Gopal Tejas, Chen Shijie, Weinhandl Eric, Hussein Wael F
Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
Satellite Healthcare, San Jose, California.
Kidney360. 2024 Nov 1;5(11):1662-1668. doi: 10.34067/KID.0000000591. Epub 2024 Sep 30.
The study explores the potential utility of the Patient Activation Measure 13-item survey as a marker for identifying high-risk patients in the dialysis population. Patient activation had a significant association with mortality. However, no association was observed with hospital admission or markers of adherence. The findings emphasize the need for further studies to validate patient activation in patients on dialysis and its role in improving patient outcomes.
Patient activation, defined as an individual's readiness, willingness, and ability to manage their own health and health care, is associated with healthy behaviors and improved outcomes. Patients undergoing in-center hemodialysis have low activation, but the association of patient activation with clinical outcomes among patients on dialysis is unclear. We investigated the association between patient activation and outcomes in patients on hemodialysis.
This cohort included 925 prevalent patients on in-center hemodialysis in ten facilities in a mid-size dialysis provider. All patients who completed the Patient Activation Measure 13-item (PAM-13) survey during a previous study were included, and their records were cross-referenced with data from the electronic heath system. Patients were followed for 180 days after completion of the survey for the primary outcomes of () time to death and () time to hospitalization. Markers of nonadherence during the months before and after completion of the PAM survey were examined as secondary outcomes, including () serum potassium >5.0 mEq/L; () serum phosphorus >5.5 mg/dl; () missed dialysis treatment because of absence (no hospitalization); and () interdialytic weight gain >4.0%. Univariate and adjusted regression models were fit to estimate associations of a three-point increment in PAM-13 score with the outcomes of interest; adjustment factors comprised age, sex, dialysis vintage, serum albumin, diabetes, and hospitalization history.
A three-point increment in PAM score was associated with lower hazard of death (univariate hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.84 to 0.94; adjusted HR, 0.90; 95% CI, 0.85 to 0.96), but not with hospitalization (univariate HR, 0.99; 95% CI, 0.96 to 1.02; adjusted HR, 0.99; 95% CI, 0.96 to 1.02). Higher scores were associated with increased odds of having high phosphorus levels in the unadjusted analysis, but this was attenuated and not significant in adjusted models. There were no significant relationships between a three-point increment in PAM score and any of the other secondary outcomes in univariate and adjusted analyses.
In a cohort of patients on prevalent, in-center hemodialysis, low activation was associated with mortality, but not with hospitalization or measures of nonadherence.
本研究探讨了13项患者激活量表调查作为识别透析人群中高危患者标志物的潜在效用。患者激活与死亡率显著相关。然而，未观察到与住院或依从性标志物之间存在关联。研究结果强调需要进一步研究来验证透析患者的患者激活情况及其在改善患者结局中的作用。
患者激活被定义为个人管理自身健康和医疗保健的准备程度、意愿和能力，与健康行为及改善的结局相关。接受中心血液透析的患者激活程度较低，但透析患者的患者激活与临床结局之间的关联尚不清楚。我们调查了血液透析患者的患者激活与结局之间的关联。
该队列包括一家中型透析服务提供商的十个机构中925名接受中心血液透析的现患患者。纳入了在之前一项研究中完成13项患者激活量表（PAM - 13）调查的所有患者，并将他们的记录与电子健康系统的数据进行交叉对照。在完成调查后的180天内对患者进行随访，观察主要结局（）死亡时间和（）住院时间。将PAM调查完成前后数月的不依从标志物作为次要结局进行检查，包括（）血清钾>5.0 mEq/L；（）血清磷>5.5 mg/dl；（）因未就诊（未住院）而错过透析治疗；以及（）透析间期体重增加>4.0%。采用单因素和校正回归模型来估计PAM - 13评分增加三分与感兴趣结局之间的关联；校正因素包括年龄、性别、透析龄、血清白蛋白、糖尿病和住院史。
PAM评分增加三分与较低的死亡风险相关（单因素风险比[HR]，0.89；95%置信区间[CI]，0.84至0.94；校正后HR，0.90；95% CI，0.85至0.96），但与住院无关（单因素HR，0.99；95% CI，0.96至1.02；校正后HR，0.99；95% CI，0.96至1.02）。在未校正分析中，较高评分与高磷水平的几率增加相关，但在校正模型中这种关联减弱且无统计学意义。在单因素和校正分析中，PAM评分增加三分与任何其他次要结局之间均无显著关系。
在一组接受中心血液透析的现患患者中，低激活与死亡率相关，但与住院或不依从措施无关。
