限制因素、自我护理障碍和支持对腹膜透析应用发生率的影响。

Impact of contraindications, barriers to self-care and support on incident peritoneal dialysis utilization.

机构信息

Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada.

出版信息

Nephrol Dial Transplant. 2010 Aug;25(8):2737-44. doi: 10.1093/ndt/gfq085. Epub 2010 Feb 25.

DOI:10.1093/ndt/gfq085

PMID:20189930

Abstract

BACKGROUND

Targets for peritoneal dialysis (PD) utilization may be difficult to achieve because many older patients have contraindications to PD or barriers to self-care. The objectives of this study were to determine the impact that contraindications and barriers to self-care have on incident PD use, and to determine whether family support increased PD utilization when home care support is available.

METHODS

Consecutive incident dialysis patients were assessed for PD eligibility, offered PD if eligible and followed up for PD use. All patients lived in regions where home care assistance was available.

RESULTS

The average patient age was 66 years. One hundred and ten (22%) of the 497 patients had absolute medical or social contraindications to PD. Of the remaining 387 patients who were potentially eligible for PD, 245 (63%) had at least one physical or cognitive barrier to self-care PD. Patients with barriers were older, weighed less and were more likely to be female, start dialysis as an inpatient and have a history of vascular disease, cardiac disease and cancer. Family support was associated with an increase in PD eligibility from 63% to 80% (P = 0.003) and PD choice from 40% to 57% (P = 0.03) in patients with barriers to self-care. Family support increased incidence PD utilization from 23% to 39% among patients with barriers to self-care (P = 0.009). When family support was available, 34% received family-assisted PD, 47% received home care-assisted PD, 12% received both family- and home care-assisted PD, and 7% performed only self-care PD. Incident PD use in an incident end-stage renal disease (ESRD) population was 30% (147 of the 497 patients).

CONCLUSIONS

Contraindications, barriers to self-care and the availability of family support are important drivers of PD utilization in the incident ESRD population even when home assistance is available. These factors should be considered when setting targets for PD.

摘要

背景

腹膜透析（PD）的目标可能难以实现，因为许多老年患者对 PD 有禁忌症或自我护理障碍。本研究的目的是确定禁忌症和自我护理障碍对 PD 使用率的影响，并确定家庭支持是否会增加 PD 的利用率，前提是有家庭护理支持。

方法

对连续发生的透析患者进行 PD 适用性评估，如果符合条件，为其提供 PD，并对 PD 的使用情况进行随访。所有患者均居住在有家庭护理援助的地区。

结果

患者的平均年龄为 66 岁。497 名患者中，有 110 名（22%）存在 PD 的绝对医学或社会禁忌症。在其余 387 名有潜在 PD 资格的患者中，有 245 名（63%）存在至少一种身体或认知方面的自我护理 PD 障碍。有障碍的患者年龄较大，体重较轻，更有可能是女性，开始透析时为住院患者，并且有血管疾病、心脏病和癌症病史。家庭支持与自我护理障碍患者的 PD 适用性从 63%增加到 80%（P=0.003）和 PD 选择从 40%增加到 57%（P=0.03）相关。在有自我护理障碍的患者中，家庭支持使 PD 的发生率从 23%增加到 39%（P=0.009）。当有家庭支持时，34%的患者接受了家庭辅助 PD，47%的患者接受了家庭护理辅助 PD，12%的患者同时接受了家庭和家庭护理辅助 PD，7%的患者仅进行了自我护理 PD。在新发生的终末期肾脏疾病（ESRD）人群中，PD 的发生率为 30%（497 名患者中有 147 名）。