Department of Medicine, Phayao Hospital, Phayao, Thailand.
Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand.
Nephrology (Carlton). 2023 Aug;28 Suppl 1:35-47. doi: 10.1111/nep.14224.
Patient-reported outcome measures (PROMs) are widely recognized as valuable predictors of clinical outcomes in peritoneal dialysis (PD). Our study aimed to explore the connections between patient-reported constipation and clinical outcomes.
We assessed constipation in patients across 22 facilities participating in the Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014 to 2017. Constipation diagnosis utilized objective assessment tools such as the Bristol stool form scale (BSFS) and a self-reported questionnaire known as the constipation severity score (CSS). The BSFS is a 7-level scale that visually inspects feces based on texture and morphology, while the CSS measures constipation duration and severity using a 5-point Likert scale for various factors. We employed Cox proportional hazards model regression to determine the associations between constipation and clinical outcomes, including mortality, hemodialysis (HD) transfer and peritonitis.
Among 975 randomly selected PD patients from 22 facilities, 845 provided written informed consent, and 729 completed CSS questionnaire. Constipation was prevalent in the PD population (13%), particularly among older patients, those who were caregiver dependent, had diabetes and poorer nutritional status (indicated by lower time-averaged serum albumin, potassium, creatinine and phosphate concentrations). Twenty-seven percent of which experiencing symptoms of constipation for over a year. Notably, self-reported constipation at baseline was significantly associated with a shorter time to first peritonitis and higher rates of peritonitis and death. However, no significant association was found between constipation and HD transfer after adjusting for various factors, including age, gender, PD vintage, comorbidities, shared frailty by study sites and serum albumin.
Patient-reported constipation independently correlated with increased risks of peritonitis and all-cause mortality, though no such correlation was observed with HD transfer. These findings underscore the need for further investigation to identify effective interventions for constipation in PD patients.
患者报告的结局测量（PROMs）被广泛认为是腹膜透析（PD）临床结局的有价值的预测指标。我们的研究旨在探讨患者报告的便秘与临床结局之间的关系。
我们评估了 2014 年至 2017 年参加泰国腹膜透析结局和实践模式研究（PDOPPS）的 22 个中心的患者的便秘情况。便秘诊断使用了客观评估工具，如布里斯托粪便形态量表（BSFS）和一种名为便秘严重程度评分（CSS）的自我报告问卷。BSFS 是一种 7 级量表，根据质地和形态对粪便进行视觉检查，而 CSS 使用 5 点 Likert 量表对各种因素的便秘持续时间和严重程度进行测量。我们采用 Cox 比例风险模型回归来确定便秘与临床结局（包括死亡率、血液透析（HD）转归和腹膜炎）之间的关系。
在 22 个中心的 975 名随机选择的 PD 患者中，845 名患者提供了书面知情同意书，729 名患者完成了 CSS 问卷。便秘在 PD 人群中很常见（13%），特别是在年龄较大的患者、依赖护理者的患者、患有糖尿病和营养状况较差（表现为血清白蛋白、钾、肌酐和磷酸盐浓度的时间平均浓度较低）的患者中。其中 27%的患者出现便秘症状超过一年。值得注意的是，基线时自我报告的便秘与首次腹膜炎发生时间较短以及腹膜炎和死亡发生率较高显著相关。然而，在调整了年龄、性别、PD 年限、合并症、研究地点共享脆弱性和血清白蛋白等各种因素后，便秘与 HD 转归之间没有显著关联。
患者报告的便秘与腹膜炎和全因死亡率的风险增加独立相关，但与 HD 转归无关。这些发现强调需要进一步研究，以确定 PD 患者便秘的有效干预措施。
