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題名 血液透析與腹膜透析對末期腎臟病患之存活影響
Comparing the risk of death between Peritoneal Dialysis and Hemodialysis of ESRD patients in Taiwan.
作者 龎婷
Pang, Ting
貢獻者 連賢明
Lien, Hsien Ming
龎婷
Pang, Ting
關鍵詞 末期腎臟病
血液透析
腹膜透析
工具變數
日期 2013
上傳時間 2-Jan-2014 14:42:42 (UTC+8)
摘要 　　台灣末期腎臟病發生率於2001至2008年間排名世界第一，疾病盛行率更於2001年起至今持續位居世界首位，居高不下的盛行率使得末期腎臟病透析治療花費亦隨之高漲。事實上，為了節省透析醫療費用，健保曾於2006年起推行一系列政策鼓勵腹膜透析。然即便如此，目前台灣末期腎臟病病患使用腹膜透析的比例仍只有一成左右，因此本文想瞭解是否血液透析與腹膜透析兩者治療效果有明顯差異？
　　本研究以血液透析與腹膜透析病患的存活情形做為透析治療品質指標。在研究方法上，未控制內生性時以Cox等比例危險模型及線性機率模型OLS來估計，結果皆顯示血液透析相對腹膜透析病患的存活情形較差。為了解決病人自我選擇透析方式與存活率間產生的選擇性偏誤(selection bias)，本文採用線性機率模型以工具變數(IV)及兩階段最小平方法(2SLS)來分析。經估計後發現無論是否使用工具變數，我們僅能猜測血液透析病人一年存活率相較腹膜透析病人低；而血液透析病人三年存活率相較腹膜透析病人則比較高，但礙於統計上不顯著，本文尚不能做進一步推論。
參考文獻 英文文獻：
Collins, A., Hao, W., Xia, H., Ebben, J., Everson, S., Constantini, E., and Jennie Z. (1999), “Mortality risks of peritoneal dialysis and hemodialysis.” American Journal of Kidney Diseases, 34(6):1065-1074.
Correa-Rotter, R. (2001), “The cost barrier to renal replacement therapy and peritoneal dialysis in the developing world.” Peritoneal Dialysis International, 21:314-317.
Diaz-Buxo, J., Crawford-Bonadio, T., St. Pierre, D., and Ingram, K. (2006), “Establishing a successful home dialysis program.” Blood Purif, 24(1):22-27.
D. R. Cox (1972), “Regression Models and Life-Tables.” Journal of the Royal Statistical Society. Series B (Methodological), 34( 2):187-220.
Fenton, S., Schaubel, D., Desmeules, M., and Morrison, H. (1997), “Hemodialysis versus peritoneal dialysis: A comparison of adjusted mortality rates.” American Journal of Kidney Diseases, 30(3):334-342.
Fox, M. (1993), “Facility reimbursement: a critical comparison between hemodialysis and peritoneal dialysis.” American journal of kidney diseases, 22(Supplement 1): 32-34.
Heaf, J., Lokkegaard, H., and Madsen, M. (2002), “Initial survival advantage of peritoneal dialysis relative to haemodialysis.” Nephrology Dialysis Transplantation, 17(1):112-117.
Huang, C., Cheng, K., and Wu, H. (2008), “Survival analysis: comparing peritoneal dialysis and hemodialysis in Taiwan.” Peritoneal Dialysis International, 28(Supplement 3):15-20.
Jaar, B., Coresh, J., Plantinga, L., Fink, N., Klag, M., Levey, A., Levin N, Sadler J, Kliger A, Powe N. (2005), “Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease.” Annals of internal medicine, 143(3):174-183.
Jager, K., Korevaar, J., Dekker, F., Krediet, R., and Boeschoten, E. (2004), “The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands.” American Journal of Kidney Diseases, 43(5):891-899.
Jung, B., Blake, P., Mehta, R., and Mendelssohn, D. (1999), “Attitudes of Canadian nephrologists toward dialysis modality selection.” Peritoneal Dialysis International, 19(3):263-268.
King, K. (2000), “Patients` perspective of factors affecting modality selection: A national kidney foundation patient survey.” Advanced Renal Replace Therapy, 7(31):261-268.
