Parapiboon Watanyu, Pitsawong Wannapat, Wongluechai Laddaporn, Thammavaranucupt Kanin, Raegasint Lalana
Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
Kidney Res Clin Pract. 2020 Dec 31;39(4):451-459. doi: 10.23876/j.krcp.20.035.
Indecision regarding the start of peritoneal dialysis (PD) is a challenging problem in chronic kidney disease (CKD) stage 5 patients who receive conventional video counseling. This study aimed to evaluate the effect of video counseling customized to the local context versus conventional video counseling on PD decision-making in CKD stage 5 patients under PD-first policy.
We enrolled 120 patients with stage 5 CKD in Thailand who initiate PD between May 2016 to January 2017 in a randomized, open-label, controlled study. Patients were randomized to either a customized or conventional video counseling group. The primary outcome was PD acceptance rate with complete PD catheter insertion on schedule. The secondary outcomes were change in patient knowledge and confidence in PD and reasons for indecision PD.
We analyzed 120 patients (customized, n = 60 vs. conventional, n = 60). The two groups were similar for age (55 vs. 56 years), blood urea nitrogen (89 vs. 86 mg/dL), creatinine (10.37 vs. 11.29 mg/dL), and eGFR (4.7 vs. 5.6 mL/min/1.73 m2). The PD acceptance rate along with PD catheter insertion on schedule in the customized video counseling group was not significantly different from that in the conventional video counseling group (66.6% vs. 63.3%, relative risk: 0.97, 95% confidence interval: 0.73 to 1.29; P = 0.86). Patient knowledge of and confidence in PD increased after counseling, but the difference was not significant.
Among stage 5 CKD patients, counseling content customized to a local context did not differ in a rate of acceptance for beginning PD with PD catheter insertion on schedule compared with conventional video counseling.
对于接受传统视频咨询的慢性肾脏病（CKD）5期患者而言，腹膜透析（PD）起始时机的决策是一个具有挑战性的问题。本研究旨在评估针对当地情况定制的视频咨询与传统视频咨询对CKD 5期患者在PD优先策略下PD决策的影响。
我们在泰国招募了120例于2016年5月至2017年1月开始进行PD的CKD 5期患者，进行一项随机、开放标签、对照研究。患者被随机分为定制视频咨询组或传统视频咨询组。主要结局是按时完成PD导管插入的PD接受率。次要结局是患者对PD的知识和信心的变化以及PD决策犹豫的原因。
我们分析了120例患者（定制组，n = 60 vs. 传统组，n = 60）。两组在年龄（55岁 vs. 56岁）、血尿素氮（89 mg/dL vs. 86 mg/dL）、肌酐（10.37 mg/dL vs. 11.29 mg/dL）和估算肾小球滤过率（eGFR）（4.7 mL/min/1.73 m² vs. 5.6 mL/min/1.73 m²）方面相似。定制视频咨询组按时进行PD导管插入的PD接受率与传统视频咨询组相比无显著差异（66.6% vs. 63.3%，相对风险：0.97，95%置信区间：0.73至1.29；P = 0.86）。咨询后患者对PD的知识和信心有所增加，但差异不显著。
在CKD 5期患者中，与传统视频咨询相比，针对当地情况定制的咨询内容在按时进行PD导管插入开始PD的接受率方面没有差异。
