The association between the severity of chronic kidney disease and medical costs among patients with type 2 diabetes

Aims: Examine healthcare costs across chronic kidney disease (CKD) stages for US patients with type 2 diabetes (T2D).

Materials and methods: IQVIA Real World Data Adjudicated Claims linked electronic medical records and insurance claims from January 1, 2012 through March 31, 2017 were used for this retrospective study. Adults diagnosed with T2D and comorbid CKD were included. General linear models incorporating splines were constructed, and information from these regressions were used to inform the relationship between medical costs and CKD. Multivariable analyses controlled for patient characteristics, vital signs, general health, prior medication use, prior visit to specialists, index A1c, and year of index date.

Results: There were 6,645 individuals who met the study criteria. Results generally indicate sharp increases in annual total medical costs and non-drug medical costs in the 1?year post-period for patients with Stage 4 or 5 CKD (estimated glomerular filtration rate [eGFR]?≤?30?mL/min/1.73 m²) with each 1 point reduction in eGFR from 30 associated with an increase of $1,870 in all-cause total medical costs (p?<?0.0001) and $1,805 of all-cause non-drug medical costs (p?<?0.0001). Similarly, each point decline below 30?mL/min was associated annual cost increases of $1,701 for CKD-related total medical costs, $1,695 for CKD-related non-drug medical costs, $173 for diabetes-related medical costs, and $187 for diabetes-related non-drug medical costs (all p?<?0.0001).

Limitations: The investigation included only patients with medical insurance and laboratory test results, and results may not be generalizable to all T2D patients with CKD. The methodology allowed us to determine associations, not causation, and potential confounders, such as duration of diabetes, diet, exercise, or social support, could not be assessed.

Conclusions: Results indicate there are sharp and significant increases in medical costs among T2D patients with Stage 4 and 5 CKD compared to those with earlier stages of CKD.     

一汽-大众奥迪品牌CKD中心仓储优化研究

针对X汽车制造厂多种车型尤其是新车型产量的增加,加大了CKD中心的零部件库存量、越库作业量的现状.为了提高CKD中心的作业质量,克服土地资源局限性,投资规模等限制因素,制订了CKD中心仓储优化方案,提出通过安装钢结构平台、GLT组合式货架、优化零件存储周期、提高现有库房的空间利用率、减少库房间越库运输等组合措施提高库房空间利用率,并实证了方案的有效性.     

降压药用药方案评估伴高血压的慢性肾脏病患者

目的评估伴高血压的慢性肾脏病（CKD）患者应用降血压药的临床治疗方案和血压达标率。方法本研究为回顾性横断面研究。对204例成年慢性肾脏病患者在肾病专科门诊至少随访6个月后,于观察期内以末次就诊时的血压达标率和用药方案与其在首诊时血压控制情况和用药方案加以比较。结果末次就诊时,超过70%的患者使用了血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体Ⅱ受体拮抗剂（ARB）,其次是钙通道阻滞剂（CCB）（51.96%）和利尿药（19.12%）。单药治疗方案中最常用的降血压药是ACEI或ARB,近50%的患者接受2药或3药联合治疗。治疗结果显示,只有31.86%的CKD患者血压达标（〈130/80mmHg）,收缩压（SBP）比舒张压（DBP）更难控制。单药和多药治疗的CKD患者血压达标率分别是39.64%和22.58%,（P〈0.01）,结论大多数的CKD患者血压未达标,所应用降血压药的临床治疗方案基本符合高血压治疗指南。需要继续优化治疗方案,正确联合用药,提高CKD患者的血压控制率。临床药师在协助医师,共同控制CKD患者血压方面将大有可为。     

重型瓦楞包装在发动机出口CKD项目中的应用

传统发动机出口包装大多采用一次性木质包装,不环保、成本高且取用不便。以出口发动机CKD项目为例,基于绿色包装理念,选用重型瓦楞包装,以纸代木,对发动机重新进行集合包装设计,满足CKD零件的包装防护需求的同时,也实现了绿色环保和降本增效的双重目标。     

上海大众汽车预批量生产CKD零件准备

上海大众新车型正式投产前需要经历预批量生产阶段，由物流部门负责零件的准备工作。文中介绍了上海大众预批量生产的过程，预批量生产阶段CKD（Completely Knocked Down）零件的准备方式、订购流程和系统架构，并对预批量订货管理提出了优化。