Department of Pediatric Nephrology, Gazi University Faculty of Medicine, Beşevler, Ankara, Turkey, 06500.
Department of Pediatric Nephrology, Eskişehir City Training and Research Hospital, Eskişehir, Turkey.
Pediatr Nephrol. 2023 Jul;38(7):2189-2198. doi: 10.1007/s00467-022-05842-5. Epub 2023 Jan 3.
Previous studies investigating hospitalizations in dialysis patients have focused primarily on patient-centered factors. We analyzed the impact of hospital and dialysis unit characteristics on pediatric dialysis patients' hospitalizations for access-related complications (ARCs).
This cross-sectional study involved 102 hemodialysis (HD) and 163 peritoneal dialysis (PD) patients. Data between July 2017 and July 2018 were analyzed.
Children's hospitals (CHs) had more pediatric nephrologists and longer PD experience (years) than general hospitals (GHs) (p = 0.026 and p = 0.023, respectively). A total of 53% of automated PD (APD) and 6% of continuous ambulatory PD (CAPD) patients were in CHs (p < 0.001). Ninety-three percent of APD and 69% of CAPD patients were treated in pediatric-specific PD units (p = 0.001). CHs had a higher prevalence in providing hemodiafiltration (HDF) than GHs (83% vs. 30%). Ninety-seven percent of HDF vs. 66% for conventional HD (cHD) patients, and 94% of patients with arteriovenous fistula (AVF) vs. 70% of those with central venous catheters (CVC), were dialyzed in pediatric-specific HD units (p = 0.001 and p = 0.016, respectively). Eighty patients (51 PD and 29 HD) had 135 (84 PD, 51 HD) hospitalizations. CAPD was an independent risk factor for hospitalizations for infectious ARCs (I-ARCs) (p = 0.009), and a health center's PD experience negatively correlated with CAPD patient hospitalizations for I-ARCs (p = 0.041). cHD and dialyzing in combined HD units significantly increased hospitalization risk for non-infectious (NI-)ARCs (p = 0.044 and p = 0.017, respectively).
CHs and pediatric-specific dialysis units have higher prevalence of APD and HDF use. Hospitalizations for I-ARCs in CAPD are lower in centers with longer PD experience, and pediatric HD units are associated with fewer hospitalizations due to NI-ARCs. A higher resolution version of the Graphical abstract is available as Supplementary information.
先前研究透析患者住院情况的研究主要集中在以患者为中心的因素上。我们分析了医院和透析单位特征对儿科透析患者因通路相关并发症（ARC）住院的影响。
这是一项横断面研究，共纳入 102 名血液透析（HD）患者和 163 名腹膜透析（PD）患者。分析了 2017 年 7 月至 2018 年 7 月的数据。
儿童医院（CH）比综合医院（GH）拥有更多的儿科肾病医生和更长的 PD 经验年限（分别为 p=0.026 和 p=0.023）。全自动 PD（APD）患者中有 53%，持续非卧床 PD（CAPD）患者中有 6%在 CH 接受治疗（p<0.001）。APD 患者中有 93%，CAPD 患者中有 69%在儿科 PD 单位接受治疗（p=0.001）。CH 提供血液透析滤过（HDF）的比例高于 GH（83%比 30%）。HDF 患者中有 97%，HD 患者中有 66%（常规 HD 患者 cHD）和 94%的动静脉瘘（AVF）患者，70%的中心静脉导管（CVC）患者在儿科专用 HD 单位接受治疗（p=0.001 和 p=0.016）。80 名患者（51 名 PD 和 29 名 HD）有 135 次（84 名 PD，51 名 HD）住院经历。CAPD 是感染性 ARC（I-ARC）住院的独立危险因素（p=0.009），且健康中心的 PD 经验与 CAPD 患者 I-ARC 住院呈负相关（p=0.041）。cHD 和在联合 HD 单位进行透析显著增加非感染性（NI-ARC）住院风险（p=0.044 和 p=0.017）。
CH 和儿科专用透析单位更常使用 APD 和 HDF。PD 经验年限较长的中心，CAPD 患者 I-ARC 住院率较低，儿科 HD 单位因 NI-ARC 住院率较低。
