Harford Antonia, Gul Ambreen, Cumber Serena, Paine Susan, Schrader Ronald, Trujillo Nicole, Zager Philip
University of New Mexico, Health Sciences Center, Division of Nephrology, Albuquerque, New Mexico, USA.
Dialysis Clinic, Inc., Quality Management, Albuquerque, New Mexico, USA.
Hemodial Int. 2017 Oct;21 Suppl 2:S27-S32. doi: 10.1111/hdi.12598.
Modifiable hemodialysis treatment parameters may impact patient reported outcomes, including recovery time. Answers to the recovery question may predict the impact of treatment parameters on clinical outcomes and health related quality of life. However, the reliability of answers to the recovery question after consecutive and nonconsecutive dialysis treatments in diverse populations has not been established.
To assess the reliability of this instrument and to determine if recovery time was associated with modifiable dialysis parameters, we conducted a quality assurance project in which we asked, "How long did it take you to recover from your last dialysis session?" after consecutive and nonconsecutive treatments.
We asked patients the recovery question ≤ seven times. We computed polychoric correlations to assess within patient correlations. We used random intercept ordinal logistic regression models to test for associations of recovery time with patient variables.
We obtained answers to the recovery question in association with 1572 treatments in 364 patients. Recovery time was <2 hours in 52.1%; 2 to 7 hours in 20.9%; and >7 hours in 27.0% of treatments. Polychoric correlations demonstrated highly reliable responses within individual patients between consecutive and nonconsecutive treatments. Prolonged recovery was associated with a dialysate potassium of 1 vs. 2 mEq/L (odds ratio [OR] 2.25 {95% confidence interval [CI] 1.43-3.55}) and 1 vs. 3 mEq/L (OR 1.88 [95% CI 1.06-3.33]); vintage >6 months (OR 2.43 [95% CI 1.42-4.16]), body mass index >35 kg/m (OR 1.94 [95% CI 1.18-3.20]), post-dialysis systolic blood pressure (SBP) <115 mmHg (OR 1.57 [95% CI 1.04-2.37]) and intradialytic cramps (OR 1.76 [95% CI 1.09-2.86]). There were no associations with gender, race, age, ESRD etiology, intradialytic SBP <90 mmHg, serum sodium or potassium, dialysate sodium, bicarbonate or temperature, blood flow rate, or ultrafiltration rate.
Responses to the recovery question were reliable and low dialysate potassium was associated with prolonged recovery.
可调整的血液透析治疗参数可能会影响患者报告的结果，包括恢复时间。对恢复问题的回答可能预测治疗参数对临床结果和健康相关生活质量的影响。然而，在不同人群中连续和非连续透析治疗后对恢复问题回答的可靠性尚未确定。
为了评估该工具的可靠性，并确定恢复时间是否与可调整的透析参数相关，我们开展了一个质量保证项目，在连续和非连续治疗后询问患者：“你从上一次透析治疗中恢复过来花了多长时间？”
我们向患者询问恢复问题的次数≤7次。我们计算了多相相关系数以评估患者内部的相关性。我们使用随机截距有序逻辑回归模型来检验恢复时间与患者变量之间的关联。
我们获得了364例患者1572次治疗的恢复问题答案。52.1%的治疗恢复时间<2小时；20.9%为2至7小时；27.0%的治疗恢复时间>7小时。多相相关系数表明，在连续和非连续治疗之间，个体患者的回答具有高度可靠性。恢复时间延长与透析液钾浓度1 vs. 2 mEq/L（优势比[OR] 2.25 {95%置信区间[CI] 1.43 - 3.55}）和1 vs. 3 mEq/L（OR 1.88 [95% CI 1.06 - 3.33]）、透析龄>6个月（OR 2.43 [95% CI 1.42 - 4.16]）、体重指数>35 kg/m²（OR 1.94 [95% CI 1.18 - 3.20]）、透析后收缩压（SBP）<115 mmHg（OR 1.57 [95% CI 1.04 - 2.37]）以及透析中痉挛（OR 1.76 [95% CI 1.09 - 2.86]）相关。与性别、种族、年龄、终末期肾病病因、透析中SBP<90 mmHg、血清钠或钾、透析液钠、碳酸氢盐或温度、血流量或超滤率无关。
对恢复问题的回答是可靠的，透析液低钾与恢复时间延长相关。
