臺灣博碩士論文加值系統

背景: 台灣的末期腎臟病盛行率居全球之冠已歷數載，而對慢性腎臟病預後依期程別的探討卻不多。本研究最主要的目的為，藉由世代研究，找出慢性腎臟三、四和五期病患進展至末期腎臟病或死亡的相關危險因子。方法: 自2001年12月6日至2011年12月31日止，由台中榮總門診收錄了的共有4702個第三至五期的慢性腎臟病患，摘錄就留紀錄追蹤至2012年7月31日或進入透析或死亡或失聯為止。利用Cox model分析進入末期腎臟病或死亡的危險因子，及利用Kaplan-Meier分析此三期病患累計透析的發生和累計致死率。結果: 根據基本資料，男性占64%，60%為≧65歲以上患者，39%有糖尿病。第三、四、五期的慢性腎臟病患，衍生末期腎臟的發生率分別為1.95%, 10.6%, 46.7%；致死率分別為4.56%, 6.23%, 4.69%。進入透析的風險隨年齡增加而降低，而死亡的風險則反之，越高；糖尿病者的透析及死亡風險都比較高；高血壓或高血脂的死亡風險較低。結論: 在這個世代的研究顯示，病患進入末期腎臟病的危害高於死亡的。年輕慢性腎臟病患者進入末期腎臟病的危險比年長者高，但死亡危險則以年長患者高。糖尿病為末期腎臟病及死亡的危險因子，而高血壓及高血脂為死亡的保護因子。

Background: The prevalence of end-stage renal disease (ESRD) in Taiwan has been the highest in the world for more than a decade since 2001. However, studies on the prognosis of chronic kidney disease (CKD) by stage are limited. This study evaluated the risk factors of ESRD and fatality for patients with stages 3, 4 and 5 of CKD. Methods: A total of 4702 patients with CKD at stages of 3-5 were identified from nephrology clinics at the Taichung Veteran General Hospital from December 6, 2001 to December 31, 2011. Prognosis records of all patients were extracted from the baseline to July 31, 2012, ESRD diagnosed, death or loss to follow-up. We used Cox models to identify risk factors associated with ESRD and deaths by stage and age, and used Kaplan-Meier method to measure the cumulative ESRD incidence and fatality for CKD patients. Results: Our study subjects consisted of 64% of male CKD patients, with 60% of patients over 65 years and 39% having diabetes. The incidence of ESRD in CKD patients at stages 3, 4, 5 were 1.95%, 10.6%, 46.7%, with fatalities of 4.56%, 6.23%, 4.69%, respectively. The elderly were at a lower risk for ESRD, but at higher risk for death, than youngers. Diabetic patients were at higher risks than non-diabetic patients for ESRD and death. Patients with hypertension or hyperlipidemia had a lowered risk for death. Conclusion: The risk of ESRD for patients with CKD increases with advanced stage. But the differences in fatality are not so acute. The elderly CKD patients are less prone to ESRD, but at an elevated risk of death.

誌謝……………………………………………………………………………….. i
中文摘要………………………………………………………………………….. ii
英文摘要………………………………………………………………………….. iii
目錄……………………………………………………………………………….. iv
表目錄…………………………………………………………………………….. v
圖目錄…………………………………………………………………………….. vi
第一章、 緒論 1
第一節、 研究背景與研究動機……………………………………………1
第二節、 研究的重要性……………………………………………………4
第三節、 研究目的…………………………………………………………5
第四節、 研究問題與研究假設……………………………………………6
第五節、 名詞界定………………………………………………………… 7
第二章、 文獻查證…………………………………………. 9
第一節、 末期腎臟病的盛行率與發生率…………………………………9
第二節、 慢性腎臟病的盛行率與發生率…………………………………11
第三節、 慢性腎臟病進展至末腎臟病或死亡的危險因子探討…………13
第四節、 研究架構………………………………………………………… 17
第三章、 研究方法……………………………………………………………...18
第一節、 研究設計…………………………………………………………18
第二節、 研究對象…………………………………………………………19
第三節、 研究工具的擬定…………………………………………………20
第四節、 資料收集過程……………………………………………………21
第五節、 資料統計與分析…………………………………………………23
第四章、 研究結果………………………………………………………… 26
第五章、 討論………………………………………………………………… 32
第六章、 結論與建議…………………………………………………………36
第一節、 結論……………………………………………………………… 36
第二節、 研究限制………………………………………………………… 37
第三節、 應用與建議……………………………………………………… 38
第三章、 參考文獻………………………………………………………………70
附錄……………………………………………………………………………… 75

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