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研究生:王詩婷
研究生(外文):Shih-Ting Wang
論文名稱:腎臟移植失敗透析病患與一般透析病患之存活及其相關因素
論文名稱(外文):Differences in Survival and Related Factors between Renal Transplantation Failure and Never Renal Transplantation among ESRD Patients.
指導教授:蔡文正蔡文正引用關係
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:醫務管理學系碩士班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:77
中文關鍵詞:腹膜透析血液透析透析腎臟移植存活分析
外文關鍵詞:Peritoneal DialysisHemodialysisDialysisRenal TransplantationSurvival Analysis
相關次數:
  • 被引用被引用:1
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  • 下載下載:4
  • 收藏至我的研究室書目清單書目收藏:1
背景:台灣2011年透析病人數為62,963人,腎臟移植為末期腎臟病患最佳治療方式,於1997-2009年屍體腎臟移植案例數僅1,883人,過去文獻多為探討腎臟移植之存活率,缺乏針對未移植透析病患與移植失敗透析病患來探討其腎臟移植失敗是否會影響其存活時間與相對風險。
目的:本研究欲探討腎臟移植失敗透析病患與無腎臟移植透析病患之存活比較及相對風險。
方法:研究對象為台灣全民健康保險研究資料庫1997-2009年間新發生透析病患100,665位,為了避免選擇性誤差,估算其腎臟移植之機率,並利用傾向分數以1:5比例配對,取得腹膜透析者840人、血液透析者2,760人,研究對象共3,600人。分析透析患者至2009年是否存活,以Cox對比涉險模式分析有移植失敗與無移植病患其存活相對風險與影響因素,並繪製存活曲線。
結果:以血液透析而言,移植失敗後繼續透析病患之死亡風險為無移植病患的0.7倍(95% CI: 0.56-0.87);而腹膜透析移植失敗繼續透析病患之死亡風險為無移植病患的0.4倍(95% CI: 0.18-0.51)。就血液透析病患而言,男性死亡風險較女性高,且年紀越大、投保金額相對較低及有其他共病症者(充血性心臟病衰竭、糖尿病、腫瘤、慢性肝炎及腦血管疾病)其死亡風險越高,不同於其他共病症有高血壓之透析病患存活情形較佳。在主要透析醫院中固定至區域醫院、地區醫院以及基層診所透析者之死亡風險較不固定就醫者低;以腹膜透析病患來說,男性死亡風險較女性高,年齡越長其死亡風險較高,且固定至區域醫院與基層診所就醫者較不固定就醫者存活情形較佳。
結論:腎臟移植失敗繼續透析並不會增加病人死亡之風險。因此,政府與醫療院所應加強推廣台灣捐腎之風氣,增加移植率。


Background: In Taiwan, 62,963 patients received dialysis treatment in 2011. Even though the renal transplant is the optima treatment for patients with end-stage renal disease (ESRD), only 1,833 cases had renal transplantation from 1997 to 2009. However, since previous study focused on the survival rate of renal transplantation, there were fewer studies examining the differences in survival and related factors between failure of renal transplantation and never renal transplantation among ESRD patients.
Objectives: This research used the matching method based on propensity of transplantation to compare the survival of ESRD patients between failure of renal transplantation and never renal transplantation among ESRD patients, and to find related factors that influenced patients’ survival.
Method: The study population was 100,665 dialysis patients from 1997 to 2009 in Taiwan. Matching based on propensity of transplantation was used and the matching ratio was 1 to 5. This study included 840 peritoneal dialysis patients (PD) and 2,760 patients with hemodialysis (HD) after matching. These 3,600 patients were observed until 2009 to examine their survival status. Cox proportional hazards model was applied to find the relative risks of death.
Results: HD patients returning to dialysis after transplant failure had lower death risk than HD patients without transplantation (HR= 0.70; 95% CI: 0.56-0.87). In addition, the death risk of PD patients returning to dialysis after transplant failure was 0.4 times (95% CI: 0.18.0.51) than PD patients without transplantation. For HD patients, male had higher death risk than that of female. People with older age, lower premium-based salary, or suffering from co-morbidity, such as congestive heart failure, diabetes, cancer, chronic hepatitis and cerebral vascular disease have higher death risk. However, the death risk of HD patients suffering from hypertension was lower than those without hypertension. Patients were dialyzed in regional hospitals, district hospitals or clinics had lower death rate than those were dialyzed in irregular hospitals. In terms of PD patients, male or older patients had higher death risk. In addition, people were dialyzed in regional hospitals or clinics also had lower death risk than who were dialyzed in irregular hospitals.
