University of Sheffield, Sheffield, United Kingdom.
University of Keele, Keele, United Kingdom.
Am J Kidney Dis. 2019 Jul;74(1):101-110. doi: 10.1053/j.ajkd.2018.12.033. Epub 2019 Feb 22.
In many countries, the use of peritoneal dialysis (PD) remains low despite arguments that support its greater use, including dialysis treatment away from hospital settings, avoidance of central venous catheters, and potential health economic advantages. Training patients to manage aspects of their own care has the potential to enhance health literacy and increase patient involvement, independence, quality of life, and cost-effectiveness of care. Complex reasons underlie the variable use of PD across the world, acting at the level of the patient, the health care team that is responsible for them, and the health care system that they find themselves in. Important among these is the availability of competitively priced dialysis fluid. A number of key interventions can affect the uptake of PD. These include high-quality patient education around dialysis modality choice, timely and successful catheter placement, satisfactory patient training, and continued support that is tailored for specific needs, for example, when people present late requiring dialysis. Several health system changes have been shown to increase PD use, such as targeted funding, PD First initiatives, or physician-inserted PD catheters. This review explores the factors that explain the considerable international variation in the use of PD and presents interventions that can potentially affect them.
在许多国家，尽管有论据支持更多地使用腹膜透析（PD），包括在医院环境之外进行透析治疗、避免使用中心静脉导管，以及具有潜在的健康经济效益，但 PD 的使用仍然很低。培训患者管理自身护理的各个方面，有可能提高健康素养，增加患者的参与度、独立性、生活质量以及护理的成本效益。复杂的原因导致 PD 在全球的使用情况存在差异，这些原因存在于患者、负责他们的医疗保健团队以及他们所处的医疗保健系统三个层面。其中重要的一点是价格有竞争力的透析液的供应情况。一些关键的干预措施可以影响 PD 的采用。这些措施包括围绕透析方式选择进行高质量的患者教育、及时和成功的置管、令患者满意的培训，以及根据具体需求提供的持续支持，例如，当人们需要透析时已经很晚了。已经有多项卫生系统的改变被证明可以增加 PD 的使用，例如有针对性的资金投入、PD 优先倡议或医生插入 PD 导管。本综述探讨了导致 PD 使用情况在国际上存在巨大差异的因素，并介绍了可能影响这些因素的干预措施。
