Yang Yan, Fan Li, Lu Binbin, Qiu Yuanhui, Chen Zhenhu, Li Jie, Zeng Yilin, Deng Lili, Ye Zhiming, Yu Xueqing
School of Medicine, South China University of Technology, Guangzhou, China.
Department of Nephrology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Science), Southern Medical University, Guangzhou, China.
Kidney Dis (Basel). 2025 Apr 23;11(1):356-364. doi: 10.1159/000545964. eCollection 2025 Jan-Dec.
Patient adherence is important for long-term outcomes of peritoneal dialysis (PD). Artificial intelligence is a good tool to manage patients. However, there are limited data regarding its impact on the patient adherence and the effect of patient adherence on serum phosphate, calcium, and intact parathyroid hormone (iPTH) control in PD patients.
This was a single-center, prospective cohort study including PD patients in Guangdong Provincial People's Hospital. Adult patients (age ≥18 years) who were included in the smart PD care program from September 1, 2020, to April 31, 2023, were enrolled. Patient adherence was assessed using the patient-reported daily PD prescription data and calculated as the total days with PD ultrafiltration reported divided by the total days of follow-up. Good adherence was defined as the reporting rate ≥80%. The primary outcome was serum phosphate, calcium, and iPTH values achieved the treatment targets at 12-month follow-up. Unadjusted and adjusted generalized estimating equations were used to evaluate the association of patient adherence with the serum phosphorus, serum calcium, and iPTH control.
A total of 267 patients were included in this study. The mean age of the whole cohort was 43.3 ± 12.8 years, 130 (48.7%) were females, and 52 (19.5%) had diabetes. Patient adherence improved after being included in the smart PD care program and the overall patient adherence during 12-month follow-up was 77.1% ± 26.4%, 93.0% ± 7.4%, and 50.9% ± 25.6% for the entire cohort, patients with good adherence, and those with poor adherence, respectively. Compared to patients with poor adherence, those with good adherence were associated with a better serum calcium (adjusted OR: 3.76; 95% CI: 2.67-5.30; < 0.001) and iPTH control (adjusted OR: 2.20; 95% CI: 1.56-3.11; < 0.001) but not for serum phosphorus control (adjusted OR: 1.31; 95% CI: 0.89-1.91; = 0.17) after being adjusted for potential confounders. Results were similar when assessing the relationship between patient adherence and the longitudinal changes of serum calcium, iPTH, and phosphorus during follow-up.
Smart PD care program was effective in improving patient adherence. Good patient adherence was associated with better serum calcium and iPTH control but not for phosphorus control in PD patients. Further studies should be done to evaluate the effect of the smart PD care program on long-term patient outcomes.
患者依从性对腹膜透析（PD）的长期预后很重要。人工智能是管理患者的良好工具。然而，关于其对患者依从性的影响以及患者依从性对PD患者血清磷、钙和完整甲状旁腺激素（iPTH）控制效果的数据有限。
这是一项单中心前瞻性队列研究，纳入了广东省人民医院的PD患者。纳入2020年9月1日至2023年4月31日参加智能PD护理项目的成年患者（年龄≥18岁）。使用患者报告的每日PD处方数据评估患者依从性，计算方法为报告的PD超滤总天数除以随访总天数。良好依从性定义为报告率≥80%。主要结局是在12个月随访时血清磷、钙和iPTH值达到治疗目标。使用未调整和调整后的广义估计方程来评估患者依从性与血清磷、血清钙和iPTH控制之间的关联。
本研究共纳入267例患者。整个队列的平均年龄为43.3±12.8岁，女性130例（48.7%），糖尿病患者52例（19.5%）。纳入智能PD护理项目后患者依从性有所改善，整个队列、依从性良好患者和依从性差患者在12个月随访期间的总体患者依从性分别为77.1%±26.4%、93.0%±7.4%和50.9%±25.6%。与依从性差的患者相比，依从性好的患者在调整潜在混杂因素后，血清钙（调整后OR：3.76；95%CI：2.67 - 5.30；P<0.001）和iPTH控制（调整后OR：2.20；95%CI：1.56 - 3.11；P<0.001）更好，但血清磷控制方面无差异（调整后OR：1.31；95%CI：0.89 - 1.91；P = 0.17）。评估患者依从性与随访期间血清钙、iPTH和磷的纵向变化之间的关系时，结果相似。
智能PD护理项目在提高患者依从性方面有效。良好的患者依从性与PD患者更好的血清钙和iPTH控制相关，但与磷控制无关。应进一步开展研究以评估智能PD护理项目对患者长期预后的影响。