Conclusions: The risk of death of patients returning to dialysis after transplant failure was not increased. Therefore, government and hospitals should promote kidney donation for increasing the renal transplant rate.


目錄
摘要 I
Abstract III
致謝 V
目錄 VI
表目錄 VIII
圖目錄 IX
第一章 緒論 1
一、研究背景與動機 1
二、研究目的 2
第二章 文獻探討 3
一、慢性腎臟病定義、分期 3
二、末期腎衰竭病患之替代療法 5
三、國內外腎臟移植之流行病學與存活率 7
四、影響透析病患存活之相關因素 13
五、文獻小結 16
第三章 研究方法 17
一、研究架構 17
二、研究假設 17
三、研究對象 19
四、資料來源 22
五、研究變項與操作型定義 23
六、統計分析方法 26
第四章 結果 28
一、透析病患等待移植時間 28
二、配對後透析病患之特性 29
三、透析病患腎臟移植失敗與無腎臟移植存活之雙變項分析 30
四、影響透析病患存活之相對風險因素 31
第五章 討論 34
一、探討腎臟移植失敗對透析病患之存活情形 34
二、影響腎臟移植失敗與未移植透析病患之存活相關因素 36
第六章 結論與建議 38
一、結論 38
二、建議 39
三、研究限制 40
參考文獻 68
附錄一、透析病患共病症編碼 73
附錄二、都市化程度分級表7級 74


表目錄
表2-1-1 慢性腎臟病分期 4
表2-1-2 ESRD與PRE-ESRD之國內外定義比較 4
表2-3-1 美國與台灣腎臟移植人數與移植率 8
表3-4-1 本研究變項之操作型定義 24
表3-6-1 腎臟移植手術後死亡人數 27
表4-1-1 移植病患從第一次透析日至移植日期所經歷時間 28
表4-2-1 腎臟移植失敗與無腎臟移植之血液透析病患PSM前後雙變項分析 41
表4-2-2 腎臟移植失敗與無腎臟移植之腹膜透析病患PSM前後雙變項分析 44
表4-2-3 配對後病患第一次透析時間分布 47
表4-3-1 血液透析病患各變項與存活與否之雙變項分析 48
表4-3-2 腹膜透析病患各變項與存活與否之雙變項分析 51
表4-4-1 血液透析病患是否存活之相關因素(排除30天內死亡) 54
表4-4-2 腹膜透析病患是否存活之相關因素(排除30天內死亡) 57
表4-4-3 血液透析病患是否存活之相關因素(排除90天內死亡) 60
表4-4-4 腹膜透析病患是否存活之相關因素(排除90天內死亡) 63


圖目錄
圖2-3-1 1998-2007年台灣境內外腎臟移植人數 9
圖2-3-2 美國與台灣腎臟移植病人存活率 11
圖2-3-3 美國與台灣腎臟移植器官存活率 12
圖3-1-1 研究架構 18
圖3-3-1 對象擷取流程圖 21
圖4-4-1 血液透析病患腎臟移植失敗繼續透析與未移植之存活曲線 66
圖4-4-2 腹膜透析病患腎臟移植失敗繼續透析與未移植之存活曲線 67


Chaudhary, K., & Khanna, R. (2008). Renal replacement therapy in end-stage renal disease patients with chronic liver disease and ascites: role of peritoneal dialysis. Perit Dial Int, 28(2), 113-117.
Dacey, L. J., Liu, J. Y., Braxton, J. H., Weintraub, R. M., DeSimone, J., Charlesworth, D. C., . . . O’Connor, G. T. (2002). Long-term survival of dialysis patients after coronary bypass grafting. The Annals of Thoracic Surgery, 74(2), 458-463. doi: 10.1016/s0003-4975(02)03768-2
Devereaux, P. J., Schunemann, H. J., Ravindran, N., Bhandari, M., Garg, A. X., Choi, P. T., . . . Guyatt, G. H. (2002). Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis. JAMA, 288(19), 2449-2457.
