Milan Manani Sabrina, Virzì Grazia Maria, Morisi Niccolò, Marturano Davide, Tantillo Ilaria, Giuliani Anna, Miranda Nunzia, Brocca Alessandra, Alfano Gaetano, Donati Gabriele, Ronco Claudio, Zanella Monica
Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy.
IRRIV-International Renal Research Institute Foundation, 36100 Vicenza, Italy.
J Clin Med. 2024 Jan 11;13(2):411. doi: 10.3390/jcm13020411.
Peritoneal dialysis (PD), as a home treatment, ensures better patient autonomy and lower intrusiveness compared to hemodialysis. However, choosing PD comes with an increased burden of responsibility that the patient may not always be able to bear, due to advanced age and deteriorating health condition. Various approaches have been explored to address this issue and mitigate its primary complications. In this study, we aim to present the ongoing PD training at-home program implemented by the Vicenza PD Center, and evaluate its impact on patients' prognoses.
We enrolled 210 patients who underwent PD at Vicenza Hospital between 1 January 2019 and 1 January 2022 for a minimum of 90 days. Each patient was observed retrospectively for one year. We categorized the patients into three groups based on their level of autonomy regarding their PD management: completely independent patients; patients able to perform some parts of the PD method on their own, while the remaining aspects were carried out by a caregiver; and patients who required complete assistance from a caregiver, like in the assisted PD program (asPD).
A total of 70% of the PD population were autonomous regarding their PD therapy, 14% had an intermediate degree of autonomy, and 16% were entirely dependent on caregivers. The PD nurses performed a median of four home visits per patient per year, with a tendency to make more visits to patients with a lower degree of autonomy. All the groups achieved similar clinical outcomes. At the end of the year of observation, only 6% of the patients witnessed a decline in their autonomy level, whereas 7% demonstrated an enhancement in their level of autonomy, and 87% remained stable.
A home care assistance program ensures clinical support to a household with the purpose of improving the empowerment of the PD population and reducing the prevalence of assisted PD. Ongoing PD training at home helps patients to maintain a stable degree of autonomy and stay in their home setting, even though they present with relative attitudinal or social barriers.
腹膜透析（PD）作为一种居家治疗方式，与血液透析相比，能确保患者有更高的自主性且侵入性更低。然而，由于年龄增长和健康状况恶化，选择腹膜透析会带来患者可能难以承受的更大责任负担。人们已经探索了各种方法来解决这个问题并减轻其主要并发症。在本研究中，我们旨在介绍维琴察腹膜透析中心实施的现行腹膜透析居家培训项目，并评估其对患者预后的影响。
我们纳入了2019年1月1日至2022年1月1日期间在维琴察医院接受腹膜透析至少90天的210名患者。对每位患者进行了为期一年的回顾性观察。我们根据患者在腹膜透析管理方面的自主程度将患者分为三组：完全独立的患者；能够自行完成腹膜透析方法的某些部分，而其余部分由护理人员完成的患者；以及像在辅助腹膜透析项目（asPD）中那样需要护理人员完全协助的患者。
共有70%的腹膜透析患者在腹膜透析治疗方面具有自主性，14%具有中等自主程度，16%完全依赖护理人员。腹膜透析护士每年每位患者平均进行4次家访，并且倾向于对自主程度较低的患者进行更多家访。所有组都取得了相似的临床结果。在观察期结束时，只有6%的患者自主水平下降，而7%的患者自主水平提高，87%保持稳定。
居家护理援助项目为家庭提供临床支持，目的是增强腹膜透析患者的能力并降低辅助腹膜透析的发生率。持续的腹膜透析居家培训有助于患者保持稳定的自主程度并留在家庭环境中，即使他们存在相对的态度或社会障碍。
