Chow Kai Ming, Szeto Cheuk Chun, Leung Chi Bon, Law Man Ching, Li Philip Kam-Tao
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
Nephrol Dial Transplant. 2005 Nov;20(11):2504-10. doi: 10.1093/ndt/gfi061. Epub 2005 Aug 9.
Clinical outcomes among patients on peritoneal dialysis (PD) might not be linked to medical factors alone. We studied the clinical impact of various social factors among patients on PD.
In a cohort of 102 consecutive patients who started PD in a single centre between 2003 and 2004, we evaluated the effects of social factors on the development of peritonitis and risk of hospitalization after initiation of PD.
Of 102 incident PD patients, 35 subjects (34.3%) were referred to nephrologists more than 3 months before dialysis initiation. During 85.7 patient-years of observation (median follow-up, 10.7 months), four subjects died and six underwent kidney transplantation. Patients receiving social security assistance and those younger than 40 years fared worse than others in terms of their risk of peritonitis. Mean peritonitis-free time for subjects who were on social security assistance was 2.7 months, and for those who were not, 16.4 months (P = 0.045). In the Cox proportional hazards analysis, need for social security assistance and illiteracy were the only statistically significant factors associated with the time to a first peritonitis, after adjustment for social characteristics and relevant coexisting medical factors. Dependence on social security assistance prior to PD was associated with a >2-fold increased likelihood of peritonitis, with an adjusted risk ratio of 2.69 (95% confidence interval, 1.10 to 6.54; P = 0.029). The total number of hospitalization days was similar between those who received social security assistance and those who did not: 17.4+/-14.6 days (range, 4-50 days) vs 17.9+/-14.0 days (range, 0-60 days) (P = 0.89).
Our results confirm that socioeconomic status is closely associated with the rate of peritonitis among PD patients. The long-term reliability of these social predictors remains to be validated.
接受腹膜透析（PD）患者的临床结局可能并非仅与医学因素相关。我们研究了各类社会因素对接受PD治疗患者的临床影响。
在2003年至2004年间于单一中心开始接受PD治疗的102例连续患者队列中，我们评估了社会因素对腹膜炎发生及PD开始后住院风险的影响。
在102例新接受PD治疗的患者中，35例（34.3%）在透析开始前3个月以上就转诊至肾病科医生处。在85.7患者年的观察期内（中位随访时间为10.7个月），4例患者死亡，6例接受了肾移植。接受社会保障援助的患者和40岁以下的患者在腹膜炎风险方面比其他患者情况更差。接受社会保障援助的患者无腹膜炎的平均时间为2.7个月，未接受援助的患者为16.4个月（P = 0.045）。在Cox比例风险分析中，在对社会特征和相关并存医学因素进行调整后，需要社会保障援助和文盲是与首次发生腹膜炎时间唯一具有统计学意义的因素。PD治疗前依赖社会保障援助与腹膜炎发生可能性增加2倍以上相关，调整后的风险比为2.69（95%置信区间，1.10至6.54；P = 0.029）。接受社会保障援助的患者与未接受援助的患者的总住院天数相似：17.4±14.6天（范围，4 - 50天）对17.9±14.0天（范围，0 - 60天）（P = 0.89）。
我们的结果证实社会经济地位与PD患者的腹膜炎发生率密切相关。这些社会预测因素的长期可靠性仍有待验证。
