Santa Casa de Misericórdia de Curitiba, PR, Brasil.
Instituto do Rim Carrascossi, Araraquara, SP, Brasil.
J Bras Nefrol. 2022 Oct-Dec;44(4):473-481. doi: 10.1590/2175-8239-JBN-2021-0113.
The coronavirus-19 pandemic threatens the lives of all people, but results in higher mortality rates for patients with end-stage kidney disease (ESKD) including those on peritoneal dialysis (PD). Telemedicine was the main alternative to reduce exposure to the virus, but it was introduced in the Brazil without proper training.
To investigate the impact of telemedicine on metabolic control, peritonitis rates, and hospitalization in PD patients during the pandemic.
This was a retrospective multicenter cohort study. We included all adult patients on chronic PD from 9 clinics selected by convenience during the pandemic. The outcomes of interest were measured and compared between before and after switching to telemedicine using repeated measure analysis and multilevel Poisson regression.
The study included 747 patients with a mean age of 59.7±16.6 years, of whom 53.7% were male and 40.8% had diabetes. Biochemical parameters including hemoglobin, potassium, phosphate, calcium, and urea serum levels did not change significantly after transition to telemedicine. There was no association between telemedicine and peritonitis rates. In contrast, hospitalization rates increased significantly in the telemedicine period. The incidence rate ratio (IRR) for hospitalization in the telemedicine period was 1.54 (95%CI 1.10-2.17; p 0.012) and 1.57 (95%CI 1.12-2.21; p 0.009) in the mixed-effects Poisson regression before and after adjustment for the presence of confounders. Admissions for hypervolemia and infections not related to PD doubled after transition to telemedicine.
The implementation of telemedicine without proper training may lead to an increase in adverse events in PD patients.
新冠疫情威胁着所有人的生命，但患有终末期肾病（ESKD）的患者，包括腹膜透析（PD）患者的死亡率更高。远程医疗是减少接触病毒的主要替代方法，但在巴西引入时没有进行适当的培训。
调查在疫情期间远程医疗对 PD 患者代谢控制、腹膜炎发生率和住院率的影响。
这是一项回顾性多中心队列研究。我们纳入了疫情期间通过便利选择的 9 个诊所中所有接受慢性 PD 的成年患者。使用重复测量分析和多层次泊松回归，比较了在转向远程医疗前后的相关结局。
研究纳入了 747 名平均年龄为 59.7±16.6 岁的患者，其中 53.7%为男性，40.8%患有糖尿病。血红蛋白、钾、磷、钙和尿素血清水平等生化参数在转向远程医疗后没有明显变化。远程医疗与腹膜炎发生率之间没有关联。相反，远程医疗期间的住院率显著增加。在调整混杂因素后，混合效应泊松回归分析显示远程医疗期间的住院率发生率比（IRR）为 1.54（95%CI 1.10-2.17；p=0.012）和 1.57（95%CI 1.12-2.21；p=0.009）。转向远程医疗后，与 PD 无关的感染和血容量过多导致的住院率增加了一倍。
在没有适当培训的情况下实施远程医疗可能会导致 PD 患者不良事件增加。
