Wilk Adam S, Tang Zhaoli, Hoge Courtney, Plantinga Laura C, Lea Janice P
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Hemodial Int. 2019 Oct;23(4):479-485. doi: 10.1111/hdi.12782. Epub 2019 Oct 3.
Compared to traditional in-center hemodialysis (HD), in-center nocturnal dialysis (INHD) is characterized by longer sessions and nighttime administration, which may lead to better outcomes for some patients. Given the importance of patient choice in the decision to initiate INHD, we explored associations between patients' psychosocial characteristics and their receipt of INHD.
Among hemodialysis patients at a medium-sized dialysis organization, we identified INHD patients as those for whom ≥80% of dialysis sessions were INHD sessions-starting at 6:30 pm or later and lasting ≥5 hours-over the 3 months (≥20 sessions total) after their first INHD session. We extracted dialysis session data from electronic medical records and psychosocial data from social worker assessments. We tested associations of patients' psychosocial characteristics-as well as demographic and clinical characteristics-with INHD receipt among all hemodialysis patients (INHD and HD) in bivariate analyses and multivariable logistic regression models.
Among 759 patients with complete data, we identified 47 (6.2%) as INHD patients. On average, these patients were more likely than HD patients to be employed (full-time 10.6% vs. 5.2%; part-time 17.0% vs. 4.2%; P < 0.001), and they were significantly less likely to require ambulatory assistance (14.9% vs. 39.6%, P < 0.001). In multivariable regressions, we found that part-time employment (versus being unemployed) was associated with a 7.1 percentage-point higher likelihood of being an INHD patient (P = 0.01), and the negative association with ambulatory assistance needs approached statistical significance (P = 0.056). No other psychosocial factors included in this main regression analysis were statistically significantly associated with INHD patient status.
Researchers comparing the outcomes of patients undergoing INHD versus other treatment modalities will need to account for differences in employment status-and other factors like requiring ambulatory assistance and age which may predict the ability to work-between INHD users and comparison patients to avoid bias in estimates.
与传统的中心血液透析（HD）相比，中心夜间透析（INHD）的特点是透析时间更长且在夜间进行，这可能会使部分患者获得更好的治疗效果。鉴于患者选择对于启动INHD的决策至关重要，我们探讨了患者的心理社会特征与其接受INHD之间的关联。
在一家中型透析机构的血液透析患者中，我们将INHD患者定义为在首次进行INHD治疗后的3个月内（总计≥20次透析），≥80%的透析治疗为INHD治疗（即下午6:30或更晚开始且持续≥5小时）的患者。我们从电子病历中提取透析治疗数据，并从社会工作者评估中提取心理社会数据。我们在双变量分析和多变量逻辑回归模型中，检验了所有血液透析患者（INHD和HD患者）的心理社会特征以及人口统计学和临床特征与接受INHD之间的关联。
在759例有完整数据的患者中，我们确定了47例（6.2%）为INHD患者。平均而言，这些患者比HD患者更有可能就业（全职10.6%对5.2%；兼职17.0%对4.2%；P<0.001），且他们需要非卧床辅助的可能性显著更低（14.9%对39.6%，P<0.001）。在多变量回归中，我们发现兼职工作（相对于失业）与成为INHD患者的可能性高7.1个百分点相关（P = 0.01），且与非卧床辅助需求的负相关接近统计学显著性（P = 0.056）。该主要回归分析中纳入的其他心理社会因素与INHD患者状态均无统计学显著关联。
比较接受INHD与其他治疗方式的患者结局的研究人员，需要考虑就业状况的差异以及其他因素，如需要非卧床辅助和年龄，这些因素可能预测INHD使用者与对照患者之间的工作能力，以避免估计中的偏差。