Duong, U., Mehrotra, R., Molnar, M. Z., Noori, N., Kovesdy, C. P., Nissenson, A. R., & Kalantar-Zadeh, K. (2011). Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus. Clin J Am Soc Nephrol, 6(5), 1041-1048. doi: 10.2215/cjn.08921010
Ferrari, P., Lim, W., Dent, H., & McDonald, S. P. (2011). Effect of donor-recipient age difference on graft function and survival in live-donor kidney transplantation. Nephrol Dial Transplant, 26(2), 702-708. doi: 10.1093/ndt/gfq383
Frei, U., Noeldeke, J., Machold-Fabrizii, V., Arbogast, H., Margreiter, R., Fricke, L., . . . Bernasconi, C. (2008). Prospective Age-Matching in Elderly Kidney Transplant Recipients—A 5-Year Analysis of the Eurotransplant Senior Program. American Journal of Transplantation, 8(1), 50-57. doi: 10.1111/j.1600-6143.2007.02014.x
Goldfarb-Rumyantzev, A. S., Koford, J. K., Baird, B. C., Chelamcharla, M., Habib, A. N., Wang, B.-J., . . . Isaacs, R. B. (2006). Role of Socioeconomic Status in Kidney Transplant Outcome. Clinical Journal of the American Society of Nephrology, 1(2), 313-322. doi: 10.2215/cjn.00630805
Guo, H., Liu, J., Collins, A. J., & Foley, R. N. (2008). Pneumonia in incident dialysis patients--the United States Renal Data System. Nephrol Dial Transplant, 23(2), 680-686. doi: 10.1093/ndt/gfm474
Hennekens, C. H. (2000). Clinical and research challenges in risk factors for cardiovascular diseases. Eur Heart J, 21(23), 1917-1921. doi: 10.1053/euhj.1999.2221
Herzog, C. A., Mangrum, J. M., & Passman, R. (2008). NON-CORONARY HEART DISEASE IN DIALYSIS PATIENTS: Sudden Cardiac Death and Dialysis Patients. Semin Dial, 21(4), 300-307. doi: 10.1111/j.1525-139X.2008.00455.x
Hsu, C. C., Lee, C. H., Hwang, S. J., Huang, S. W., Yang, W. C., Chang, Y. K., . . . Kuo, K. N. (2011). Outcomes of overseas kidney transplantation in chronic haemodialysis patients in Taiwan. [Comparative Study]. Nephrology (Carlton), 16(3), 341-348. doi: 10.1111/j.1440-1797.2010.01426.x
Hwang, S. J., Tsai, J. C., & Chen, H. C. (2010). Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. [Review]. Nephrology, 15, 3-9. doi: 10.1111/j.1440-1797.2010.01304.x
Hwang, S. J., Yang, W. C., Lin, M. Y., Mau, L. W., & Chen, H. C. (2010). Impact of the clinical conditions at dialysis initiation on mortality in incident haemodialysis patients: a national cohort study in Taiwan. Nephrol Dial Transplant, 25(8), 2616-2624. doi: 10.1093/ndt/gfq308
Just, P. M., Riella, M. C., Tschosik, E. A., Noe, L. L., Bhattacharyya, S. K., & de Charro, F. (2008). Reimbursement and economic factors influencing dialysis modality choice around the world. Nephrol Dial Transplant, 23(7), 2365-2373. doi: 10.1093/ndt/gfm939
Kalantar-Zadeh, K., Block, G., Humphreys, M. H., & Kopple, J. D. (2003). Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int, 63(3), 793-808.
Kalantar-Zadeh, K., Kuwae, N., Regidor, D. L., Kovesdy, C. P., Kilpatrick, R. D., Shinaberger, C. S., . . . Kopple, J. D. (2006). Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int, 70(4), 771-780.
