Lanot Antoine, Bechade Clémence, Couchoud Cécile, Lassalle Mathilde, Chantrel François, Sarraj Ayman, Ficheux Maxence, Boyer Annabel, Lobbedez Thierry
Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, Caen, France.
School of medicine, Normandie université, Unicaen, UFR de médecine, Caen, France.
Clin Kidney J. 2024 Jul 10;17(7):sfae094. doi: 10.1093/ckj/sfae094. eCollection 2024 Jul.
Home dialysis therapies such as peritoneal dialysis (PD) and home hemodialysis (HHD) are beneficial for quality of life and patient empowerment. The short technique survival time partly explains their low prevalence. We aimed to assess the risk of transfer to facility-based hemodialysis in patients treated with autonomous PD, assisted PD and HHD.
This was a retrospective study using data from the REIN registry of patients starting home dialysis in France from 2002 to 2019. The risks of transfer to facility-based hemodialysis (HD) were compared between three modalities of home dialysis (HHD, nurse-assisted PD, autonomous PD) using survival models with a propensity score (PS)-matched and unmatched cohort of patients.
The study included 17 909 patients: 628 in the HHD group, 10 214 in the autonomous PD group, and 7067 in the assisted PD group. During the follow-up period, there were 5347 transfers to facility-based HD. The observed number of transfers was 2458 (13.7%) at 1 year and 5069 (28.3) at 5 years after the start of home dialysis, including 3272 (32%) on autonomous PD, 1648 (23.3%) on assisted PD, and 149 (23.7) on HHD. Owing to clinical characteristics differences, only 38% of HHD patients could be matched to patients from the others group. In the PS-matched cohort, the adjusted Cox model showed no difference in the risk of transfer for assisted PD (cs-HR 1.04, 95% CI 0.75-1.44) or HHD (cs-HR 1.07, 95% CI 0.77-1.48) compared with autonomous PD.
Unlike results from other countries, where nurse assistance is not fully available for PD-associated care, there was no difference in technique survival between autonomous PD, nurse-assisted PD, and HHD in France. This discrepancy may be attributed to our inclusion of a broader spectrum of patients who derive significant benefits from assisted PD.
腹膜透析（PD）和家庭血液透析（HHD）等家庭透析疗法对生活质量和患者自主管理有益。技术生存时间短在一定程度上解释了它们的低普及率。我们旨在评估接受自主腹膜透析、辅助腹膜透析和家庭血液透析治疗的患者转为机构血液透析的风险。
这是一项回顾性研究，使用了法国2002年至2019年开始家庭透析的患者的REIN登记数据。使用倾向评分（PS）匹配和未匹配的患者队列的生存模型，比较了三种家庭透析方式（家庭血液透析、护士辅助腹膜透析、自主腹膜透析）转为机构血液透析（HD）的风险。
该研究纳入了17909名患者：家庭血液透析组628例，自主腹膜透析组10214例，辅助腹膜透析组7067例。在随访期间，有5347例转为机构血液透析。家庭透析开始后1年观察到的转例数为2458例（13.7%），5年时为5069例（28.3%），其中自主腹膜透析3272例（32%）,辅助腹膜透析1648例（23.3%），家庭血液透析149例（23.7%）。由于临床特征差异，只有38%的家庭血液透析患者能与其他组患者匹配。在PS匹配队列中，调整后的Cox模型显示，与自主腹膜透析相比，辅助腹膜透析（校正风险比1.04，95%可信区间0.75-1.44）或家庭血液透析（校正风险比1.07，95%可信区间0.77-1.48）的转例风险无差异。
与其他国家因腹膜透析相关护理无法充分获得护士协助的结果不同，在法国，自主腹膜透析、护士辅助腹膜透析和家庭血液透析的技术生存时间没有差异。这种差异可能归因于我们纳入了更广泛的患者群体，这些患者从辅助腹膜透析中获得了显著益处。
