中国腹透发展现状与挑战.ppt

1、中国腹透发展现状与挑战,余 学 清,中国腹透发展现状 中国腹透未来发展,内容提要,广州CKD的患病率: 12.1% 北京CKD的患病率: 11.3% 上海CKD的患病率: 11.8% 郑州CKD的患病率: 13.5%,Chen W, Yu XQ. et al. NDT 2009;24:1205-12 Zhang L, Wang H.et al. AJKD, 2008 ;51(3):373-84 Chen N, Fan Q. et al. NDT 2009;24:2117-23 Liu ZS, .et al. Chin J of Nephrol. 2008; 24(8):524,CKD是中国重要

2、的公共健康问题,150,000 dialysis patients in China,中国ESRD患者数量快速增长,中国腹膜透析的需求增加,人口数量激增，特别是老年群体比例增加 CKD患病率高, 越来越多的ESRD患者 随着经济的发展，医疗保障覆盖更多透析患者 有限的资源和基础设施（空间，设备，技术人员） 家庭透析逐渐普及和接受,腹膜透析在中国的优势,安全，方便以及容易掌握 有益于远离透析中心居住的患者 中国大多数人民居住在农村 大部分县级医院没有血液透析设备 适合患有具传染性疾病的患者,ESRD患者：100多万 HD：20万 PD：2.3万,中国透析登记资料,中国不同透析方式现状,20062

3、010中国腹透病人数*,*由于目前尚未得到全国腹透病人的数据，此数据仅为百特工作人员的推测数据,中国腹透的发展情况,Dialysis modality choice varies widely around the world,9,USRDS ADR 2008 Table 12.d,全球各地不同透析方式构成,卫生部腹膜透析专家组会议,腹膜透析方式的政府支持,卫办医政函2011549号颁布, 文件中详细阐述了 提高我国腹膜透析水平，扩大腹膜透析覆盖面的管理要求 制定了逐级开展腹透培训，提高医疗机构腹透治疗能力的路径 部署了按照腹膜透析标准操作流程进行系列培训的实施办法 要求各省级卫生行政部门在制

4、定医疗质量考核和医院评审、评价指标时，腹透液费用不计入药品收入，按照医用耗材进行统计,“关于做好腹膜透析相关工作的通知”,卫办医政函2011549号,卫生部办公厅, 2011年6月13日,腹膜透析数量与腹透质量同步提高 腹透临床和腹透科研齐头并进 不同级别医院腹透中心共同发展,中国腹透未来发展的方向,不同治疗年限的腹透病人生存率均显著提高,Jessica Kendrick and Isaac Teitelbaum, Clin J Am Soc Nephrol 5: 1123-1131, 2010,影响患者生存率的因素,中心规模50 与50 比较，腹透病人临床预后较好,HD = hemodial

5、ysis; pt-yr = patient-year; RH = relative hazard; CI = confidence interval; ref. = reference value a p 0.05 b Demographics: age, sex, and race; Clinical: Index of Coexistent Disease score, diabetic status, and body mass index; Laboratory: albumin and creatinine,Laura al: PDI, Vol. 29, pp. 285291,中心规

6、模与腹透患者临床预后密切相关,退出率DOR%,治疗持续时间TOT（月）,Big is Beautiful in PD! -Prof. Peter Blake,* 百特中国数据,腹透中心的规模与治疗质量成正相关*,腹透临床和腹透科研齐头并进,中国腹透未来发展的方向,2012.2.31 1009,Rapid increase in PD patient number at SYSU,Patient Survival for Prevalent Patients,Data from SYSU PD registration system,Technique Survival for Prevalen

7、t Patients,Data from SYSU PD registration system,KPI Approach in SYSU 2010,Johnson,DW, et al. ISPD ACM 2010,8:2-3,The role of TGF-/smads in the mechanism of peritoneal fibrosis,Nie J, Yu XQ*. . Perit Dial Int. 2007; 27(5):580-8. Nie J,Yu XQ*. Kidney Int. 2007; 72(11):1336-44. Sun YY, Yu XQ*. Am J Ne

