Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France.
U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France.
BMC Nephrol. 2020 May 29;21(1):205. doi: 10.1186/s12882-020-01867-w.
Peritoneal dialysis (PD) is a home-based therapy performed by patients or their relatives in numerous cases, and the role of patients' educational practices in the risk of peritonitis is not well assessed. Our aim was to evaluate the effect of PD learning methods on the risk of peritonitis.
This was a retrospective multicentric study based on data from a French registry. All incident adults assisted by family or autonomous for PD exchanges in France between 2012 and 2015 were included. The event of interest was the occurrence of peritonitis. Cox and hurdle regression models were used for statistical analysis to asses for the survival free of peritonitis, and the risk of first and subsequent peritonitis.
1035 patients were included. 967 (93%) received education from a specialized nurse. Written support was used for the PD learning in 907 (87%) patients, audio support in 221 (21%) patients, and an evaluation grid was used to assess the comprehension in 625 (60%) patients. In the "zero" part of the hurdle model, the use of a written support and starting PD learning with hands-on training alone were associated with a lower survival free of peritonitis (respectively HR 1.59, 95%CI 1.01-2.5 and HR 1.94, 95%CI 1.08-3.49), whereas in the "count" part, the use of an audio support and starting of PD learning with hands-on training in combination with theory were associated with a lower risk of presenting further episodes of peritonitis after a first episode (respectively HR 0.55, 95%CI 0.31-0.98 and HR 0.57, 95%CI 0.33-0.96).
The various PD education modalities were associated with differences in the risk of peritonitis. Prospective randomized trials are necessary to confirm causal effect. Caregivers should assess the patient's preferred learning style and their literacy level and adjust the PD learning method to each individual.
腹膜透析（PD）是一种在家中进行的治疗方法，在许多情况下由患者或其亲属进行，患者的教育实践在腹膜炎风险中的作用尚未得到充分评估。我们的目的是评估 PD 学习方法对腹膜炎风险的影响。
这是一项基于法国登记处数据的回顾性多中心研究。纳入 2012 年至 2015 年间法国所有由家庭或自主进行 PD 交换的成年患者。主要事件为腹膜炎的发生。使用 Cox 和障碍回归模型进行统计分析，以评估无腹膜炎生存的情况，以及首次和随后腹膜炎的风险。
共纳入 1035 例患者。967 例（93%）接受了专业护士的教育。907 例（87%）患者使用书面支持进行 PD 学习，221 例（21%）患者使用音频支持，625 例（60%）患者使用评估表评估理解程度。在障碍模型的“零”部分，使用书面支持和单独进行实践培训开始 PD 学习与较低的无腹膜炎生存相关（分别 HR 1.59，95%CI 1.01-2.5 和 HR 1.94，95%CI 1.08-3.49），而在“计数”部分，使用音频支持和在进行 PD 学习时结合理论的实践培训与首次发作后出现进一步腹膜炎发作的风险降低相关（分别 HR 0.55，95%CI 0.31-0.98 和 HR 0.57，95%CI 0.33-0.96）。
各种 PD 教育模式与腹膜炎风险的差异相关。需要进行前瞻性随机试验以确认因果关系。护理人员应评估患者的首选学习方式和他们的读写水平，并根据个体调整 PD 学习方法。
