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 Nov;42(6):602-614. doi: 10.1177/08968608221078903. Epub 2022 Feb 15.
Although caregivers allow peritoneal dialysis (PD) patients with disabilities the opportunity to perform PD, it is crucial to clarify the safety and effectiveness of assisted PD performed by caregivers compared to self-PD.
PD patients from 22 PD centres in Thailand were prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study during 2016-2017. Patients receiving assisted PD performed by caregivers were matched 1:1 with self-PD patients using propensity scores calculated by logistic regression. The associations between assisted PD and risk of mortality, peritonitis and permanent transfer to haemodialysis (HD) were assessed by multivariable competing risk regression.
Of 778 eligible patients, 447 (57%) required assisted PD performed by caregivers. Most of the caregivers were family members (98%), while the rest were non-family paid caregivers (2%). Patient factors associated with assisted PD were older age, female gender, lower educational level, cardiovascular comorbidities, diabetes, automated PD modality, poorer functional status and lower blood chemistries (albumin, creatinine, sodium, potassium and phosphate). After 1:1 matching, the baseline characteristics were adequately matched, and 269 patients in each group were analysed. Compared with self-PD, assisted PD was significantly associated with an increased risk of all-cause mortality (adjusted sub-hazard ratio: 2.15, 95% confidence interval: 1.24-3.74). There were no differences in the occurrences of peritonitis and permanent HD transfer between the groups.
Assisted PD was required by more than half of Thai PD patients and was independently associated with a higher mortality risk. This may reflect causal effect or confounding by indication.
尽管照料者为残疾的腹膜透析（PD）患者提供了进行 PD 的机会，但明确照料者辅助 PD 与患者自我 PD 的安全性和有效性至关重要。
2016-2017 年，在腹膜透析结局和实践模式研究中，前瞻性随访了来自泰国 22 个 PD 中心的 PD 患者。通过逻辑回归计算的倾向评分，将接受照料者辅助 PD 的患者与自我 PD 患者进行 1:1 匹配。通过多变量竞争风险回归评估辅助 PD 与死亡率、腹膜炎和永久性转血液透析（HD）的风险之间的关联。
在 778 名符合条件的患者中，447 名（57%）需要照料者辅助 PD。大多数照料者是家庭成员（98%），其余是非家庭成员付费照料者（2%）。与辅助 PD 相关的患者因素包括年龄较大、女性、教育程度较低、心血管合并症、糖尿病、自动化 PD 模式、功能状态较差以及血液化学物质（白蛋白、肌酐、钠、钾和磷酸盐）水平较低。在 1:1 匹配后，基线特征得到充分匹配，每组 269 名患者进行分析。与自我 PD 相比，辅助 PD 与全因死亡率增加显著相关（调整后的亚风险比：2.15，95%置信区间：1.24-3.74）。两组之间腹膜炎和永久性 HD 转归的发生率没有差异。
超过一半的泰国 PD 患者需要辅助 PD，且与死亡率升高独立相关。这可能反映了因果关系或指示性混杂。
