Blake P G, Korbet S M, Blake R, Bargman J M, Burkart J M, Delano B G, Dasgupta M K, Fine A, Finkelstein F, McCusker F X, McMurray S D, Zabetakis P M, Zimmerman S W, Heidenheim P
Optimal Dialysis Research Unit, London Health Sciences Centre, London.
Am J Kidney Dis. 2000 Mar;35(3):506-14. doi: 10.1016/s0272-6386(00)70205-8.
Recent evidence suggested that noncompliance (NC) with continuous ambulatory peritoneal dialysis (CAPD) exchanges may be more common in US than in Canadian dialysis centers. This issue was investigated using a questionnaire-based method in 656 CAPD patients at 14 centers in the United States and Canada. NC was defined as missing more than one exchange per week or more than two exchanges per month. Patients were ensured of the confidentiality of their individual results. Mean patient age was 56 +/- 16 years, 52% were women, and 39% had diabetes. The overall admitted rate of NC was 13%, with a rate of 18% in the United States and 7% in Canada (P < 0.001). NC was more common in younger patients (P < 0.0001), those without diabetes (P < 0.001), and employed patients (P < 0.05). It was also more common in black and Hispanic than in Asian and white patients (P < 0.001). NC was more common in patients prescribed more than four exchanges daily (P < 0.0001) but was not affected by dwell volume. On multiple regression analysis, the independent predictors of NC, in order of importance, were being prescribed more than four exchanges per day, black race, being employed, younger age, and not having diabetes. Being treated in a US unit did not quite achieve significance as a multivariate independent predictor. These findings suggest that NC is not uncommon in CAPD patients and is more frequent in US than in Canadian patients. However, country of residence is less powerful as a predictor of NC than a variety of other demographic and prescription factors.
最近的证据表明，在美国，持续性非卧床腹膜透析（CAPD）换液不依从的情况可能比加拿大透析中心更为常见。采用问卷调查法对美国和加拿大14个中心的656例CAPD患者进行了此项调查。不依从被定义为每周错过超过一次换液或每月错过超过两次换液。确保患者个人结果的保密性。患者平均年龄为56±16岁，52%为女性，39%患有糖尿病。不依从的总体发生率为13%，美国为18%，加拿大为7%（P<0.001）。不依从在年轻患者（P<0.0001）、无糖尿病患者（P<0.001）和就业患者中更为常见（P<0.05）。在黑人和西班牙裔患者中也比在亚洲和白人患者中更为常见（P<0.001）。每天规定换液超过4次的患者中不依从更为常见（P<0.0001），但不受留腹量的影响。多因素回归分析显示，按重要性排序，不依从的独立预测因素依次为每天规定换液超过4次、黑人种族、就业、年龄较小和无糖尿病。在美国的透析单位接受治疗作为多变量独立预测因素未达到显著水平。这些发现表明，CAPD患者中不依从并不罕见，且在美国患者中比在加拿大患者中更频繁。然而，与其他各种人口统计学和处方因素相比，居住国家作为不依从预测因素的作用较小。
