Kanjanabuch Talerngsak, Puapatanakul Pongpratch, Halue Guttiga, Lorvinitnun Pichet, Tangjittrong Kittisak, Pongpirul Krit, Narenpitak Surapong, Boonyakrai Chanchana, Tatiyanupanwong Sajja, Chieochanthanakij Rutchanee, Treamtrakanpon Worapot, Parinyasiri Uraiwan, Lounseng Niwat, Songviriyavithaya Phichit, Sritippayawan Suchai, Perl Jeffrey, Pecoits-Filho Roberto, Robinson Bruce, Davies Simon J, Johnson David W, Tungsanga Kriang
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Perit Dial Int. 2022 Jan;42(1):83-91. doi: 10.1177/0896860821993950. Epub 2021 Mar 11.
Despite the implementation of a 'Peritoneal Dialysis (PD) First' policy in Thailand since 2008, nationwide PD practices and patients' outcomes have rarely been reported.
As part of the multinational PD Outcomes and Practice Patterns Study (PDOPPS), PD patients from 22 PD centres from different geographic regions, sizes and affiliations, representing Thailand PD facilities, have been enrolled starting in May 2016. Demographic, clinical and laboratory data and patients' outcomes were prospectively collected and analysed.
The pilot and implementation phases demonstrated excellent concordance between study data and validation data collected at enrolment. In the implementation phase, 848 PD patients (including 262 (31%) incident PD patients) were randomly sampled from 5090 patients in participating centres. Almost all participants (95%) performed continuous ambulatory PD (CAPD), and a high proportion had hypoalbuminemia (67%, serum albumin < 3.5 g/dL), anaemia (42%, haemoglobin <10 g/dL) and hypokalaemia (37%, serum potassium < 3.5 mmol/L). The peritonitis rate was 0.40 episodes/year, but the culture-negative rate was high (0.13 episodes/year, 28% of total episodes). The patients from PD clinics located in Bangkok metropolitan region had higher socio-economic status, more optimal nutritional markers, blood chemistries, haemoglobin level and lower peritonitis rates compared to the provincial regions, emphasizing the centre effect on key success factors in PD.
Participation in the PDOPPS helps unveil the critical barriers to improving outcomes of PD patients in Thailand, including a high prevalence of hypokalaemia, anaemia, poor nutritional status and culture-negative peritonitis. These factors should be acted upon to formulate solutions and implement quality improvement on a national level.
尽管泰国自2008年起实施了“优先腹膜透析（PD）”政策，但全国范围内的腹膜透析实践及患者预后情况鲜有报道。
作为跨国腹膜透析结局与实践模式研究（PDOPPS）的一部分，自2016年5月起，来自泰国不同地理区域、规模和附属机构的22个腹膜透析中心的腹膜透析患者被纳入研究，这些中心代表了泰国的腹膜透析设施。前瞻性收集并分析了人口统计学、临床和实验室数据以及患者的预后情况。
试点阶段和实施阶段表明，研究数据与入组时收集的验证数据之间具有高度一致性。在实施阶段，从参与中心的5090例患者中随机抽取了848例腹膜透析患者（包括262例（31%）新发病例）。几乎所有参与者（95%）都进行持续性非卧床腹膜透析（CAPD），且很大一部分患者患有低蛋白血症（67%，血清白蛋白<3.5g/dL）、贫血（42%，血红蛋白<10g/dL）和低钾血症（37%，血清钾<3.5mmol/L）。腹膜炎发生率为0.40次/年，但培养阴性率较高（0.13次/年，占总发作次数的28%）。与省级地区相比，位于曼谷大都市区的腹膜透析诊所的患者具有更高的社会经济地位、更理想的营养指标、血液化学指标、血红蛋白水平以及更低的腹膜炎发生率，这凸显了中心对腹膜透析关键成功因素的影响。
参与PDOPPS有助于揭示泰国改善腹膜透析患者预后的关键障碍，包括低钾血症、贫血、营养状况差和培养阴性腹膜炎的高患病率。应针对这些因素制定解决方案并在全国范围内实施质量改进措施。