Lameire, N., Peeters, P., Vanholder, R., and Van Biesen, W. (2006), “Peritoneal dialysis in Europe: an analysis of its rise and fall.” Blood Purif, 24(1):107-114.
Levitt, S. D. (1997), “Using electoral cycles in police hiring to estimate the effect of police on crime.”, American Economic Review, 87(3): 270-290.
Lien Hsien-Ming, Shin-Yi Chou, and Jin-Tan Liu. (2008), “Hospital Ownership and Performance: Evidence from Stroke and Cardiac Treatment in Taiwan.” Journal of Health Economics, 27(5):1208-1223.
Little, J., Irwin, A., Marshall, T., Rayner, H., and Smith, S. (2001), “Predicting a patient’s choice of dialysis modality: experience in a United Kingdom renal department.” American Journal of Kidney Diseases, 37(5):981-986.
McDonald S.P., Marshall M.R., Johnson D.W., Polkinghorne K.R. (2009), “Relationship between dialysis modality and mortality.” Journal of the American Society of Nephrology, 20:155-163.
Mehrotra, R., Blake, P., Berman, N., and Nolph, K. (2002), “An analysis of dialysis training in the United States and Canada.” American Journal of Kidney Diseases, 40(1):152-160.
Mendelssohn, D.C., Mullaney, S.R., Jung, B., Blake, P.G., and Mehta, R.L. (2001), “What do American nephrologists think about dialysis modality selection?” American Journal of Kidney Disease, 37:22-29.
Nissenson, A., Prichard, S., Cheng, I., Gokal, R., Kubota, M., Maiorca, R., Riella M.C., Rottembourg J., and Stewart J.H. (1993), “Non-medical factors that impact on ESRD modality selection.” Kidney International, Supplement, 40: 120-127.
Nissenson, A., Prichard, S., Cheng, I., Gokal, R., Kubota, M., Maiorca, R., Riella M.C., Rottembourg J, and Stewart J.H. (1997), “ESRD modality selection into the 21st century: The importance of non medical factors.” Asaio Journal, 43(3):143-150.
Paul M. Just, Frank Th. de Charro, Elizabeth A. Tschosik, Les L. Noe, Samir K. Bhattacharyya, and Miguel C. Riella. (2008), “Reimbursement and economic factors influencing dialysis modality choice around the word.” Nephrology Dialysis Transplantation, 23: 2365-2373.
Pfister-Minogue, K. (1993), “Enhancing patient compliance: A guide for nurse.” Geriatric Nursing, 14(3):124-132.
Sarah S. Prichard. (1996), “Comorbidities and their impact on outcome in patients with end-stage renal disease” Kidney International, 57:100-104.
Stack, A., Molony, D., Rahman, N., Dosekun, A., and Murthy, B. (2003), “Impact of dialysis modality on survival of new ESRD patients with congestive heart failure in the United States.” Kidney International, 64(3):1071-1079.
Termorshuizen, F., Korevaar, J., Dekker, F., van Manen, J., Boeschoten, E., and Krediet, R. (2003), “Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis: analysis of The Netherlands Cooperative Study on the Adequacy of Dialysis.” Journal of the American Society of Nephrology, 14(11):2851-2860.
Thamer, M., Hwang, W., Fink, N., Sadler, J., Wills, S., Levin N.W., Bass E.B., Levey A.S., Brookmeyer R., and Powe N.R. (2000), “US nephrologists’ recommendation of dialysis modality: results of a national survey.” American journal of kidney diseases, 36(6):1155-1165.
United States Renal Data System, Annual data report, (2012).
van de Luijtgaarden M.W., Noordzij M., Stel V.S., Ravani P., Jarraya F., Collart F., Schön S., Leivestad T., Puttinger H., Wanner C., Jager K.J. (2011), “Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in Europe.” Nephrology Dialysis Transplantation, 26:2940-2947.
Vanherweghem, J-L., C. Tielemans, D. Abramowicz, M. Depierreux, R. VanhaelenFastre, M. Vanhaelen, M. Dratwa, C. Richard,D. Vandervelde, D. Verbeelen, and M.Jadoul. (1993), “Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.” TheLancet, 341, 387-414
Vonesh, E., Snyder, J., Foley, R., and Collins, A. (2004), “The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis.” Kidney International, 66(6):2389-2401.
