Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Université, Caen, France.
UNICAEN, UFR de Médecine, Normandie Université, Caen, France.
Nephrol Dial Transplant. 2022 Jul 26;37(8):1520-1528. doi: 10.1093/ndt/gfab354.
We aimed to evaluate sex differences in peritoneal dialysis (PD) outcomes and to explore direct and indirect effects of nurse-assisted PD on outcomes.
This was a retrospective study using data from the Registre de Dialyse Péritonéale de Langue Française of incident PD patients between 2005 and 2016. Cox proportional hazards modelling was used to analyse transfer to haemodialysis (HD), death, PD failure, peritonitis and renal transplantation. Mediation analyses with a counterfactual approach were carried out to evaluate natural direct and indirect effects of sex on transfer to HD and peritonitis, with nurse-assisted PD as a mediator a priori.
Of the 14 659 patients included, there were 5970 females (41%) and 8689 males (59%). Women were more frequently treated by nurse-assisted PD than men [2926/5970 (49.1%) versus 3357/8689 (38.7%)]. In the multivariable analysis, women had a lower risk of transfer to HD [cause-specific hazard ratio {cs-HR} 0.82 {95% confidence interval (CI) 0.77-0.88}], death [cs-HR 0.90 (95% CI 0.85-0.95)], peritonitis [cs-HR 0.82 (95% CI 0.78-0.87)], PD failure [cs-HR 0.86 (95% CI 0.83-0.90)] and a lower chance of undergoing transplant [cs-HR 0.83 (95% CI 0.77-0.90)] than men. There was a direct effect of sex on the risk of transfer to HD [cs-HR 0.82 (95% CI 0.82-0.83)], with an indirect effect of nurse-assisted PD [cs-HR 0.97 (95% CI 0.96-0.99)]. Nurse-assisted PD had no indirect effect on the risk of peritonitis.
Our results suggest that compared with men, women have a lower risk of both transfer to HD and peritonitis. Mediation analysis showed that nurse assistance was a potential mediator in the causal pathway between sex and transfer to HD.
本研究旨在评估腹膜透析（PD）结局的性别差异，并探讨护士辅助 PD 对结局的直接和间接影响。
这是一项回顾性研究，使用了 2005 年至 2016 年期间法国腹膜透析登记处中初发 PD 患者的数据。采用 Cox 比例风险模型分析转为血液透析（HD）、死亡、PD 失败、腹膜炎和肾移植的情况。采用反事实方法进行中介分析，以评估性别对转为 HD 和腹膜炎的直接和间接影响，并将护士辅助 PD 作为事先确定的中介因素。
在纳入的 14659 例患者中，女性 5970 例（41%），男性 8689 例（59%）。与男性相比，女性更常接受护士辅助 PD 治疗[2926/5970（49.1%）比 3357/8689（38.7%）]。多变量分析显示，女性转为 HD 的风险较低[特定原因风险比（cs-HR）0.82（95%置信区间（CI）0.77-0.88）]、死亡风险较低[cs-HR 0.90（95% CI 0.85-0.95）]、腹膜炎风险较低[cs-HR 0.82（95% CI 0.78-0.87）]、PD 失败风险较低[cs-HR 0.86（95% CI 0.83-0.90）]和移植机会较低[cs-HR 0.83（95% CI 0.77-0.90）]。性别对转为 HD 的风险有直接影响[cs-HR 0.82（95% CI 0.82-0.83）]，护士辅助 PD 有间接影响[cs-HR 0.97（95% CI 0.96-0.99）]。护士辅助 PD 对腹膜炎风险无间接影响。
与男性相比，女性转为 HD 和腹膜炎的风险均较低。中介分析表明，护士辅助可能是性别与转为 HD 之间因果关系的潜在中介因素。
