund to be more reasonably used.
ObjectiveTo investigate the influence of evidence-based nursing intervention on the treatment effect and quality of life in patients with peritoneal dialysis. MethodSixty-four patients who underwent peritoneal dialysis between January 2013 and December 2014 in our hospital were randomly divided into control group (n=32) and intervention group (n=32) . The control group received routine nursing and the intervention group received evidencebased nursing intervention. Urea clearance index (KT/V), serum albumin and hemoglobin levels were detected for both groups of patients before and after nursing intervention. Generic Quality of Life Inventory (GQOLI)-74 scale was used to assess patients' quality of life. ResultsAfter nursing intervention, KT/V, serum albumin and hemoglobin levels in the intervention group were significantly higher than those in the control group (P<0.05) . The scores of such items as physical function, psychological function, social function and overall evaluation in the GQOLI-74 scale in the intervention group were significantly higher than those in the control group (P<0.05) . ConclusionsEvidence-based nursing intervention can effectively improve the treatment effect and quality of life in patients with peritoneal dialysis, which is worthy of clinical popularization and application.
ObjectiveTo explore the safety and efficacy of patients with dialysis-dependent end-stage renal disease who underwent coronary artery bypass grafting (CABG). Methods We retrospectively analyzed the data of 40 dialysis-dependent patients who underwent CABG in Beijing Anzhen Hospital between January 1, 2006 and August 20, 2013. There were 27 male and 13 female patients at mean age of 63.52±9.17 years. Of them, 33 patients underwent off-pump CABG were in the off-pump CABG group, while 7 patients underwent on-pump CABG were in the on-pump CABG group. ResultsThe average number of the grafts is 2.27±0.68. In the off-pump CABG group, 1 patient died from perioperative myocardial infarction with mortality of 3.0%.In the on-pump CABG group, the operative mortality was 28.6%, with 1 death because of serious infection and secondary multi-organ failure 15 days after the operation, and another death because of ventricular fibrillation 4 days after the operation. The follow-up rate was 100.00%. Overall mean follow-up time was 4.3±2.1 years. During the follow-up, the overall survival rate at 1 year, 3 years, and 5 years was 92.68%, 89.43%, and 82.04% respectively. ConclusionCABG can be performed in the patients with dialysis-dependent end-stage renal disease who also suffered with severe coronary artery disease, despite higher mortality. Surgeons should carefully select patients for the operation. Through optimal way of revascularization, and reasonable perioperative therapy, especially more actively use of continues renal replacement therapy, good results could be got in those kinds of patients.
In 2017, the Acute Dialysis Quality Initiative (ADQI) Consensus Group released a series of guidelines on the topic of "Precision Continuous Renal Replacement Therapy (CRRT)". The updated content in this guideline included four parts: patient selection and timing of CRRT, precision CRRT and solute control, precision fluid management in CRRT, and role of technology for the management of AKI in critically ill patients. This review will interpret the 2017 ADQI guidelines update in detail.
Objective To understand the incidence of stigma in non-dialysis chronic kidney disease (CKD) patients, and to explore its influencing factors, so as to provide a basis for scientific management of non-dialysis CKD patients. Methods Convenience sampling method was used to select non-dialysis CKD patients hospitalized in the Department of Nephrology, West China Hospital, Sichuan University between December 2019 and December 2020 as the research subjects. The general information questionnaire, Social Impact Scale and Social Support Rating Scale were used to investigate, and logistic regression analysis was used to explore the influencing factors of stigma in CKD patients without dialysis. Results A total of 300 questionnaires were distributed in this study, and 272 valid questionnaires were recovered, with an effective recovery rate of 90.67%. The age of the patients ranged from 15 to 83 years old, with an average of (38.34±13.64) years old. The disease course ranged from 1 month to 18 years, with a median of 3 years. The patients’ stigma score ranged from 23 to 86 points, with an average score of (40.14±1.67) points, of which 101 patients had a score of ≥48 (with stigma), accounting for 37.13%. Logistic regression analysis showed that gender [odds ratio (OR)=1.871, 95% confidence interval (CI) (1.018, 3.347), P=0.042], place of residence [OR=2.991, 95%CI (1.645, 5.824), P=0.001], personal monthly income [OR=0.575, 95%CI (0.260, 0.857), P=0.013], received CKD self-management education or not [OR=0.468, 95%CI (0.258, 0.843), P=0.011], and social support level [OR=0.418, 95%CI (0.230, 0.737), P=0.003] were influencing factors of stigma in CKD patients without dialysis. Conclusion The stigma of non-dialysis CKD patients is at a moderate level. Female, living in rural areas, personal monthly income ≤ 3000 yuan, not receiving CKD self-management education, and low social support level are risk factors for stigma in non-dialysis CKD patients.