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CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan
RATIONALE & OBJECTIVE: Taiwan implemented national pay-for-performance programs for chronic kidney disease (CKD) care in 2006 and 2011; however, it is unknown whether this affected trends in maintenance dialysis. This study assessed the temporal trends in the incidence, prevalence, and mortality...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257411/ https://www.ncbi.nlm.nih.gov/pubmed/35812528 http://dx.doi.org/10.1016/j.xkme.2022.100485 |
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author | Lin, Ming-Yen Chiu, Yi-Wen Hsu, Yung-Ho Wu, Mai-Szu Chang, Jer-Ming Hsu, Chih-Cheng Yang, Chih-Wei Yang, Wu-Chang Hwang, Shang-Jyh |
author_facet | Lin, Ming-Yen Chiu, Yi-Wen Hsu, Yung-Ho Wu, Mai-Szu Chang, Jer-Ming Hsu, Chih-Cheng Yang, Chih-Wei Yang, Wu-Chang Hwang, Shang-Jyh |
author_sort | Lin, Ming-Yen |
collection | PubMed |
description | RATIONALE & OBJECTIVE: Taiwan implemented national pay-for-performance programs for chronic kidney disease (CKD) care in 2006 and 2011; however, it is unknown whether this affected trends in maintenance dialysis. This study assessed the temporal trends in the incidence, prevalence, and mortality of individuals treated with maintenance dialysis from 2002-2016 in Taiwan. STUDY DESIGN: Follow-up study using Taiwan Renal Disease System Databases. SETTING & PARTICIPANTS: Participants who received dialysis for ≥90 days. PREDICTORS: Age, sex, and calendar year. OUTCOMES: Incidence, prevalence of maintenance dialysis, or death, ascertained using the National Death Registry database. ANALYTICAL APPROACH: The estimated annual percentage change was assessed by a generalized linear model, and the association of the programs with changes in the incidence of maintenance dialysis was evaluated using an age-period-cohort model. RESULTS: A total of 144,258 incident cases with a follow-up of 346 million person-years were analyzed during the observed periods. The estimated annual percentage change of the expected crude incidence rate was slightly reduced by 0.41% (95% CI, −1.06 to 0.24) and was more obvious in women and patients aged greater than 70 years; whereas, it was significantly increased in those aged greater than 75 years. After disentangling age and cohort effects, the implementation of the care programs was associated with an overall net drift of −1.09% (95% CI, −1.65 to −0.52) per year and a significant linear reduction in the period rate ratio from 1.06 (95% CI, 1.02-1.09) in the years 2002-2006 to 0.95 (95% CI, 0.92-0.98) in 2012-2016, using years 2007-2011 as reference. LIMITATIONS: The findings of the study may have limited inferences to other countries with different health care systems. CONCLUSIONS: The implementation of universal CKD care programs in Taiwan has significantly reduced the long-term trends in the incidence of maintenance dialysis; hence, devoting governmental resources to CKD care and prevention is advocated. |
format | Online Article Text |
id | pubmed-9257411 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-92574112022-07-07 CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan Lin, Ming-Yen Chiu, Yi-Wen Hsu, Yung-Ho Wu, Mai-Szu Chang, Jer-Ming Hsu, Chih-Cheng Yang, Chih-Wei Yang, Wu-Chang Hwang, Shang-Jyh Kidney Med Original Research RATIONALE & OBJECTIVE: Taiwan implemented national pay-for-performance programs for chronic kidney disease (CKD) care in 2006 and 2011; however, it is unknown whether this affected trends in maintenance dialysis. This study assessed the temporal trends in the incidence, prevalence, and mortality of individuals treated with maintenance dialysis from 2002-2016 in Taiwan. STUDY DESIGN: Follow-up study using Taiwan Renal Disease System Databases. SETTING & PARTICIPANTS: Participants who received dialysis for ≥90 days. PREDICTORS: Age, sex, and calendar year. OUTCOMES: Incidence, prevalence of maintenance dialysis, or death, ascertained using the National Death Registry database. ANALYTICAL APPROACH: The estimated annual percentage change was assessed by a generalized linear model, and the association of the programs with changes in the incidence of maintenance dialysis was evaluated using an age-period-cohort model. RESULTS: A total of 144,258 incident cases with a follow-up of 346 million person-years were analyzed during the observed periods. The estimated annual percentage change of the expected crude incidence rate was slightly reduced by 0.41% (95% CI, −1.06 to 0.24) and was more obvious in women and patients aged greater than 70 years; whereas, it was significantly increased in those aged greater than 75 years. After disentangling age and cohort effects, the implementation of the care programs was associated with an overall net drift of −1.09% (95% CI, −1.65 to −0.52) per year and a significant linear reduction in the period rate ratio from 1.06 (95% CI, 1.02-1.09) in the years 2002-2006 to 0.95 (95% CI, 0.92-0.98) in 2012-2016, using years 2007-2011 as reference. LIMITATIONS: The findings of the study may have limited inferences to other countries with different health care systems. CONCLUSIONS: The implementation of universal CKD care programs in Taiwan has significantly reduced the long-term trends in the incidence of maintenance dialysis; hence, devoting governmental resources to CKD care and prevention is advocated. Elsevier 2022-05-21 /pmc/articles/PMC9257411/ /pubmed/35812528 http://dx.doi.org/10.1016/j.xkme.2022.100485 Text en © 2022 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Original Research Lin, Ming-Yen Chiu, Yi-Wen Hsu, Yung-Ho Wu, Mai-Szu Chang, Jer-Ming Hsu, Chih-Cheng Yang, Chih-Wei Yang, Wu-Chang Hwang, Shang-Jyh CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan |
title | CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan |
title_full | CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan |
title_fullStr | CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan |
title_full_unstemmed | CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan |
title_short | CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan |
title_sort | ckd care programs and incident kidney failure: a study of a national disease management program in taiwan |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257411/ https://www.ncbi.nlm.nih.gov/pubmed/35812528 http://dx.doi.org/10.1016/j.xkme.2022.100485 |
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