Vonkataraman, V., and Nolph, K.D. (1999), “Socioeconomic aspects of PD in North America: Role of non-medical factors in the choice of dialysis.” Peritoneal Dialysis International, 19 (Supplement 2) : 419-422.
Weinhandl E.D., Foley R.N., Gilbertson D.T., Arneson T.J., Snyder J.J., and 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.
Whittaker, A., and Albee, B. (1996), “Factors influencing patient selection of dialysis treatment modality.” ANNA journal (American Nephrology Nurses Association), 23(4):369.
Wuerth, D. B., Finkelstein, S. H., Schwetz, O., Carey, H., Kliger, A. S., and Finkelstein, F. O. (2002), “Patients’ descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis.” Peritoneal Dialysis International, 22(2):184-190.
Yeates K., Zhu N., Vonesh E., Trpeski L., Blake P., and Fenton S. (2012), “Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada.” Nephrology Dialysis Transplantation 27(9):3568-3575.

中文文獻：
王榮德 (2008)，「全國透析病人透析前腎毒性中西藥處方之分析研究」，《中醫藥年報》，4(26)，477-500。
王麗玲、楊麗芬 (2004)，「末期腎病患者選擇透析模式的影響因素」，《腎臟與透析》，16(4)，241-246。
胡潔瑩、林秋菊 (1999)，「末期腎臟疾病患者面對透析治療方式的抉擇衝突」，《腎臟與透析》，11(2)，106-109。
高芷華 (2012)，「臺灣透析病人的存活研究」，國立台灣大學職業醫學與工業衛生研究所博士論文。
常逸平、錢慶文、楊耿如 (2007)，「全民健保腹膜透析比血液透析省錢嗎？」，《台灣衛誌》，26(5)，400-408。
許績天、連賢明 (2007)，「賺得越少，洗得越多？－台灣末期腎臟病患之血液透析誘發性需求」，《經濟論文叢刊》，354(2)，415-450。
連賢明 (2011)，「如何使用健保資料推估社經變數？」，《人文及社會科學集刊》，23(3)，371-398。
張蒙西 (2011)，「末期糖尿病腎病變患者使用血液及腹膜透析對醫療費用，合併症及死亡率之比較」，國立陽明大學醫務管理研究所碩士論文。
梁嘉慧、楊勤熒、盧國城、朱柏齡、陳瓊華、謝湘俐、周桂如 (2008)，「慢性腎臟疾病患者選擇腹膜透析模式影響之因素」，《台灣腎臟護理學會雜誌》，7(2)。
黃嬿倫 (2006)，「醫療院所特性對洗腎品質影響之研究」，國立政治大學國際貿易研究所碩士論文。
鄧安智 (2009)，「台灣末期腎臟病患腹膜透析與血液透析之存活比較」，國立台灣大學醫療機構管理研究所碩士論文。
鄭振廷、侯宏彬、錢慶文 (2005)，「影響洗腎病患定期血液透析醫療資源耗用之因素」，《醫務管理期刊》，6(3)，291-308。

其他參考資料：
台北市立萬芳醫院，腎臟內科衛教園區，陳彥成醫師，2011。http://www.wanfang.gov.tw/W402008web_new/subject/healthshow.asp?dept_code=0500&news_id=510&item=6
台北榮總腎臟科，慢性腎臟病衛教專區。http://homepage.vghtpe.gov.tw/~neph/contents/7.htm#4
台灣腎臟醫學會，「台灣腎臟病現況與未來」，林裕峯，2009。
全民健康保險醫療費用協定委員會─「門診透析服務品質保證保留款實施方案」，94至99年。http://www.realsun.com.tw/new_web/pdf/97n_064.pdf
行政院衛生署國民健康局，《慢性腎臟病防治手冊》，行政院衛生署，2010。
陳永順、謝恩得、黃宣翰、唐秀麗 (2007)，「莫讓偽劣藥戕害國人專題系列報導」，《聯合報》，3月20日~ 3月24日。
健保局，《全民健康保險雙月刊》，2007年11月，70期，頁15-17。
健保局，醫療服務給付項目及支付標準查詢。http://www.nhi.gov.tw/query/query2.aspx?menu=20&menu_id=712&WD_ID=830
健保局，「98年全民健康保險統計」、「99年全民健康保險統計」、「100年全民健康保險統計」。
健保局，「全民健康保險總額支付制度協商參考指標要覽」，98至100年。
