Bernardini J, Piraino B
University of Pittsburgh Medical Center, PA 15213-2550, USA.
Am J Kidney Dis. 1998 Jan;31(1):101-7. doi: 10.1053/ajkd.1998.v31.pm9428459.
This study was performed to determine compliance with prescribed exchanges in continuous ambulatory peritoneal dialysis (CAPD) and continuous cycler peritoneal dialysis (CCPD) patients via a home supply inventory, to evaluate numerous other factors against this standard, and to compare compliant and noncompliant patient characteristics and outcomes. It was an open enrollment of patients with prospective follow-up of 49 CAPD and CCPD adult patients at a university dialysis center. Two home visits for dialysis solution inventories were conducted 1 to 3 months apart. The number of exchanges actually performed (based on the inventory and deliveries) divided by the number of exchanges prescribed determined the percent compliance. Patient self-evaluation of compliance, attitudes about compliance and medical care, Derogatis Affects Balance Sheet (DABS) (a validated tool of affects balance), staff evaluations, patient demographics, hospitalizations, dialysis adequacy (measured to predicted creatinine ratio) and patient outcomes were evaluated against compliance with prescribed exchanges. Thirty-five percent of the patients were found to be noncompliant with prescribed exchanges based on the supply inventory, performing only 74% of exchanges. Compliant and noncompliant patients were not different by age, race, gender, peritoneal dialysis (PD) time, number of comorbid conditions, nor incidence of diabetes. The affects balance score from the DABS test was a poor predictor of compliance, as were staff evaluations. Delivered dialysis, adjusted for percentage of compliance, was significantly lower in noncompliant than in compliant patients by weekly Kt/V (2.2 v 1.74, P < 0.003), Ccreatinine L/week/1.73m2 (69 v 58, P = 0.05), as was normalized protein nitrogen appearance rates (nPNA), g/kg/day (0.89 v 0.70, P = 0.001). Technique survival was significantly lower (P < 0.05) in noncompliant patients. Twenty-nine percent of the noncompliant patients transferred to hemodialysis for uremia compared with 6% of compliant patients, P = .04, with a mean follow-up time of 1 year per patient. Patient survival did not differ in the two groups. Peritonitis rates were higher in noncompliant than compliant patients (1.03/yr v 0.66/yr, P < 0.03), as were days hospitalized (908 per 100 patient-years v 1,016 per 100 patient-years, P < 0.04). Noncompliance with PD exchanges is significantly common in CAPD and CCPD patients. It occurs in one third of the patients at our center and contributes significantly to technique failure, inadequate dialysis, and an increased risk of both peritonitis and hospitalized days. Home visits to conduct supply inventories provide an excellent method of monitoring compliance.
本研究旨在通过家庭供应库存确定持续性非卧床腹膜透析（CAPD）和持续性循环腹膜透析（CCPD）患者对规定换液的依从性，评估众多其他因素与该标准的对比情况，并比较依从和不依从患者的特征及结局。这是一项在大学透析中心对49例CAPD和CCPD成年患者进行前瞻性随访的开放式患者招募研究。相隔1至3个月进行了两次家庭访视以清点透析液库存。实际进行的换液次数（基于库存和交付量）除以规定的换液次数得出依从百分比。根据规定换液的依从性评估患者的自我依从性评价、对依从性和医疗护理的态度、德罗加蒂斯情感平衡量表（DABS）（一种经过验证的情感平衡工具）、工作人员评价、患者人口统计学特征、住院情况、透析充分性（以实测肌酐与预测肌酐比值衡量）以及患者结局。根据供应库存发现35%的患者未依从规定的换液，仅完成了74%的换液。依从和不依从患者在年龄、种族、性别、腹膜透析（PD）时间、合并症数量或糖尿病发病率方面并无差异。DABS测试的情感平衡得分以及工作人员评价对依从性的预测能力较差。经依从百分比调整后的每周Kt/V（2.2对1.74，P<0.003）、每周每1.73m²的肌酐清除率（69对58，P = 0.05）以及标准化蛋白氮出现率（nPNA），克/千克/天（0.89对0.70，P = 0.001）显示，不依从患者的透析液交付量显著低于依从患者。不依从患者的技术生存率显著较低（P<0.05）。29%的不依从患者因尿毒症转为血液透析，而依从患者中这一比例为6%，P = 0.04，每位患者的平均随访时间为1年。两组患者的生存率并无差异。不依从患者的腹膜炎发生率高于依从患者（1.03/年对0.66/年，P<0.03），住院天数也更高（每100患者年908天对每100患者年1016天，P<0.04）。CAPD和CCPD患者中不依从腹膜透析换液的情况显著常见。在我们中心，三分之一的患者存在这种情况，这对技术失败、透析不充分以及腹膜炎和住院天数增加的风险有显著影响。进行家庭访视以清点供应库存是监测依从性的极佳方法。
