Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Solna, Sweden.
Department of Renal Medicine, Karolinska University Hospital Huddinge, , M99, Stockholm, 141 86, Sweden.
BMC Nephrol. 2024 Oct 14;25(1):349. doi: 10.1186/s12882-024-03799-1.
In-center hemodialysis (IHD) is the most common dialysis modality. Assisted peritoneal dialysis (assPD) is an option for frail and/or incapacitated patients. Both modalities can be used to alleviate uremic symptoms towards the end of life. There are few studies comparing these modalities. The primary aim is to compare hospital admissions between assPD and IHD. The secondary aim is to compare continuation of the dialysis modality and patient survival.
Patients > 65 years, registered in the Swedish Renal Registry (SRR) and starting dialysis 2010-2017 were eligible for inclusion. Patients starting on assPD were matched with patients starting on IHD according to sex, Charlson Index, age and date for start of dialysis. Data were collected from SRR and other registries.
During the first year, patients on assPD and IHD had in median one (IQR 0-5.0; 0-4.0) hospitalization (p = 0.412). There was no significant difference after two years, in the annual number of days admitted to hospital, in hospitalizations with cardiovascular or infectious disease diagnoses or continuation of the dialysis modality, respectively. However, patients on assPD had a worse median survival (1.1 years IQR 0.6-2.1; IHD 3.1 years IQR 0.2-5.8; p < 0.001).
In this study patients starting assPD, often as a palliative treatment, showed no difference compared to IHD concerning the number of hospitalizations, number of days in hospital/year or continuation of the dialysis modality. Patients on assPD had a worse survival, which is likely due to residual confounding. Without that, patients on assPD would probably have lower number of hospitalizations. Despite limitations due to the retrospective observational design of the study, the results indicate that assPD is a feasible alternative to IHD when self-care dialysis is not possible and/or IHD too arduous.
中心血液透析（IHD）是最常见的透析方式。辅助性腹膜透析（assPD）是虚弱和/或丧失能力患者的一种选择。这两种方式都可以用于缓解生命末期的尿毒症症状。比较这两种方式的研究很少。主要目的是比较 assPD 和 IHD 之间的住院情况。次要目的是比较透析方式的延续和患者的生存情况。
符合纳入标准的患者为年龄>65 岁，在瑞典肾脏登记处（SRR）登记并于 2010-2017 年开始透析的患者。开始接受 assPD 的患者根据性别、Charlson 指数、年龄和透析开始日期与开始接受 IHD 的患者进行匹配。数据来自 SRR 和其他登记处。
在第一年，接受 assPD 和 IHD 的患者中位数各有一次（IQR 0-5.0；0-4.0）住院治疗（p=0.412）。两年后，在每年住院天数、心血管或感染性疾病诊断的住院次数或透析方式的延续方面，两组间无显著差异。然而，接受 assPD 的患者中位生存时间更差（1.1 年 IQR 0.6-2.1；IHD 3.1 年 IQR 0.2-5.8；p<0.001）。
在这项研究中，开始接受 assPD 的患者，通常作为姑息治疗，与 IHD 相比，在住院次数、每年住院天数或透析方式的延续方面没有差异。接受 assPD 的患者生存时间更差，这可能是由于残余混杂因素所致。如果没有这些因素，接受 assPD 的患者的住院次数可能会更少。尽管由于研究的回顾性观察设计存在局限性，但结果表明，当自我护理透析不可行和/或 IHD 过于艰难时，assPD 是 IHD 的一种可行替代方案。
