Renal Unit, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
Cardiff and Vale NHS Trust, Cardiff, UK.
BMJ Open. 2024 Feb 13;14(2):e082386. doi: 10.1136/bmjopen-2023-082386.
To identify the factors that determine treatment choices following pre-dialysis education.
Retrospective cohort study using data linkage with univariate and multivariate analyses using linked data.
Secondary care National Health Service Wales healthcare system.
All people in Wales over 18 years diagnosed with established kidney disease, who received pre-dialysis education between 1 January 2016 and 12 December 2018.
Patient choice of dialysis modality and any kidney replacement therapy started.
Mean age was 67 years; n=1207 (60%) were male, n=878 (53%) had ≥3 comorbidities, n=805 (66%) had mobility problems, n=700 (57%) had pain symptoms, n=641 (52%) had anxiety or were depressed, n=1052 (61.6%) lived less than 30 min from their treatment centre, n=619 (50%) were on a spectrum of frail to extremely vulnerable. n=424 (25%) chose home dialysis, n=552 (32%) chose hospital-based dialysis, n=109 (6%) chose transplantation, n=231 (14%) chose maximum conservative management and n=391 (23%) were 'undecided'. Main reasons for not choosing home dialysis were lack of motivation/low confidence in capacity to self-administer treatment, lack of home support and unsuitable housing. Patients who choose home dialysis were younger, had lower comorbidities, lower frailty and higher quality of life scores. Multivariate analysis found that age and frailty were predictors of choice, but we did not find any other demographic associations. Of patients who initially chose home dialysis, only n=150 (54%) started on home dialysis.
There is room for improvement in current pre-dialysis treatment pathways. Many patients remain undecided about dialysis choice, and others who may have chosen home dialysis are still likely to start on unit haemodialysis.
确定透析前教育后决定治疗选择的因素。
使用数据链接进行回顾性队列研究，对单变量和多变量进行分析。
威尔士国民保健署二级保健系统。
2016 年 1 月 1 日至 2018 年 12 月 12 日期间，在威尔士被诊断为慢性肾脏病且接受过透析前教育的 18 岁以上人群。
患者选择的透析方式和开始任何肾脏替代治疗。
平均年龄为 67 岁；1207 名（60%）为男性，878 名（53%）有≥3 种合并症，805 名（66%）有行动问题，700 名（57%）有疼痛症状，641 名（52%）有焦虑或抑郁症状，1052 名（61.6%）居住地距离治疗中心不足 30 分钟，619 名（50%）处于虚弱到极度脆弱的范围，424 名（25%）选择家庭透析，552 名（32%）选择住院透析，109 名（6%）选择移植，231 名（14%）选择最大保守治疗，391 名（23%）选择“未决定”。不选择家庭透析的主要原因是缺乏动力/对自我治疗能力的信心低、缺乏家庭支持和住房不适合。选择家庭透析的患者更年轻，合并症更少，脆弱程度更低，生活质量评分更高。多变量分析发现，年龄和脆弱程度是选择的预测因素，但我们没有发现任何其他人口统计学关联。在最初选择家庭透析的患者中，只有 150 名（54%）开始接受家庭透析。
当前透析前治疗途径仍有改进空间。许多患者对透析选择仍未决定，而其他可能选择家庭透析的患者仍可能开始接受住院血液透析。
