Patient Dialysis Knowledge Is Associated with Permanent Arteriovenous Access Use in Chronic Hemodialysis
Patient Dialysis Knowledge Is Associated with Permanent Arteriovenous Access Use in Chronic Hemodialysis
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DOI：
10.2215/cjn.04580908
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发表时间：
2009-05-01
影响因子：
9.8
通讯作者：
Ikizler, T. Alp
中科院分区：
文献类型：
--
作者：
Cavanaugh, Kerri L.;Wingard, Rebecca L.;Ikizler, T. Alp
背景和目标：患者对慢性血液透析（CHD）的知识是重要的，有效的自我管理behaviors.Design，设置，参与者，和测量：前瞻性队列的成人事件CHD患者从2002年5月至2005年11月，并随后为6个月后开始血液透析（HD）的关联，但鲜为人知。使用慢性血液透析知识调查（CHeKS）测量患者知识。主要结局为基线、HD开始后3个月和6个月时的透析通路类型。次要结果包括贫血，营养和矿物质实验室measurement.Results：在490例患者中，中位数（四分位数范围）CHeKS评分（0至100%）为65%[52%至78%]。较低的分数与年龄较大，受教育年限较少和非白人种族有关。在HD开始时和调整年龄、性别、种族、教育和糖尿病后6个月，与导管相比，CHeKS评分高20个百分点的患者更有可能使用动静脉瘘或移植物。除了与血清白蛋白中度相关外，知识与实验室结果指标之间没有统计学显著相关性。潜在的局限性包括剩余的混杂和动力不足的研究，以确定与一些临床measurements.Conclusions：透析知识较少的患者可能不太可能使用动静脉通路进行透析在开始和开始血液透析后。需要更多的研究来探讨患者透析知识的影响，以及教育干预后的改善，对血液透析中血管通路的影响。Clin J Am Soc Nephrol 4：950-956，2009. doi：10.2215/CJN.04580908
Background and objectives: Patient knowledge about chronic hemodialysis (CHD) is important for effective self-management behaviors, but little is known about its association with vascular access use.Design, setting, participants, & measurements: Prospective cohort of adult incident CHD patients from May 2002 until November 2005 and followed for 6 mo after initiation of hemodialysis (HD). Patient knowledge was measured using the Chronic Hemodialysis Knowledge Survey (CHeKS). The primary outcome was dialysis access type at: baseline, 3 mo, and 6 mo after HD initiation. Secondary outcomes included anemia, nutritional, and mineral laboratory measures.Results: In 490 patients, the median (interquartile range) CHeKS score (0 to 100%) was 65%[52% to 78%]. Lower scores were associated with older age, fewer years of education, and nonwhite race. Patients with CHeKS scores 20 percentage points higher were more likely to use an arteriovenous fistula or graft compared with a catheter at HD initiation and 6 mo after adjustment for age, sex, race, education, and diabetes mellitus. No statistically significant associations were found between knowledge and laboratory outcome measures, except for a moderate association with serum albumin. Potential limitations include residual confounding and an underpowered study to determine associations with some clinical measures.Conclusions: Patients with less dialysis knowledge may be less likely to use an arteriovenous access for dialysis at initiation and after starting hemodialysis. Additional studies are needed to explore the impact of patient dialysis knowledge, and its improvement after educational interventions, on vascular access in hemodialysis. Clin J Am Soc Nephrol 4: 950-956, 2009. doi: 10.2215/CJN.04580908