Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, No. 8, Xishiku Street, Xicheng District, Beijing, 100034, China.
Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
J Nephrol. 2024 Sep;37(7):1853-1861. doi: 10.1007/s40620-024-02090-8. Epub 2024 Sep 14.
Carrying out dialysis at home brings non-medical factors, including social support, or caretaker relationship, and internal features relevant to personality into the forefront. In this study, we aimed to explore the relationship between coping strategies of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and health outcomes.
Our post-hoc analysis was based on one previous randomized controlled trial that enrolled 150 incident patients who started CAPD from December 2010 to June 2016. All patients were followed until withdrawal from PD or May 4, 2023. Medical Coping Modes Questionnaire (MCMQ) was examined, evaluating the dominant method of coping (avoidance, acceptance-resignation, or confrontation) demonstrated by patients, in addition to Social Support Rating Scale (SSRS) and Eysenck Personality Questionnaire (EPQ).
Among the three mechanisms of coping, avoidance, at both the continuous and categorical variable levels, was significantly predictive of all-cause mortality. This relationship remained unchanged after adjustment for clinical covariates. Meanwhile, the high tertile of acceptance-resignation and other scores of confrontation independently predicted lower death risks after adjustment of the aforementioned variables. Avoidance and confrontation levels also independently predicted first-episode peritonitis. No associations between coping modes and transfer to hemodialysis were observed. Social support and personality were found to be confounders for the predictive effect of coping on all-cause mortality and first-episode peritonitis.
Coping models were independently related to all-cause mortality and first-episode peritonitis among CAPD patients, confounded by their associations with social support and personality. Our findings strengthen the need to integrate coping strategies into the practice of patient-centered care.
家庭透析将非医学因素，包括社会支持或照顾者关系以及与人格相关的内在特征置于重要位置。在这项研究中，我们旨在探讨接受持续非卧床腹膜透析（CAPD）的患者应对策略与健康结果之间的关系。
我们的事后分析基于一项先前的随机对照试验，该试验纳入了 2010 年 12 月至 2016 年 6 月期间开始接受 CAPD 的 150 例首发患者。所有患者均随访至退出 PD 或 2023 年 5 月 4 日。采用医学应对方式问卷（MCMQ）评估患者的主导应对方式（回避、接受-顺其自然或对抗），同时采用社会支持评定量表（SSRS）和艾森克人格问卷（EPQ）。
在三种应对机制中，回避在连续和分类变量水平上均与全因死亡率显著相关。在调整临床协变量后，这种关系仍然不变。同时，接受-顺其自然和对抗高分 tertile 独立预测上述变量调整后的死亡风险较低。回避和对抗水平也独立预测首次腹膜炎发作。应对方式与转为血液透析之间无关联。社会支持和人格被发现是应对方式对全因死亡率和首次腹膜炎发作的预测作用的混杂因素。
应对模式与 CAPD 患者的全因死亡率和首次腹膜炎发作独立相关，与社会支持和人格的关联存在混杂。我们的研究结果强调需要将应对策略纳入以患者为中心的护理实践中。
