台灣慢性腎臟病的發生率居全世界之冠，帶來龐大的醫療花費與社會負擔。Healthy People 2010開始推動對慢性腎臟病預防控制之衛教活動，台灣也於2003年開始推動「慢性腎臟疾病保健防治」計劃，希冀有效控制慢性腎臟病病情的惡化，從根本著手改善。然而目前在衛教成效評估上的研究較為缺乏，因此本研究希望探討慢性腎臟病衛教介入之重要性與其影響，以及探討慢性腎臟病病患腎臟科門診回診頻率的影響。

研究方法：本研究主要收集南部區域及地區醫院共299位慢性腎臟病病患病例，根據病患之基本資料、病史、以及臨床生化值紀錄進行研究分析。

研究結果：研究結國指出及早發現慢性腎臟病並接受治療，與減緩臨床生化值惡化有關聯；部份合併疾病在病情嚴重度與住院次數上顯著高於沒有相關疾病之慢性腎臟病病。而在衛教介入上，雖然對臨床生化值變化沒有顯著差異，但在腎臟科回診次數上有著顯著的差異。

結論：研究結果發現使慢性腎臟病病患早期接受治療，控制相關疾病可能造成的影響，將能對病情進行有效的控制。同時對慢性腎臟病患進行有效之衛教介入，將可提高病患回診利用，定情回診追蹤病情，以控制腎臟的衰竭，減緩病情的惡化。

The incidence rate of Chronic Kidney Disease（CKD） in Taiwan is the highest among the world. This burden of disease is paralleled by enormous healthcare spending and society’s pressure. Healthy People 2010 started to promote education program for the prevention of chronic kidney disease. A program has started in Taiwan since 2003 in order to control CKD progresses to end stage renal disease（ESRD）. However, few studies evaluated the effects of such program. This research will focus on the importance and outcome for the intervention of CKD education program and the impact on frequency for nephrology outpatient follow-up visit.

Methods: 299 CKD patients were collected for their personal information, history of disease, and clinical values from hospitals in southern part of Taiwan.

Results: The result indicated that early intervention for CKD had reduced the execration of clinical value. CKD patients with comorbidities have higher disease severity and inpatient utilization compare with those who without comorbidities. Although CKD education intervention has no significant difference on the change of clinical value, it is significant on the frequency of nephrology outpatient follow-up visit.

Conclusion: Early intervention for patient with CKD has great impact on the progression of kidney failure. Effective CKD education program will increase nephrology follow-up visit so that patient could update the education plan and meet individual needs for the decrease of kidney function.

目錄
圖表目錄
第一章 前言
第一節 研究背景.............................................................................................1
第二節 研究目的.............................................................................................2
第二章 文獻探討
第一節 慢性腎臟病介紹..................................................................................4
第二節 衛教介入的影響................................................................................13
第三章 研究方法與步驟
第一節 研究架構...........................................................................................19
第二節 研究假設...........................................................................................21
第三節 研究對象與資料來源.........................................................................23
第四節 研究變項與操作性定義.....................................................................25
第五節 研究資料處理與分析.........................................................................28
第四章 研究結果
第一節 研究對象之基本資料分析.................................................................29
第二節 就醫紀錄...........................................................................................33
第三節 衛教有無分析....................................................................................35
第四節 相關病史有無與慢性腎臟病病情控制...............................................38
第五節 慢性腎臟病病患及早接受治療對未來的病情控制.............................41
第六節 有無衛教之影響................................................................................43
第七節 回診次數與臨床生化值、住院次數關係...........................................44
第八節 影響回診次數之複迴歸分析.............................................................45
第九節 影響依年內臨床生化值變化之複迴歸分析.......................................48

第五章 討論
第一節 研究結果之探討................................................................................51
第二節 研究限制...........................................................................................55
第六章 結論與建議
第一節 結論...................................................................................................56
第二節 研究貢獻............................................................................................58
第三節 研究建議............................................................................................59
參考文獻



圖表目錄
圖2-1 2003年透析病患之年齡分布....................................................................3
表2-1 慢性腎臟病階段.......................................................................................4
表2-2 慢性腎臟病照護各階段之衛教內容.........................................................6
表2-3 MDRD之預測GFR公式..........................................................................8
圖2-2 2003年透析病患之發病原因分析.............................................................9
圖2-3 2003年在進入末期腎臟病前兩年所罹患之合併症數...............................10
表2-4 慢性腎臟病之警示症狀...........................................................................12
圖2-4 衛教基本模式..........................................................................................16
表3-1 研究架構..................................................................................................20
表4-1 基本資料之次數與百分比........................................................................31
表4-2 就醫紀錄之次數與百分比........................................................................34
表4-3 衛教有無與基本資料間之差異................................................................35
表4-4 衛教有無與透析間之關係.......................................................................37
表4-5 有無高血壓相關病史..............................................................................38
表4-6 有無腎臟疾病相關病史...........................................................................39
表4-7 有無糖尿病相關病史...............................................................................40
表4-8 治療早晚與臨床生化值變化、相關疾病、家族疾病相關........................42
表4-9 有無衛教與生化值改善情形及醫療利用..................................................43
表4-10 回診次數與臨床生化值、住院次數關係................................................44
表4-11 影響回診次數之複迴歸分析..................................................................46
表4-12 影響一年內臨床生化值變化之複迴歸分析............................................49

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