Béchade Clémence, Lanot Antoine, Guillouët Sonia, Ficheux Maxence, Boyer Annabel, Lobbedez Thierry
Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France.
"ANTICIPE" U1086 INSERM-UCN, Centre François Baclesse, Caen, France.
Perit Dial Int. 2022 Mar;42(2):185-193. doi: 10.1177/08968608211039669. Epub 2021 Sep 13.
Diabetic patients often have physical impairment that could lead to manipulation errors in peritoneal dialysis (PD) and touch contamination. Nurse assistance in diabetic PD patients is known to help prevent peritonitis. We made the hypothesis that this lower risk of peritonitis was observed thanks to prevention of breach in aseptic procedure. We evaluated the impact of nurse-assisted PD on specific causes of peritonitis, especially on peritonitis due to a breach in aseptic procedure.
This was a retrospective observational study of the data from the French Language Peritoneal Dialysis Registry. All diabetic patients older than age 18 years starting PD in France between 1 January 2012 and 31 December 2015 were included in the study. The event of interest was the first peritonitis event due to a breach in aseptic procedure. Death, kidney transplantation and peritonitis due to another mechanism were considered as competing events. We examined the association of the covariates with all the possible outcomes using a subdistribution hazard model developed for survival analysis in the presence of competing risks.
Four thousand one hundred one diabetic patients incident in PD were included in the study. At least one peritonitis event occurred in 1611 patients over the study period. A breach in aseptic procedure was reported in 441/1611 cases (27.3%): 209/575 (36.3%) in the self-care PD group, 56/217 (25.8%) in the family-assisted PD group and 176/819 (21.5%) in the nurse-assisted PD group. Both nurse and family assistance were associated with a lower risk of peritonitis due to breach in aseptic procedure in bivariate analysis. After adjustment on age, modified Charlson index, sex and diabetic nephropathy, patients treated by nurse-assisted PD (subdistribution hazard ratio (sd-HR) 0.52, 95% confidence interval (CI) 0.40-0.67) and those treated by family-assisted PD (sd-HR 0.70, 95% CI 0.51-0.95) had a lower likelihood of peritonitis due to a connection error compared to self-care PD in multivariate analysis. The modality of assistance was not associated with other causes of peritonitis in the multivariate analysis.
While both nurse-assisted PD and family-assisted PD were associated with lower risk of peritonitis due to a breach in aseptic procedure compared to self-care PD in our study, the protective effect was greater with nurse assistance.
糖尿病患者常存在身体功能障碍，这可能导致腹膜透析（PD）操作失误及接触污染。已知护士协助糖尿病PD患者有助于预防腹膜炎。我们提出假设，即观察到腹膜炎风险较低是由于预防了无菌操作的违规。我们评估了护士协助PD对腹膜炎特定病因的影响，尤其是对因无菌操作违规导致的腹膜炎的影响。
这是一项对法语腹膜透析登记处数据的回顾性观察研究。纳入了2012年1月1日至2015年12月31日期间在法国开始PD的所有18岁以上糖尿病患者。感兴趣的事件是因无菌操作违规导致的首次腹膜炎事件。死亡、肾移植及因其他机制导致的腹膜炎被视为竞争事件。我们使用为存在竞争风险时的生存分析开发的亚分布风险模型，研究协变量与所有可能结局的关联。
4101例新发PD糖尿病患者纳入研究。在研究期间，1611例患者至少发生过一次腹膜炎事件。441/1611例（27.3%）报告存在无菌操作违规：自我护理PD组209/575例（36.3%），家庭协助PD组56/217例（25.8%），护士协助PD组176/819例（21.5%）。在双变量分析中，护士和家庭协助均与因无菌操作违规导致的腹膜炎风险较低相关。在对年龄、改良Charlson指数、性别和糖尿病肾病进行调整后，多变量分析显示，与自我护理PD相比，护士协助PD治疗的患者（亚分布风险比（sd-HR）0.52，95%置信区间（CI）0.40 - 0.67）和家庭协助PD治疗的患者（sd-HR 0.70，95% CI 0.51 - 0.95）因连接错误导致腹膜炎的可能性较低。在多变量分析中，协助方式与其他腹膜炎病因无关。
在我们的研究中，与自我护理PD相比，护士协助PD和家庭协助PD均与因无菌操作违规导致的腹膜炎风险较低相关，但护士协助的保护作用更大。
