援助对腹膜透析持续时间的时间依赖性影响：来自法语腹膜透析登记处的数据分析。
The Time-Dependent Effect of Assistance on Peritoneal Dialysis Duration: An Analysis of Data from the French Language Peritoneal Dialysis Registry.
作者信息
Boyer Annabel, Lanot Antoine, Ficheux Maxence, Guillouet Sonia, Bechade Clémence, Lobbedez Thierry
机构信息
Centre Universitaire des Maladies Rénales, CHU de Caen, 14033 Caen Cedex 9, France.
U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer, François Baclesse, Caen, France.
出版信息
Kidney360. 2024 Oct 1;5(10):1500-1509. doi: 10.34067/KID.0000000577. Epub 2024 Sep 19.
KEY POINTS
It is unknown whether the benefit of assisted peritoneal dialysis (PD) programs appears immediately after PD initiation or rather after some time spent on PD. The protective effect of assisted PD on the risk of transfer to hemodialysis was not constant over time; it started after the first 6 months on PD. Assisted PD programs should be sustainable for at least 6 months to observe their benefits.
BACKGROUND
Peritoneal dialysis (PD) patient compliance is crucial for the prevention of complications. Assistance is associated with a lower risk of transfer to hemodialysis. As the risk of noncompliance increases over time, the protective effect of assistance on the risk of transfer to hemodialysis may not be immediate after PD initiation, but rather may appear after some time on PD. We aimed to analyze the time-varying effect of assistance on the risk of PD cessation.
METHODS
This retrospective study was conducted using data from the French Language PD Registry of incident PD patients between 2002 and 2018. Because of nonproportional hazards, with a change in the effect of the assistance modality on the different outcomes appearing at 6 months after PD initiation, the associations between the assistance modality and the different outcomes were explored using time-dependent coefficient Cox regression.
RESULTS
The study included 15,675 patients; 6717 deaths, 4973 transfers to hemodialysis, and 3065 kidney transplantations occurred. Both patients receiving nurse- and family-assisted PD had a lower risk of transfer to hemodialysis (mean cause-specific hazard ratio [cs-HR], 0.67; 95% confidence interval [CI], 0.62 to 0.72; and mean cs-HR, 0.75; 95% CI, 0.67 to 0.84). In the first 6 months after PD initiation, nurse-assisted PD patients had a greater risk of transfer to hemodialysis (<6 months cs-HR, 1.18; 95% CI, 1.03 to 1.36) but had a lower likelihood afterward (≥6 months cs-HR, 0.57; 95% CI, 0.53 to 0.62). Family-assisted PD was not associated with the risk of transfer to hemodialysis in the first 6 months after PD initiation, and those patients had a lower risk of transfer to hemodialysis afterward (≥6 months cs-HR, 0.72; 95% CI, 0.63 to 0.82).
CONCLUSIONS
When implementing a national nurse-assisted PD program, its positive impact on PD duration should not be expected immediately after PD initiation. Assisted PD programs should be sustainable for at least 6 months to observe their benefits.
PODCAST
This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2024_10_31_KID0000000577.mp3
关键点
辅助性腹膜透析（PD）项目的益处是在开始PD后立即显现，还是在进行一段时间的PD后才出现，目前尚不清楚。辅助性PD对转血液透析风险的保护作用并非随时间恒定不变；它在开始PD后的前6个月后才开始显现。辅助性PD项目应至少持续6个月以观察其益处。
背景
腹膜透析（PD）患者的依从性对于预防并发症至关重要。辅助与转血液透析的较低风险相关。随着时间推移，不依从的风险增加，辅助对转血液透析风险的保护作用可能在开始PD后并非立即出现，而是可能在进行一段时间的PD后才出现。我们旨在分析辅助对PD终止风险的时间变化效应。
方法
本回顾性研究使用了2002年至2018年间法国语言PD登记处新发病例PD患者的数据。由于存在非比例风险，辅助方式对不同结局的影响在开始PD后6个月出现变化，因此使用时间依赖系数Cox回归探讨辅助方式与不同结局之间的关联。
结果
该研究纳入了15675例患者；发生了6717例死亡、4973例转血液透析以及3065例肾移植。接受护士辅助和家庭辅助PD的患者转血液透析的风险均较低（平均病因特异性风险比[cs-HR]，0.67；95%置信区间[CI]，0.62至0.72；以及平均cs-HR，0.75；95%CI，0.67至0.84）。在开始PD后的前6个月，接受护士辅助PD的患者转血液透析的风险更高（<6个月cs-HR，1.18；95%CI，1.03至1.36），但此后风险较低（≥6个月cs-HR，0.57；95%CI，0.53至0.62）。家庭辅助PD在开始PD后的前6个月与转血液透析风险无关，且这些患者此后转血液透析的风险较低（≥6个月cs-HR，0.72；95%CI，0.63至0.82）。
结论
在实施全国性护士辅助PD项目时，不应期望在开始PD后立即看到其对PD持续时间的积极影响。辅助性PD项目应至少持续6个月以观察其益处。
播客
本文包含一个播客，网址为https://www.asn-online.org/media/podcast/K360/2024_10_31_KID0000000577.mp3
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