Assisted peritoneal dialysis compared to in-centre hemodialysis - an observational study of outcomes from the Swedish Renal Registry.

IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY BMC Nephrology Pub Date : 2024-10-14 DOI:10.1186/s12882-024-03799-1
Helena Rydell, Mårten Segelmark, Naomi Clyne
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Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

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辅助腹膜透析与中心内血液透析的比较--瑞典肾脏登记结果观察研究。
背景:中心内血液透析(IHD)是最常见的透析方式。辅助腹膜透析(assPD)是体弱和/或无行为能力患者的一种选择。这两种方式都可用于缓解生命末期的尿毒症症状。对这两种方式进行比较的研究很少。本研究的主要目的是比较急性尿毒症和急性肾功能衰竭患者的入院情况。次要目的是比较透析方式的持续性和患者的存活率:年龄大于 65 岁、在瑞典肾脏登记处 (SRR) 登记并在 2010-2017 年开始透析的患者均符合纳入条件。根据性别、查尔森指数、年龄和开始透析的日期,将开始使用 assPD 的患者与开始使用 IHD 的患者进行配对。数据来自 SRR 和其他登记处:第一年,接受 assPD 和 IHD 治疗的患者住院次数中位数分别为 1 次(IQR 0-5.0; 0-4.0)(p = 0.412)。两年后,在每年住院天数、因心血管疾病或传染病住院或继续使用透析方式方面分别没有明显差异。然而,接受 assPD 的患者的中位生存期较短(1.1 年,IQR 0.6-2.1;IHD 3.1 年,IQR 0.2-5.8;P 结论:在这项研究中,开始接受 assPD 的患者的中位生存期较短,而接受 IHD 的患者的中位生存期较长:在这项研究中,开始使用 assPD(通常作为姑息治疗)的患者在住院次数、每年住院天数或继续透析方式方面与 IHD 相比没有差异。接受assPD治疗的患者生存率较低,这可能是由于残余混杂因素造成的。如果没有这些因素,使用辅助透析的患者住院次数可能会更少。尽管这项研究的回顾性观察设计存在局限性,但研究结果表明,在无法进行自理透析和/或自理透析过于艰苦的情况下,assPD是一种可行的替代性血液透析方法。
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来源期刊
BMC Nephrology
BMC Nephrology UROLOGY & NEPHROLOGY-
CiteScore
4.30
自引率
0.00%
发文量
375
审稿时长
3-8 weeks
期刊介绍: BMC Nephrology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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