Lyons Hannah C, Selman Lucy E, Ben-Shlomo Yoav, Caskey Fergus J, Inward Carol D, Hamilton Alexander
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol.
Kidney Med. 2025 Feb 15;7(4):100983. doi: 10.1016/j.xkme.2025.100983. eCollection 2025 Apr.
Peritoneal dialysis (PD) preserves kidney function and offers flexibility; however, few young adults have it compared with hemodialysis (HD). This study aimed to understand factors influencing the change from PD to HD.
This was a sequential explanatory mixed-methods study.
SETTING & PARTICIPANTS: Quantitative data were collected from 470 participants (50% male participants, 85% White, mean age: 16 years) who received dialysis between 1987 and 2015. Cox proportional hazards analysis was used to examine psychosocial factors associated with transitions from PD to HD. Qualitative data were gathered from 13 young adults (aged 14-29 years) who received dialysis between 2013 and 2015, with retrospective interviews conducted in 2020.
25% of participants experienced multiple episodes of PD. Survival rates for PD at 1 and 5 years were 71% and 37%, respectively. Risk factors for transitioning to HD included young adulthood (age: 15-30 years), with higher transition risks in older age groups (age: 15-19 years, HR: 2.41; age: 20-24 years, HR: 3.39; age: 25-30 years, HR: 3.14; < 0.005). Other factors included primary kidney disease type (systemic diseases vs tubulointerstitial diseases). Leading causes for transition were infection (50%), noncompliance (21%), and mechanical issues (18%). Qualitative analysis revealed the key themes around communicating treatment options, life impact, and support structures. Resilience was an additional theme among those who continued PD.
The study was based on cross-sectional psychosocial data, lacked detailed parental involvement, and may have suffered recall bias.
Young adults are at higher risk of transitioning to HD owing to both transplant failure and complications with PD. Challenges of PD have been underestimated, and there is a need to educate young adults well on all dialysis options. Additional support including mental health support, peer support, and support during life changes, such as moving out of their family home, is recommended.
腹膜透析（PD）可保留肾功能并具有灵活性；然而，与血液透析（HD）相比，接受腹膜透析的年轻成年人较少。本研究旨在了解影响从腹膜透析转为血液透析的因素。
这是一项顺序解释性混合方法研究。
定量数据收集自1987年至2015年间接受透析的470名参与者（50%为男性参与者，85%为白人，平均年龄：16岁）。采用Cox比例风险分析来检查与从腹膜透析转为血液透析相关的心理社会因素。定性数据收集自2013年至2015年间接受透析的13名年轻成年人（年龄在14 - 29岁之间），并于2020年进行了回顾性访谈。
25%的参与者经历过多次腹膜透析发作。腹膜透析1年和5年的生存率分别为71%和37%。转为血液透析的风险因素包括青年期（年龄：15 - 30岁），年龄较大的年龄组（年龄：15 - 19岁，风险比：2.41；年龄：20 - 24岁，风险比：3.39；年龄：25 - 30岁，风险比：3.14；P < 0.005）风险更高。其他因素包括原发性肾脏疾病类型（全身性疾病与肾小管间质疾病）。转为血液透析的主要原因是感染（50%）、不依从（21%）和机械问题（18%）。定性分析揭示了围绕治疗方案沟通、生活影响和支持结构的关键主题。复原力是继续接受腹膜透析者中的另一个主题。
该研究基于横断面心理社会数据，缺乏详细的父母参与情况，可能存在回忆偏差。
由于移植失败和腹膜透析并发症，年轻成年人转为血液透析的风险更高。腹膜透析的挑战被低估了，有必要对年轻成年人就所有透析选择进行充分教育。建议提供额外支持，包括心理健康支持、同伴支持以及在生活变化（如搬离家庭住所）期间的支持。
