Valson Anna T, Asad Riyaz A, Radhakrishnan Radhika C, Sinha Shampa, Jacob Shibu, Varughese Santosh, Tamilarasi Veerasamy
Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
Perit Dial Int. 2018 Jul-Aug;38(4):305-308. doi: 10.3747/pdi.2017.00116.
Peritoneal dialysis (PD) penetration in India remains low despite the huge chronic kidney disease burden and unmet need for renal replacement therapy (RRT). In order to understand the socioeconomic reasons that govern patients' preference for hemodialysis (HD), we carried out an opinion survey among prevalent in-center HD patients at our institution using a multiple response questionnaire that was verbally administered to them at the dialysis facility by the investigators. Close to 80% were self-financed and 49.5% were on twice weekly HD. Despite the majority (95%) receiving RRT education from a nephrologist, 43.4% were not aware of PD as an RRT modality. The treating nephrologist's recommendation was the most important reason given for choosing HD (77.8%) and not choosing PD (69.7%). Other reasons for not choosing PD included lack of a dedicated caregiver or "clean area" at home (15.1%), fear of infection (15.1%), disruption of work (14.1%), and the high cost of PD (7%). The perceived advantages of HD over PD were greater convenience because of need for only twice or thrice weekly sessions (61%), supervised care received in a hospital setting (28.8%), and less disruption of the patient's and family's routine (22%). We discuss the implications of these findings and what policy makers and nephrologists in India and other developing countries can do to improve PD penetration and utilization.
尽管印度慢性肾病负担沉重且肾替代治疗（RRT）需求未得到满足，但腹膜透析（PD）的普及率仍然很低。为了了解影响患者选择血液透析（HD）的社会经济原因，我们在本机构对接受中心血液透析的患者进行了一项意见调查，使用多选项问卷，由研究人员在透析设施中对他们进行口头询问。近80%的患者是自费，49.5%的患者每周接受两次血液透析。尽管大多数患者（95%）接受过肾病专家的肾替代治疗教育，但43.4%的患者不知道腹膜透析也是一种肾替代治疗方式。选择血液透析（77.8%）和不选择腹膜透析（69.7%）的最重要原因是主治肾病专家的建议。不选择腹膜透析的其他原因包括家中缺乏专门的护理人员或“清洁区域”（15.1%）、担心感染（15.1%）、工作受到影响（14.1%）以及腹膜透析成本高（7%）。血液透析相对于腹膜透析的明显优势在于，每周只需进行两到三次透析，更加方便（61%），在医院环境中接受监督护理（28.8%），以及对患者及其家人日常生活的干扰较少（22%）。我们讨论了这些研究结果的意义，以及印度和其他发展中国家的政策制定者和肾病专家可以采取哪些措施来提高腹膜透析的普及率和利用率。
