目的：本研究的主要目的是探討預建透析通路對醫療耗用及透析品質之影響。
方法：本研究以彰化縣某一區域教學醫院透析單位的末期腎臟病患者為研究對象，研究期間是自2008年1月1日至2011年02月28日止，該單位在上述期間申請血液或腹膜透析國際疾病分類(ICD-9-CM)編碼為585重大傷病卡者為樣本共計101個案。蒐集資料方式是採用醫院透析病歷中的相關變項資料以及住院申報檔來分析醫療耗用情況。
結果：末期腎病患者在有預建透析通路上，是以有經慢性腎臟病照護者居多(P<0.001)，且有預建透析通路者之首次透析方式以門診方式占72.5%最多，其次為住院方式占25%，住進加護病房者最少占2.5%，住院天數也較短，相對在住院醫療花費也減少，以上均達統計上顯著差異。進入透析後在血比容(Hematocrite；Hct)及透析效率(KT/V)的變化上以有預建透析通路者佳，其平均變化上都有增加情形，但在白蛋白(Albumin)是以無預建者平均增加較多，尿素氮(Blood urea nitrogen；BUN)及肌酸酐(Creatinine；Cr)之血清生化值上是以無預建者下降較多。
結論：預先建立一條好的透析通路，在進入透析後之透析品質方面有較正向影響，相對在醫療利用與資源耗用方面也有明顯下降情形。本研究期望能夠藉由實證研究結果，說服末期腎病患者在首次透析前便進行預建透析通路，期望以實證資料支持預先建立通路對末期腎臟病患者透析品質的提升和醫療耗用的減少有效果，並能對此健康促進的政策和機構服務的推動有所助益。
Objective: The aim of this study is to examine the influence of the creation of pre-dialysis access on health care utilization and dialysis quality for patients with the end-stage renal diseases.
Method: The study subjects were from a public hospital in Chang-Hua County, and followed up from Jan 1st, 2008 to Feb 28th, 2011. A total of 101 ESRD patients with ICD-9 CM code of 585 were in hemodialysis or peritoneal dialysis therapy. The data on age, sex, educational levels, ever having chronic kidney education program or not before the first time dialysis, and the biomarker values on dialysis quality were collected from chart records, and the medical utilization were from the inpatient declaration values to national health insurance .
Result: The medical utilization was less for patients with the creation of pre-dialysis access before the first-time dialysis therapy than that for patients without. The changes in the the biomarker values of dialysis quality, Hematocrite, KT/V and Almumin, presented positive trends for patients with the creation of pre-dialysis access; but the trends reversed for BUN and Creatinine. These reversed trends may be attributed to the worse renal status for patients without the precreation access, which in turn resulting in larger increased changes after the following dialysis therapy.
Conclusion: This study suggested that creating pre-dialysis access before the first time dialysis be able to decrease the medical utilization and have helpful effects on the progress for dialysis therapy for the ESRD patients.
