| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 100 === Background：Although medical care is progressing, acute renal failure still leads to about 20% to 90% mortality, and is also a single risk factor for death. Recently, in response to the domestic tendency of an aging population，the age of patients with acute renal failure also grows, frequently complicated by multiple organ failure. Mortality caused by pulmonary complications reaches up to 80%. Therefore, influence of acute renal functions worsening has become a worldwide health issue.
Objective：In light of the relevance of pulmonary complication caused by acute renal failure on patients undergoing dialysis and health expenditure to mortality, major objective of this study is to: 1.understand the relevance of acute renal failure to pulmonary complications on patients with long-term dialysis. 2. evaluate the influence of acute renal failure on health expenditure of patients undergoing long-term dialysis. 3. deduce the death risk of acute renal failure to patients undergoing long-term dialysis
Methods：With national health insurance academic research database from 2003 to 2006 as data source, additional patients with acute renal failure, undergoing long-term dialysis, were selected as samples. With gender, age group and complications three interference variables as the pairing condition, researchers drew objects consistent with the condition at random from additional patients undergoing long-term dialysis at a ratio of 1:4, and finally divided objects into experimental group (441) and control group (1,764). Statistical analysis technique has three parts: 1. Analyze sample characteristics distribution and state of death by descriptive statistics. 2. Inferential statistics was to analyze the risk of death and suffering pulmonary complications based on Cox Proportional Hazards Regression Model while health expenditure was to analyze based on generalized linear model. 3. Kaplan-Meier curve was used to calculate difference in survival percentage after a three-year follow-up of patients undergoing long-term dialysis, and time of occurrence of pulmonary complications on patients undergoing long-term dialysis was analyzed by Logrank test statistics.
Results：In additional patients undergoing long-term dialysis, patients with acute renal failure accounted for 12%, with its overall mortality of 49.43% and survival rate in the third year of 55%, while hazard ratio of patients with ARF was 1.30 times than patients without ARF. 2. In additional patients undergoing long-term dialysis, death ratio of patients with pulmonary edema was 54.92%, respiratory failure as 87.85% and pneumonia as 59.72%., and risk of ARF patients suffering from pulmonary complications was 1.50 times than patients not suffering from acute renal failure. 3. For patients with acute renal failure undergoing long-term dialysis, total health expenditure per person each year were 15,673 yuan higher than that on common patients with long-term dialysis, while average hospitalization expense on each patient with acute renal failure undergoing long-term dialysis each year was 1.23 times than that on each patient without ARF.
Conclusions：With ageing of population, lifetime extension, growth of chronic diseases year by year, added by influences of factors such as drug, food, environmental poisoning and etc., renal diseases have been listed as one of ten causes of people’s death. Although healthcare level in Taiwan improves unceasingly, and death rate of dialysis is lower than that of other countries, overall death rate of patients with acute renal failure still exceeds 50%. Therefore, further efforts are required by treatment for patients with acute renal failure, so as to improve overall medical care for chronic renal diseases.
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