Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
Wessex Renal and Transplant Service, Queen Alexandra Hospital, Portsmouth, UK.
Sci Rep. 2017 Jul 12;7(1):5214. doi: 10.1038/s41598-017-05544-1.
The prevalence of patients on automated peritoneal dialysis (APD) is increasing worldwide and may be guided by clinical characteristics, financial issues and patient option. Whether socioeconomic factors at the patient level may influence the decision for the initial peritoneal dialysis (PD) modality is unknown. This is a prospective cohort study. The primary outcome of interest was the probability to start PD on APD. The inclusion criteria were adult patients incident in PD. Exclusion criteria were missing data for either race or initial PD modality. We used a mixed-model analysis clustering patients according to their PD center and region of the country. We included 3,901 patients of which 1,819 (46.6%) had APD as their first modality. We found a significant disparity for race and educational level with African American patients less likely to start on APD (Odds ratio 0.74 CI95% 0.58-0.94) compared to Whites whilst those with greater educational levels were more likely to start on APD (Odds ratio 3.70, CI95% 2.25-6.09) compared to illiterate patients. Limiting the use of APD in disadvantaged population may be unethical. Demographics and socioeconomic status should not be necessarily part of the decision-making process of PD modality choice.
全球接受自动化腹膜透析（APD）治疗的患者人数不断增加，这种趋势可能受到临床特征、经济因素和患者选择的影响。目前尚不清楚患者层面的社会经济因素是否会影响初始腹膜透析（PD）方式的选择。本研究为前瞻性队列研究。主要研究结果为开始 APD 治疗的概率。纳入标准为新开始 PD 治疗的成年患者。排除标准为种族或初始 PD 方式的数据缺失。我们采用混合模型分析，根据患者的 PD 中心和所在地区对患者进行聚类。共纳入 3901 名患者，其中 1819 名（46.6%）患者的初始 PD 方式为 APD。研究发现，患者的种族和受教育程度存在显著差异，与白人患者相比，非裔美国人开始 APD 治疗的可能性较低（比值比 0.74，95%置信区间 0.58-0.94），而受教育程度较高的患者开始 APD 治疗的可能性更高（比值比 3.70，95%置信区间 2.25-6.09）。与文盲患者相比。限制在弱势群体中使用 APD 可能不道德。人口统计学和社会经济状况不一定应成为 PD 方式选择决策过程的一部分。
