Néphrologie, CHU CAEN, 14000 CAEN CEDEX 9, France.
RDPLF, 95300 Pontoise, France.
Nephrol Dial Transplant. 2017 Jun 1;32(6):1018-1023. doi: 10.1093/ndt/gfx051.
BACKGROUND.: This study investigated the centre effect on the risk of peritonitis in peritoneal dialysis (PD) patients.
METHODS.: This was a retrospective cohort study based on data from the French Language Peritoneal Dialysis Registry. We analysed 5017 incident patients starting PD between January 2008 and December 2012 in 127 PD centres. The end of the observation period was 1 January 2014. The event of interest was the first peritonitis episode. The analysis was performed with a multilevel Cox model and a Fine and Gray model.
RESULTS.: Among the 5017 patients, 3190 peritonitis episodes occurred in 1796 patients. There was significant heterogeneity between centres (variance of the random effect: 0.11). The variance of the centre effect was reduced by 9% after adjusting for patient characteristics and by 35% after adjusting on centre covariate. In the multivariate analysis with a multilevel Cox model, centre with a nurse specialized in PD or centre providing home visits before dialysis initiation decreased the centre effect on peritonitis. Patients treated in centres with a nurse specialized in PD or in centres providing home visits before dialysis initiation had a lower risk of peritonitis [cause-specific hazard ratio (cs-HR): 0.75 (95% confidence interval, CI, 0.67-0.83) and cs-HR: 0.87 (95% CI 0.76-0.97), respectively]. The data show that neither centre type nor centre volume influenced peritonitis risk. In the competing risk analysis, centre with a nurse specialized in PD and centre with home visits had a protective effect on peritonitis [sub-distribution HR (sd-HR): 0.77 (95% CI 0.70-0.85) and sd-HR: 0.85 (95% CI 0.77-0.94), respectively].
CONCLUSION.: There is a significant centre effect on the risk of peritonitis that can be decreased by home visits before dialysis initiation and by the presence of a nurse specialized in PD.
本研究调查了中心效应对腹膜透析（PD）患者腹膜炎风险的影响。
这是一项基于法国腹膜透析登记处数据的回顾性队列研究。我们分析了 2008 年 1 月至 2012 年 12 月期间在 127 个 PD 中心开始 PD 的 5017 例新发病例患者。观察期结束于 2014 年 1 月 1 日。观察终点是第一次腹膜炎发作。采用多层次 Cox 模型和 Fine-Gray 模型进行分析。
在 5017 例患者中，1796 例患者发生 3190 例腹膜炎发作。中心之间存在显著的异质性（随机效应方差：0.11）。调整患者特征后，中心效应的方差减少了 9%，调整中心协变量后减少了 35%。在多变量分析中，使用多层次 Cox 模型，有 PD 专科护士的中心或透析开始前提供家访的中心可降低腹膜炎的中心效应。在有 PD 专科护士的中心或透析开始前提供家访的中心接受治疗的患者，腹膜炎的风险较低[特定病因危害比（cs-HR）：0.75（95%置信区间，CI，0.67-0.83）和 cs-HR：0.87（95%CI 0.76-0.97）]。数据表明，中心类型和中心容量均不影响腹膜炎风险。在竞争风险分析中，有 PD 专科护士的中心和提供家访的中心对腹膜炎具有保护作用[亚分布危害比（sd-HR）：0.77（95%CI 0.70-0.85）和 sd-HR：0.85（95%CI 0.77-0.94）]。
中心效应对腹膜炎风险有显著影响，通过透析前家访和 PD 专科护士的存在可以降低这种影响。