楊五常 (2009)，「腹膜透析初期存活率提高」，《聯合晚報》，11月11日。
楊五常，張曉卉 (2009)，《愛腎好生活》，台灣：天下雜誌股份有限公司。
描述 碩士
國立政治大學
財政研究所
100255015
102
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0100255015
資料類型 thesis
dc.contributor.advisor 連賢明zh_TW
dc.contributor.advisor Lien, Hsien Mingen_US
dc.contributor.author (Authors) 龎婷zh_TW
dc.contributor.author (Authors) Pang, Tingen_US
dc.creator (作者) 龎婷zh_TW
dc.creator (作者) Pang, Tingen_US
dc.date (日期) 2013en_US
dc.date.accessioned 2-Jan-2014 14:42:42 (UTC+8)-
dc.date.available 2-Jan-2014 14:42:42 (UTC+8)-
dc.date.issued (上傳時間) 2-Jan-2014 14:42:42 (UTC+8)-
dc.identifier (Other Identifiers) G0100255015en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/63233-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 財政研究所zh_TW
dc.description (描述) 100255015zh_TW
dc.description (描述) 102zh_TW
dc.description.abstract (摘要) 　　台灣末期腎臟病發生率於2001至2008年間排名世界第一，疾病盛行率更於2001年起至今持續位居世界首位，居高不下的盛行率使得末期腎臟病透析治療花費亦隨之高漲。事實上，為了節省透析醫療費用，健保曾於2006年起推行一系列政策鼓勵腹膜透析。然即便如此，目前台灣末期腎臟病病患使用腹膜透析的比例仍只有一成左右，因此本文想瞭解是否血液透析與腹膜透析兩者治療效果有明顯差異？
　　本研究以血液透析與腹膜透析病患的存活情形做為透析治療品質指標。在研究方法上，未控制內生性時以Cox等比例危險模型及線性機率模型OLS來估計，結果皆顯示血液透析相對腹膜透析病患的存活情形較差。為了解決病人自我選擇透析方式與存活率間產生的選擇性偏誤(selection bias)，本文採用線性機率模型以工具變數(IV)及兩階段最小平方法(2SLS)來分析。經估計後發現無論是否使用工具變數，我們僅能猜測血液透析病人一年存活率相較腹膜透析病人低；而血液透析病人三年存活率相較腹膜透析病人則比較高，但礙於統計上不顯著，本文尚不能做進一步推論。		zh_TW
dc.description.tableofcontents 謝辭 I
摘要 II
目次 III
圖表目錄 IV
第一章　緒論 1
第二章　研究背景 4
第一節　末期腎臟病及治療 4
第二節　台灣透析治療現況 8
第三節　健保透析給付制度及政策 11
第三章　文獻回顧 17
第一節　影響透析模式選擇之因素 17
第二節　透析模式與存活率 20
第四章　資料 26
第一節　資料來源 26
第二節　敘述統計 30
第五章　模型及實證結果 36
第一節　Cox等比例危險模型 (Cox Proportional Hazard Model) 36
第二節　工具變數及線性機率模型 41
第六章　結論與建議 48
參考文獻 50		zh_TW
dc.format.extent 873818 bytes-
dc.format.mimetype application/pdf-
dc.language.iso en_US-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0100255015en_US
dc.subject (關鍵詞) 末期腎臟病zh_TW
dc.subject (關鍵詞) 血液透析zh_TW
dc.subject (關鍵詞) 腹膜透析zh_TW
dc.subject (關鍵詞) 工具變數zh_TW
dc.title (題名) 血液透析與腹膜透析對末期腎臟病患之存活影響zh_TW
dc.title (題名) Comparing the risk of death between Peritoneal Dialysis and Hemodialysis of ESRD patients in Taiwan.en_US
dc.type (資料類型) thesisen
dc.relation.reference (參考文獻) 英文文獻：
Collins, A., Hao, W., Xia, H., Ebben, J., Everson, S., Constantini, E., and Jennie Z. (1999), “Mortality risks of peritoneal dialysis and hemodialysis.” American Journal of Kidney Diseases, 34(6):1065-1074.
