Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA.
Satellite Healthcare, San Jose, CA, USA.
Perit Dial Int. 2024 Jan;44(1):16-26. doi: 10.1177/08968608231214143. Epub 2023 Nov 28.
People on peritoneal dialysis (PD) at risk of transfer to haemodialysis (HD) need support to remain on PD or ensure a safe transition to HD. Simple point-of-care risk stratification tools are needed to direct limited dialysis centre resources. In this study, we evaluated the utility of collecting clinicians' identification of patients at high risk of transfer to HD using a single point of care question.
In this prospective observational study, we included 1275 patients undergoing PD in 35 home dialysis programmes. We modified the palliative care 'surprise question' (SQ) by asking the registered nurse and treating nephrologist: 'Would you be surprised if this patient transferred to HD in the next six months?' A 'yes' or 'no' answer indicated low and high risk, respectively. We subsequently followed patient outcomes for 6 months. Cox regression model estimated the hazard ratio (HR) of transfer to HD.
Patients' mean age was 59 ± 16 years, 41% were female and the median PD vintage was 20 months (interquartile range: 9-40). Responses were received from nurses for 1123 patients, indicating 169 (15%) as high risk and 954 (85%) as low risk. Over the next 6 months, transfer to HD occurred in 18 (11%) versus 29 (3%) of the high and low-risk groups, respectively (HR: 3.92, 95% confidence interval (CI): 2.17-7.05). Nephrologist responses were obtained for 692 patients, with 118 (17%) and 574 (83%) identified as high and low risk, respectively. Transfer to HD was observed in 14 (12%) of the high-risk group and 14 (2%) of the low-risk group (HR: 5.56, 95% CI: 2.65-11.67). Patients in the high-risk group experienced higher rates of death and hospitalisation than low-risk patients, with peritonitis events being similar between the two groups.
The PDSQ is a simple point of care tool that can help identify patients at high risk of transfer to HD and other poor clinical outcomes.
正在接受腹膜透析 (PD) 治疗且有转为血液透析 (HD) 风险的患者需要获得支持以继续进行 PD 治疗或确保安全过渡到 HD。需要简单的即时护理风险分层工具来指导有限的透析中心资源。在这项研究中，我们评估了使用单一即时护理问题收集临床医生识别高危患者转 HD 的能力。
在这项前瞻性观察研究中，我们纳入了 35 个家庭透析计划中 1275 名正在接受 PD 治疗的患者。我们修改了姑息治疗“惊讶问题”（SQ），询问注册护士和治疗肾病医生：“如果这名患者在接下来的六个月内转至 HD，您会感到惊讶吗？”回答“是”或“否”分别表示低风险和高风险。随后，我们对患者的 6 个月结局进行了随访。Cox 回归模型估计了转 HD 的风险比 (HR)。
患者的平均年龄为 59 ± 16 岁，41%为女性，PD 治疗的中位时间为 20 个月（四分位距：9-40）。1123 名患者收到了护士的回复，其中 169 名（15%）被认为是高风险，954 名（85%）是低风险。在接下来的 6 个月中，高风险组中有 18 名（11%）和低风险组中有 29 名（3%）患者转至 HD（HR：3.92，95%置信区间 (CI)：2.17-7.05）。我们获得了 692 名患者的肾病医生的回复，其中 118 名（17%）和 574 名（83%）被识别为高风险和低风险。在高风险组中观察到 14 名（12%）和低风险组中 14 名（2%）患者转至 HD（HR：5.56，95% CI：2.65-11.67）。高风险组患者的死亡率和住院率均高于低风险患者，两组间腹膜炎事件相似。
PDSQ 是一种简单的即时护理工具，可以帮助识别有高风险转 HD 和其他不良临床结局的患者。
