Chow Kai Ming, Szeto Cheuk Chun, Leung Chi Bon, Law Man Ching, Kwan Bonnie Ching-Ha, Li Philip Kam-Tao
Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
Nephrol Dial Transplant. 2007 Feb;22(2):545-51. doi: 10.1093/ndt/gfl563. Epub 2006 Oct 11.
Shortening behaviour during peritoneal dialysis training can be easily measured, and likened to the skipping behaviour in haemodialysis subjects, although its effect on peritoneal dialysis outcomes is now well understood. We studied the clinical impact of failing to adhere to a peritoneal dialysis training programme among incident dialysis patients.
This study included 159 consecutive inception peritoneal dialysis patients in a single centre from September 1999 through November 2002. We evaluated the effects of behavioural compliance quantified by the per cent time arriving late for scheduled peritoneal dialysis training. The patients were categorized by whether they arrived late in >20% of their peritoneal dialysis training sessions.
Of the 159 incident peritoneal dialysis patients (mean age 57 +/- 13 years) who attended peritoneal dialysis training, 70 subjects (44%) arrived late in >20% of the sessions. They were younger by 5 years than patients who arrived late < or =20%. Mean peritonitis-free time for subjects who arrived late for training in >20% the of sessions was 30.9 months, as compared with 41.8 months in subjects with < or =20% late attendance behaviour (log rank test, P = 0.038). Multivariable Cox proportional hazards analysis showed that late attendance behaviour and baseline serum albumin were the only independent risk factors for the time to a first peritonitis after adjustment for diabetes mellitus and relevant coexisting medical factors. Late arrival in >20% of the peritoneal dialysis training sessions was associated with >50% increased likelihood of subsequent peritonitis, with an adjusted risk ratio of 1.56 (95% confidence interval, 1.02-2.39; P = 0.04).
These findings show that the behavioural measure of late attendance for peritoneal dialysis training has a crucial role in predicting peritonitis. It may therefore represent a practical strategy for identifying poor adherence or predicting medical outcomes.
腹膜透析培训期间的缩短行为易于测量，类似于血液透析患者的跳过行为，尽管其对腹膜透析结局的影响目前已得到充分了解。我们研究了新发病透析患者未坚持腹膜透析培训计划的临床影响。
本研究纳入了1999年9月至2002年11月期间在单一中心连续入组的159例新发病腹膜透析患者。我们评估了通过预定腹膜透析培训迟到时间百分比量化的行为依从性的影响。根据患者在>20%的腹膜透析培训课程中是否迟到进行分类。
在参加腹膜透析培训的159例新发病腹膜透析患者（平均年龄57±13岁）中，70例患者（44%）在>20%的课程中迟到。他们比迟到≤20%的患者年轻5岁。培训迟到>20%课程的患者无腹膜炎平均时间为30.9个月，而迟到≤20%行为的患者为41.8个月（对数秩检验，P=0.038）。多变量Cox比例风险分析表明，在调整糖尿病和相关并存医疗因素后，迟到行为和基线血清白蛋白是首次发生腹膜炎时间的仅有的独立危险因素。腹膜透析培训课程迟到>20%与随后发生腹膜炎的可能性增加>50%相关，调整后的风险比为1.56（95%置信区间，1.02-2.39；P=0.04）。
这些发现表明，腹膜透析培训迟到的行为指标在预测腹膜炎方面具有关键作用。因此，它可能代表一种识别依从性差或预测医疗结局的实用策略。
