Marrón Belén, Martínez Ocaña Juan Carlos, Salgueira Mercedes, Barril Guillermina, Lamas José M, Martín Marisa, Sierra Tomás, Rodríguez-Carmona Ana, Soldevilla Amparo, Martínez Francisco
Renal Division Baxter, Spain.
Perit Dial Int. 2005 Feb;25 Suppl 3:S56-9.
Despite advances in predialysis care, morbidity and mortality remain high.
To analyze end-stage renal disease (ESRD) patient demographics and clinical data on education on dialysis treatment options, type of chronic renal replacement therapy (RRT), and effects of planned versus non-planned dialysis start.
621 patients, from 24 Spanish hospitals, who started RRT in 2002. Peritoneal or vascular access at dialysis initiation was considered "planned."
304 (49%) patients were non-planned and half of them had prior nephrology follow-up. Of the patients with >3 months nephrology follow-up (76% of all), only half were educated on dialysis modalities. Dialysis education was associated with planned start in 73.4% versus 26% in non-educated patients (p < 0.05), shorter follow-up (55 vs 65 months, p = 0.033), more medical visits in the prior year (6.5 vs 4.4, p < 0.001), more patients starting peritoneal dialysis (31% vs 8.3%), and more specific follow-up by ESRD unit versus general nephrology care (63% vs 26%). Non-planned start was associated with older age (63 vs 60.6 years, p = 0.06), fewer medical visits (4.6 vs 6.4), less education about modality options, and greater use of hemodialysis (92% vs 75%*). Planned patients had better biochemical parameters at start of dialysis.
Despite nephrology follow-up, half the patients did not have a planned dialysis start. Planned start was associated with better clinical status. More patients chose peritoneal dialysis when educated about dialysis modality options. ESRD-specific units were more likely to provide patient education.
尽管透析前护理有所进展，但发病率和死亡率仍然很高。
分析终末期肾病（ESRD）患者的人口统计学和临床数据，内容包括透析治疗选择的教育情况、慢性肾脏替代治疗（RRT）的类型以及计划性与非计划性透析开始的影响。
来自24家西班牙医院的621例患者于2002年开始接受RRT。透析开始时的腹膜或血管通路被视为“计划性的”。
304例（49%）患者为非计划性透析，其中一半患者此前接受过肾脏病随访。在随访时间超过3个月的患者中（占所有患者的76%），只有一半患者接受了透析方式的教育。接受透析教育的患者中，73.4%为计划性开始透析，而未接受教育的患者中这一比例为26%（p<0.05）；接受透析教育的患者随访时间较短（55个月对65个月，p=0.033），前一年的就诊次数更多（6.5次对4.4次，p<0.001），开始腹膜透析的患者更多（31%对8.3%），并且与普通肾脏病护理相比，ESRD专科单位进行的特定随访更多（63%对26%）。非计划性开始透析与年龄较大有关（63岁对60.6岁，p=0.06），就诊次数较少（4.6次对6.4次），对透析方式选择的教育较少，并且血液透析的使用率更高（92%对75%*）。计划性透析的患者在透析开始时具有更好的生化指标。
尽管进行了肾脏病随访，但仍有一半患者没有计划性透析开始。计划性开始透析与更好的临床状态相关。当患者接受透析方式选择的教育时，更多患者选择腹膜透析。ESRD专科单位更有可能提供患者教育。