Kaplan, B., & Meier-Kriesche, H.-U. (2002). Death After Graft Loss: An Important Late Study Endpoint in Kidney Transplantation. American Journal of Transplantation, 2(10), 970-974. doi: 10.1034/j.1600-6143.2002.21015.x
Klassen, A. C., & Klassen, D. K. (1996). Who Are the Donors in Organ Donation? The Family''s Perspective in Mandated Choice. Annals of Internal Medicine, 125(1), 70-73. doi: 10.1059/0003-4819-125-1-199607010-00011
Lassalle, M., Labeeuw, M., Frimat, L., Villar, E., Joyeux, V., Couchoud, C., & Stengel, B. (2010). Age and comorbidity may explain the paradoxical association of an early dialysis start with poor survival. Kidney Int, 77(8), 700-707. doi: 10.1038/ki.2010.14
Mailloux, L. U., Bellucci, A. G., Mossey, R. T., Napolitano, B., Moore, T., Wilkes, B. M., & Bluestone, P. A. (1988). Predictors of survival in patients undergoing dialysis. The American Journal of Medicine, 84(5), 855-862. doi: 10.1016/0002-9343(88)90063-0
Mandayam, S., & Shahinian, V. B. (2008). Are chronic dialysis patients at increased risk for cancer? J Nephrol, 21(2), 166-174.
McDonald, S. P., Marshall, M. R., Johnson, D. W., & Polkinghorne, K. R. (2009). Relationship between dialysis modality and mortality. J Am Soc Nephrol, 20(1), 155-163. doi: 10.1681/asn.2007111188
O''Hare, A. M., Johansen, K. L., & Rodriguez, R. A. (2006). Dialysis and kidney transplantation among patients living in rural areas of the United States. Kidney Int, 69(2), 343-349.
OPTN. (2012). National Data Retrieved 6/4, 2012, from http://optn.transplant.hrsa.gov/latestData/step2.asp
Ponticelli, C., Villa, M., Cesana, B., Montagnino, G., & Tarantino, A. (2002). Risk factors for late kidney allograft failure. Kidney Int, 62(5), 1848-1854.
Salahudeen, A. K. (2003). Obesity and survival on dialysis. American Journal of Kidney Diseases, 41(5), 925-932. doi: 10.1016/s0272-6386(03)00189-6
Scialla, J. J., Plantinga, L. C., Kao, W. H. L., Jaar, B., Powe, N. R., & Parekh, R. S. (2011). Soluble P-Selectin Levels Are Associated with Cardiovascular Mortality and Sudden Cardiac Death in Male Dialysis Patients. American Journal of Nephrology, 33(3), 224-230.
Singh, T. P., Gauvreau, K., Bastardi, H. J., Blume, E. D., & Mayer, J. E. (2009). Socioeconomic Position and Graft Failure in Pediatric Heart Transplant Recipients / CLINICAL PERSPECTIVE. Circulation: Heart Failure, 2(3), 160-165. doi: 10.1161/circheartfailure.108.800755
Sozio, S. M., Armstrong, P. A., Coresh, J., Jaar, B. G., Fink, N. E., Plantinga, L. C., . . . Parekh, R. S. (2009). Cerebrovascular Disease Incidence, Characteristics, and Outcomes in Patients Initiating Dialysis: The Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. American Journal of Kidney Diseases, 54(3), 468-477. doi: 10.1053/j.ajkd.2009.01.261
Stehman-Breen, C. O., Emerson, S., Gretch, D., & Johnson, R. J. (1998). Risk of death among chronic dialysis patients infected with hepatitis C virus. American Journal of Kidney Diseases, 32(4), 629-634. doi: 10.1016/s0272-6386(98)70027-7
Stewart, J. H., Vajdic, C. M., van Leeuwen, M. T., Amin, J., Webster, A. C., Chapman, J. R., . . . McCredie, M. R. (2009). The pattern of excess cancer in dialysis and transplantation. Nephrol Dial Transplant, 24(10), 3225-3231. doi: 10.1093/ndt/gfp331
Stivelman, J. C., Soucie, J. M., Hall, E. S., & Macon, E. J. (1995). Dialysis survival in a large inner-city facility: a comparison to national rates. J Am Soc Nephrol, 6(4), 1256-1261.
Terasaki, P, I., Gjertson, D, W., Cecka, J, M., . . . Yong Won Cho, G. (1997). Significance of the donor age effect on kidney transplants (Vol. 11). Hoboken, NJ, ETATS-UNIS: Wiley.
