Shah Nikhil, Bennett Paul N, Cho Yeoungjee, Leibowitz Saskia, Abra Graham, Kanjanabuch Talerngsak, Baharani Jyoti
Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.
Renal Nursing (Clinical & Health Sciences), University of South Australia, Adelaide, Australia.
Kidney Int Rep. 2024 Feb 2;9(4):941-950. doi: 10.1016/j.ekir.2024.01.041. eCollection 2024 Apr.
Despite the growing number of patients requiring kidney replacement therapy (KRT), peritoneal dialysis (PD) is underutilized globally. A contributory factor may be clinician myths about its use. The aim of this study was to explore perceptions about PD initiation by clinicians according to various physical, social, and clinical characteristics of patients.
An online global survey (in English and Thai) was administered to ascertain nephrologists' and nephrology trainees' decisions on recommending PD as a treatment modality.
A total of 645 participants (522 nephrologists and 123 trainees; 56% male) from 54 countries (66% from high-income countries [HICs], 22% from upper middle-income countries [UMICs], 12% from lower middle-income countries, and 1% from low-income countries [LICs]) completed the survey. Of the respondents, 81% identified as attending physicians or consultants, and 19% identified as trainees or other. PD was recommended for most scenarios, including repeated exposures to heavy lifting, swimming (especially in a private pool and ocean), among patients with cirrhosis or cognitive impairment with available support, and those living with a pet if a physical separation can be achieved during PD. Certain abdominal surgeries were more acceptable to proceed with PD (hysterectomy, 90%) compared to others (hemicolectomy, 45%). Similar variation was noted for different types of stomas (nephrostomies, 74%; suprapubic catheters, 53%; and ileostomies, 27%).
The probability of recommending PD in various scenarios was greater among clinicians from HICs, larger units, and consultants with more clinical experience. There is a disparity in recommending PD across various clinical scenarios driven by experience, unit-level characteristics, and region of practice. Globally, evidence-informed education is warranted to rectify misconceptions to enable greater PD uptake.
尽管需要肾脏替代治疗（KRT）的患者数量不断增加，但腹膜透析（PD）在全球范围内的利用率仍较低。一个促成因素可能是临床医生对其使用存在误解。本研究的目的是根据患者的各种身体、社会和临床特征，探讨临床医生对开始腹膜透析的看法。
进行了一项在线全球调查（英文和泰文），以确定肾病学家和肾病学实习生关于推荐腹膜透析作为一种治疗方式的决定。
来自54个国家的645名参与者（522名肾病学家和123名实习生；56%为男性）完成了调查（66%来自高收入国家[HICs]，22%来自中高收入国家[UMICs]，12%来自中低收入国家，1%来自低收入国家[LICs]）。在受访者中，81%为主治医师或顾问，19%为实习生或其他人员。在大多数情况下都推荐腹膜透析，包括反复进行重物搬运、游泳（尤其是在私人泳池和海洋中），对于有可用支持的肝硬化或认知障碍患者，以及如果在腹膜透析期间能够实现物理隔离则与宠物一起生活的患者。某些腹部手术比其他手术（半结肠切除术，45%）更适合在术后进行腹膜透析（子宫切除术，90%）。不同类型的造口情况也有类似差异（肾造口术，74%；耻骨上导管，53%；回肠造口术，27%）。
来自高收入国家、较大单位以及临床经验更丰富的顾问医生在各种情况下推荐腹膜透析的可能性更大。在不同临床情况下推荐腹膜透析存在差异，这是由经验、单位层面特征和执业地区驱动的。在全球范围内，有必要开展基于证据的教育，以纠正误解，从而提高腹膜透析的使用率。
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