Rangaswamy Dharshan, Guddattu Vasudeva, Webster Angela C, Borlace Monique, Boudville Neil, Clayton Philip, Badve Sunil, Johnson David W, Sud Kamal
Department of Nephrology, Kasturba Hospital and Medical College, Manipal Academy of Higher Education, Manipal, Udupi, India.
Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Udupi, India.
Perit Dial Int. 2020 Mar;40(2):209-219. doi: 10.1177/0896860819894058. Epub 2020 Jan 17.
Icodextrin is a high molecular weight, starch-derived glucose polymer that is used as an osmotic agent in peritoneal dialysis (PD) to promote ultrafiltration. There has been wide variation in its use across Australia and the rest of the world, but it is unclear whether these differences are due to patient- or centre-related factors.
Using the Australia and New Zealand Dialysis and Transplant Registry, all adult patients (>18 years) who started PD in Australia between 1 January 2007 and 31 December 2014 were included. The primary outcome was icodextrin use at PD commencement. Hierarchical logistic regression clustered around the treatment centre was applied to determine the patient- and centre-related characteristics associated with icodextrin use. The impact of centre-level practice pattern variability on icodextrin uptake was estimated using the intra-cluster correlation coefficient (ICC).
Of 5948 patients starting on PD in 58 centres during the study period, 2002 (33.7%) received icodextrin from the outset. Overall uptake of icodextrin increased from 29% in 2010 to 42.5% in 2014. Patient-level characteristics associated with an increased likelihood of commencing PD with icodextrin included male sex (adjusted odds ratio (OR) 1.55, 95% confidence interval (CI) 1.35-1.77; < 0.001), prior haemodialysis or kidney transplantation (OR 1.26, 95% CI 1.09-1.47), obesity (OR 1.66, 95% CI 1.41-1.96), diabetes mellitus (OR 2.32, 95% CI 2.03-2.64) and residing in a postcode with the highest decile of socio-economic status (OR 1.43, 95% CI 1.11-1.85). The centre-level characteristic associated with an increased likelihood of commencing PD with icodextrin was routine assessment of a peritoneal equilibration test (OR 1.45, 95% CI 1.27-1.66). Centres with fewer patients on automated peritoneal dialysis (APD) were less likely to start on icodextrin (APD proportion <57%; OR 0.45, 95% CI 0.20-0.99). Centre factors accounted for 25% of the variation in icodextrin use solution among incident PD patients (ICC 0.25).
Icodextrin use in incident Australian PD patients is increasing variable and associated with both patient and centre characteristics. Centre-related factors explained 25% of variability in icodextrin use.
艾考糊精是一种高分子量的、由淀粉衍生的葡萄糖聚合物，在腹膜透析（PD）中用作渗透剂以促进超滤。其在澳大利亚和世界其他地区的使用存在很大差异，但尚不清楚这些差异是由患者相关因素还是中心相关因素导致的。
利用澳大利亚和新西兰透析与移植登记处的数据，纳入了2007年1月1日至2014年12月31日期间在澳大利亚开始进行PD的所有成年患者（>18岁）。主要结局是PD开始时使用艾考糊精的情况。应用围绕治疗中心聚类的分层逻辑回归来确定与使用艾考糊精相关的患者和中心特征。使用组内相关系数（ICC）估计中心层面实践模式变异性对艾考糊精使用的影响。
在研究期间，58个中心的5948例开始进行PD的患者中，2002例（33.7%）从一开始就接受了艾考糊精治疗。艾考糊精的总体使用率从2010年的29%增加到2014年的42.5%。与开始使用艾考糊精进行PD可能性增加相关的患者层面特征包括男性（调整后的优势比（OR）为1.55，95%置信区间（CI）为1.35 - 1.77；<0.001）、既往血液透析或肾移植（OR为1.26，95%CI为1.09 - 1.47）、肥胖（OR为1.66，95%CI为1.41 - 1.96）、糖尿病（OR为2.32，95%CI为2.03 - 2.64）以及居住在社会经济地位十分位数最高的邮政编码地区（OR为1.43，95%CI为1.11 - 1.85）。与开始使用艾考糊精进行PD可能性增加相关的中心层面特征是常规进行腹膜平衡试验评估（OR为1.45，95%CI为1.27 - 1.66）。接受自动腹膜透析（APD）治疗的患者较少的中心开始使用艾考糊精的可能性较小（APD比例<57%；OR为0.45），95%CI为0.20 - 0.99）。中心因素占新发病例PD患者中艾考糊精使用溶液变异性的25%（ICC为0.25）。
澳大利亚新发病例PD患者中艾考糊精的使用越来越多样化，且与患者和中心特征均相关。中心相关因素解释了艾考糊精使用变异性的25%。