Correa-Rotter, R. (2001), “The cost barrier to renal replacement therapy and peritoneal dialysis in the developing world.” Peritoneal Dialysis International, 21:314-317.
Diaz-Buxo, J., Crawford-Bonadio, T., St. Pierre, D., and Ingram, K. (2006), “Establishing a successful home dialysis program.” Blood Purif, 24(1):22-27.
D. R. Cox (1972), “Regression Models and Life-Tables.” Journal of the Royal Statistical Society. Series B (Methodological), 34( 2):187-220.
Fenton, S., Schaubel, D., Desmeules, M., and Morrison, H. (1997), “Hemodialysis versus peritoneal dialysis: A comparison of adjusted mortality rates.” American Journal of Kidney Diseases, 30(3):334-342.
Fox, M. (1993), “Facility reimbursement: a critical comparison between hemodialysis and peritoneal dialysis.” American journal of kidney diseases, 22(Supplement 1): 32-34.
Heaf, J., Lokkegaard, H., and Madsen, M. (2002), “Initial survival advantage of peritoneal dialysis relative to haemodialysis.” Nephrology Dialysis Transplantation, 17(1):112-117.
Huang, C., Cheng, K., and Wu, H. (2008), “Survival analysis: comparing peritoneal dialysis and hemodialysis in Taiwan.” Peritoneal Dialysis International, 28(Supplement 3):15-20.
Jaar, B., Coresh, J., Plantinga, L., Fink, N., Klag, M., Levey, A., Levin N, Sadler J, Kliger A, Powe N. (2005), “Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease.” Annals of internal medicine, 143(3):174-183.
Jager, K., Korevaar, J., Dekker, F., Krediet, R., and Boeschoten, E. (2004), “The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands.” American Journal of Kidney Diseases, 43(5):891-899.
Jung, B., Blake, P., Mehta, R., and Mendelssohn, D. (1999), “Attitudes of Canadian nephrologists toward dialysis modality selection.” Peritoneal Dialysis International, 19(3):263-268.
King, K. (2000), “Patients` perspective of factors affecting modality selection: A national kidney foundation patient survey.” Advanced Renal Replace Therapy, 7(31):261-268.
Lameire, N., Peeters, P., Vanholder, R., and Van Biesen, W. (2006), “Peritoneal dialysis in Europe: an analysis of its rise and fall.” Blood Purif, 24(1):107-114.
Levitt, S. D. (1997), “Using electoral cycles in police hiring to estimate the effect of police on crime.”, American Economic Review, 87(3): 270-290.
Lien Hsien-Ming, Shin-Yi Chou, and Jin-Tan Liu. (2008), “Hospital Ownership and Performance: Evidence from Stroke and Cardiac Treatment in Taiwan.” Journal of Health Economics, 27(5):1208-1223.
Little, J., Irwin, A., Marshall, T., Rayner, H., and Smith, S. (2001), “Predicting a patient’s choice of dialysis modality: experience in a United Kingdom renal department.” American Journal of Kidney Diseases, 37(5):981-986.
McDonald S.P., Marshall M.R., Johnson D.W., Polkinghorne K.R. (2009), “Relationship between dialysis modality and mortality.” Journal of the American Society of Nephrology, 20:155-163.
Mehrotra, R., Blake, P., Berman, N., and Nolph, K. (2002), “An analysis of dialysis training in the United States and Canada.” American Journal of Kidney Diseases, 40(1):152-160.
Mendelssohn, D.C., Mullaney, S.R., Jung, B., Blake, P.G., and Mehta, R.L. (2001), “What do American nephrologists think about dialysis modality selection?” American Journal of Kidney Disease, 37:22-29.
Nissenson, A., Prichard, S., Cheng, I., Gokal, R., Kubota, M., Maiorca, R., Riella M.C., Rottembourg J., and Stewart J.H. (1993), “Non-medical factors that impact on ESRD modality selection.” Kidney International, Supplement, 40: 120-127.
Nissenson, A., Prichard, S., Cheng, I., Gokal, R., Kubota, M., Maiorca, R., Riella M.C., Rottembourg J, and Stewart J.H. (1997), “ESRD modality selection into the 21st century: The importance of non medical factors.” Asaio Journal, 43(3):143-150.
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