8、phrol. 2009;18;30(1):84-94. Liu QH, Yu XQ*. Peri Dial Int. 2008, 28:S88-95. Wu J, Yu XQ *. Inflamm Res. 2009; March 7 Epub ahead of print.,The Regulating Mechanism of TGF-/Smads on EMT,Wang XY, Yu XQ *. Biochim Biophys Acta. 2008,1782:51-59. Nie J,Yu XQ*. Biochim Biophys Acta. 2009 ;1792:122-31. Mao

9、 H,Yu XQ*. Am J Physiol - Renal Physiol. 2008;295(1):F202-14. Zhang HY, Yu XQ*. Nephrology. 2009; 14(3):302-10 Zhou Y, Yu XQ*. JASN 2010; 21:598-609 Zhu FX, et al. Am J Pathol 2010;176:650-9. Zhou Q, et al. J Biol Chem. 2010 ; 285(51):40019-27,Clinical Research Program in PD,Preservation of Peritone

10、al function Preservation of residual renal function Prevention of CVD in PD patients Bio-maker for the early diagnosis Satellite Center for out of Guangzhou,The Ongoing Program in SYSU,ACEI, ARB and combination in the preservation of peritoneal and RRF. Restricted diet protein plus ketoacid in the p

11、reservation of peritoneal and RRF The molecular mechanism of pathogen in the PD related peritonitis and preventive strategy for the relapse peritonitis.,An Excellent PD Team,不同地区腹透中心共同发展,中国腹透未来发展的一些思考,Higher dropout of PD patients in Suburban,2008.6.,Majority of patients live in suburban areas,Data

12、from 2008,Satellite center,27 doctors and nurses trained in our center,PD satellite Center Program in Guangzhou,This program was supported by the Baxter Clinical Evidence Council (CEC) grant 2008,Background for PD satellite center,50% patients need to go to the different areas in Guangdong province

13、for follow up There exist some problems in those regions Small scale and havent had a PD team Poor PD technique and center management Weak/poor training, teaching and follow up program High peritonitis and dropout rates, poor patient survival,Purpose of the program,To establish advanced PD satellite

14、 centers in Guangdong province with well education and training system Using standard PD program in patients training, education and follow-up procedures To set up a good model to improve PD outcome (i.e. patient and technical survival) and QOI,PD Satellite Center Running Procedure,The PD center in

15、Sun Yat-Sen University initiated and running this program Each satellite PD center need to have full-time PD doctor and nurses, and, use the same program for training, education, follow up and for all treatment protocols. All the centers report their work to the Sun Yat-sen university PD center ever

16、y month and join the regular meeting every 6 months Regular site observation and feed back our comments,Regular data collection,Incidence patients and causes PD adequacy and analysis Nutritional status Complication incidence Patient- and technical- survival Patient drop-outs and reasons,Summary of t

17、he satellite PD center,12 PD centers joined this program 26 doctors and 32 nurses trained PD pts increased from 1010 to1860,Clinical data of PD patients,Some Indexes have shown improvement,The future plan for this program,Expand our experience in the PD satellite center Program To conduct more multi

18、-centeric clinical research in China. To expand this program to South China or other provinces where they needed the most.,交流与合作,积极参加国际会议和学术交流 选择国内外先进中心学习 邀请国际专家来中心指导 与国外专家共同探讨：Workshop 开展多中心的临床研究,2009年苏黎世大学学术交流会特邀讲座,2009年瑞典卡罗琳斯卡医学院学术交流会,2009年 参加医院赴美国UCLA大学学术交流,与前任ISPD主席加拿大Oreopoulos教授留影,瑞典卡罗琳斯卡学院 Jonas Axelsson,ISPD