卒中合并肾病患者早期康复的安全性和有效性：一项有索赔数据的队列研究

IF 1.9 Q2 REHABILITATION

Archives of rehabilitation research and clinical translation Pub Date : 2025-06-01 DOI:10.1016/j.arrct.2025.100434

Takuaki Tani RPT, PhD , Kiyohide Fushimi MD, PhD , Shinobu Imai RPh, PhD

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引用次数: 0

摘要

目的评价脑卒中合并慢性肾脏疾病（CKD）患者在24 ~ 48小时内开始早期康复治疗的有效性和安全性。DesignDatabase队列研究。SettingAcute医院。该研究纳入了2018年4月1日至2020年3月31日期间入院的卒中患者（n= 21061）和合并CKD患者，包括接受早期康复（n= 10129）和常规护理（n=2702）的CKD患者，以及接受早期康复（n=3086）和常规护理（n=954）的终末期肾病（ESKD）患者。人口平均（标准差）年龄为76.5（11.1）岁，性别分布为67.3%的男性和32.7%的女性。主要结局指标主要结局指标是住院相关死亡率，次要结局指标包括日常生活活动的变化（使用Barthel指数测量）和住院时间。结果早期康复与死亡风险增加无相关性(危险比[HR]， 0.82；95%置信区间（95% CI）， 0.67-1.02；P= 0.070)，而ESKD患者与死亡风险无显著相关性(HR, 0.79；95% ci, 0.55-1.14；P = .213)。早期康复组和常规护理组患者的日常生活改善活动度和住院时间差异无统计学意义(P=。103和P=。499年,分别)。在随访分析中，接受早期康复治疗的CKD患者死亡风险降低29% (HR, 0.76；95% ci, 0.62-0.92；P = .006)。相比之下，早期康复对ESKD患者的死亡风险没有影响(HR, 0.80；95% ci, 0.56-1.14；P = .217)。结论本研究支持卒中合并CKD患者早期康复治疗的安全性。此外，早期康复可以降低需要长期住院的患者的死亡率。

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Safety and Effectiveness of Early Rehabilitation in Patients With Stroke and Concomitant Kidney Disease: A Cohort Study With Claims Data

Objectives

To evaluate the effectiveness and safety of early rehabilitation started within 24 to 48 hours in patients with stroke and chronic kidney disease (CKD).

Design

Database cohort study.

Setting

Acute hospital.

Participants

The study included patients with stroke (n=21,061) and concomitant CKD who were admitted to an acute hospital between April 1, 2018, and March 31, 2020, including those with CKD who underwent early rehabilitation (n=10,129) and usual care (n=2702), as well as those with end-stage kidney disease (ESKD) who underwent early rehabilitation (n=3086) and usual care (n=954). The mean (standard deviation) age of the population was 76.5 (11.1) years, and the sex distribution was 67.3% men and 32.7% women.

Main Outcome Measures

The primary outcome was hospitalization-related mortality, and the secondary outcomes included changes in activities of daily living, measured using the Barthel Index, and length of hospital stay.

Results

Early rehabilitation was no associated with increase in mortality risk (hazard ratio [HR], 0.82; 95% confidence interval (95% CI), 0.67-1.02; P=.070) in patients with CKD, whereas no significant association with mortality risk was observed in patients with ESKD (HR, 0.79; 95% CI, 0.55-1.14; P=.213). The activity of daily living improvement and length of stay did not differ between the early rehabilitation and usual care groups (P=.103 and P=.499, respectively). In the follow-up analysis, patients with CKD undergoing early rehabilitation exhibited a 29% reduction in mortality risk (HR, 0.76; 95% CI, 0.62-0.92; P=.006). In contrast, early rehabilitation did not affect the mortality risk in patients with ESKD (HR, 0.80; 95% CI, 0.56-1.14; P=.217).

Conclusions

This study supports the safety of implementing early rehabilitation in patients with stroke and CKD. Moreover, early rehabilitation may reduce mortality in patients requiring long-term hospitalization.

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来源期刊

Archives of rehabilitation research and clinical translation Medicine and Dentistry (General)

CiteScore

3.00

自引率

0.00%

发文量

审稿时长

8 weeks