USRDS. (2012). 2011 Atlas of ESRD-International Comparisons Retrieved 6/5, 2012, from http://www.usrds.org/atlas.htm
Vollmer, W. M., Wahl, P. W., & Blagg, C. R. (1983). Survival with Dialysis and Transplantation in Patients with End-Stage Renal Disease. New England Journal of Medicine, 308(26), 1553-1558. doi:10.1056/NEJM198306303082602
Watnick, S., Kirwin, P., Mahnensmith, R., & Concato, J. (2003). The prevalence and treatment of depression among patients starting dialysis. Am J Kidney Dis, 41(1), 105-110. doi: 10.1053/ajkd.2003.50029
Weinhandl, E. D., Foley, R. N., Gilbertson, D. T., Arneson, T. J., Snyder, J. J., & Collins, A. J. (2010). Propensity-Matched Mortality Comparison of Incident Hemodialysis and Peritoneal Dialysis Patients. Journal of the American Society of Nephrology, 21(3), 499-506. doi: 10.1681/asn.2009060635
WHO. (2011). Human organ transplantation Retrieved 7/8, 2011, from http://www.who.int/transplantation/organ/en/
Wolfe, R. A., Ashby, V. B., Milford, E. L., Ojo, A. O., Ettenger, R. E., Agodoa, L. Y. C., . . . Port, F. K. (1999). Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant. New England Journal of Medicine, 341(23), 1725-1730. doi: doi:10.1056/NEJM199912023412303
Zhang, W., Gong, Z., Peng, X., Tang, S., Bi, M., & Huang, W. (2010). Clinical characteristics and outcomes of rural patients with ESRD in Guangxi, China: one dialysis center experience. International Urology and Nephrology, 42(1), 195-204. doi: 10.1007/s11255-009-9609-y
中華民國器官捐贈協會(2011)。台灣近十年器官移植術後存活率。線上檢索日期:2011年7月18日。網址:http://www.organ.org.tw/
吳紅蓮、曾進忠、楊麗芬、黃建鐘、謝日耀(2004)。每天兩公升1.1%胺基酸透析液對蛋白質熱量營養不良之慢性腹膜透析病人的體位測量和身體組成之影響。臺灣營養學會雜誌,29(2),112-119。.
李伯璋(2010)。台灣腎臟移植現況之困境及其解決方法。臺灣醫界,53(6),36-38。
財團法人器官捐贈移植登入中心(2012a)。捐贈與移植。線上檢索日期:2012年6月4日。網址:http://www.torsc.org.tw/organ/organ.jsp
財團法人器官捐贈移植登入中心(2012b)。登入中心即時統計。線上檢索日期:2012年6月4日。網址:http://www.torsc.org.tw/
健保局(2011)。全民健康保險初期慢性腎臟病醫療給付改善方案。線上檢索日期:2011年7月11日。網址:http://www.nhi.gov.tw/resource/Webdata/19257_2_初期慢性腎臟病醫療給付改善方案.pdf
健保局(2012)。100年第4季門診透析總額報告(台灣腎臟醫學會提供)(101.04.27新增) 。線上檢索日期:2012年5月22日。網址:http://www.nhitb.gov.tw/webdata/webdata.aspx?menu=23&menu_id=818&WD_ID=818&webdata_id=818
國民健康局(2010)。。慢性腎臟病防治手冊。線上檢索日期:2011年7月18日。網址:http://www.bhp.doh.gov.tw/bhpnet/portal/file/ThemeULFile/201101250426547663/%E6%85%A2%E6%80%A7%E8%85%8E%E8%87%9F%E7%97%85%E9%98%B2%E6%B2%BB%E6%89%8B%E5%86%8A+%E6%96%B0%E7%89%88_%E5%85%A8%E6%96%87_Final_1000125.pdf.
國民健康局(2011)。台灣洗腎人口多的原因。線上檢索日期:2011年7月20日。網址:http://www.bhp.doh.gov.tw/BHPnet/Portal/Them_Show.aspx?Subject=200712250019&Class=2&No=201006210001
劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫(2006)。台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊,4,1-22。
蔡文正、龔佩珍、徐約翰、廖凱平(2004)。不同經營特性洗腎機構之洗腎服務滿意度。醫務管理期刊,5(1),101-119。
謝忠憲、蔡孟昆、林水龍(2002)。一位腎臟移植病人發生迴腸結核感染病例報告。腎臟與透析,14(3),148-151。
邱永仁(2004)。境外腎臟移植。台灣醫界,47(4),37-39。
蔡文正等(2009)。慢性腎臟病防治科技研究計畫四-醫療給付及腎臟移植制度研究(國民健康局九十七年度委託研究計畫成果報告編號:DOH97-HP-1104。台北:行政院衛生署國民健康局。


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