Comorbidity and other factors associated with modality selection in incident dialysis patients: The CHOICE Study
Comorbidity and other factors associated with modality selection in incident dialysis patients: The CHOICE Study
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DOI：
10.1053/ajkd.2002.30552
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发表时间：
2002-02-01
影响因子：
13.2
通讯作者：
Levey, AS
中科院分区：
文献类型：
--
作者：
Miskulin, DC;Meyer, KB;Levey, AS
病例组合因素影响终末期肾病（ESRD）透析方式的选择和结局。尽管在未来比较不同模式组的结局时考虑基线差异的重要性，但尚未对腹膜透析（PD）和血液透析（HD）患者在透析治疗开始时的病例组合差异进行详细描述。我们比较了279例PD和759例HD患者的基线特征，这些患者参加了终末期肾病护理健康结局选择（CHOICE）队列研究，这是一项针对偶发透析患者的前瞻性研究。使用共存疾病指数（ICED）对合并症进行评估，包括对19种医疗状况的病历审查和对11种身体功能的基于合并症的评估。ICED评分范围为0 - 3分，评分越高反映合并症越严重。PD患者的合并症严重程度低于HD患者：PD患者中ICED 0-1、ICED 2和ICED 3的患者比例分别为52%、26%和22%，HD患者中分别为30%、39%和31%（P < 0.001）。在控制所有其他因素后，共患病率的差异仍然显著。与ICED 0-1的患者相比，ICED 2和ICED 3的患者接受PD治疗的比值（比值比[OR]和95%置信区间）分别为0.31（0.17 - 0.56）和0.50（0.28 - 0.90）。在选择PD的患者中，ESRD发作时共病的数量和严重程度显著较低，与影响治疗方式选择的其他因素无关。最近研究中报告的PD患者生存率的增加可能只是反映了自我或医生导向的选择更健康的PD患者。在接受PD与HD治疗的患者中，调整病例组合差异对于评估透析方式对结局的独立影响至关重要。(C)2002年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Case-mix factors influence both the selection of dialysis modality and outcomes In end-stage renal disease (ESRD). A detailed characterization of the case-mix differences between peritoneal dialysis (PD) and hemodialysis (HD) patients at the onset of dialysis therapy has not been performed, despite the Importance of accounting for baseline differences in future comparisons of outcomes across modality groups. We compared baseline characteristics of 279 PD and 759 HD patients enrolled in the Choices for Healthy Outcomes In Caring for End-Stage Renal Disease (CHOICE) Cohort Study, a prospective study of Incident dialysis patients. Comorbidity was assessed using the Index of Coexistent Diseases (ICED), consisting of a medical record review of 19 medical conditions and an observer-based assessment of 11 physical functions. ICED scores range from 0 to 3, with higher levels reflecting more severe comorbidity. Comorbidity was less severe in PD patients than In HD patients: the proportions of patients with ICED 0-1, ICED 2, and ICED 3 were 52%, 26%, and 22%, respectively, among the PD patients and 30%, 39%, and 31%, respectively, among the HD patients (P < 0.001). After controlling for all other factors, the differences In comorbidity remained significant. As compared with patients with ICED 0-1, the odds of being treated with PD for patients with ICED 2 and ICED 3 were less (odds ratio [OR] and 95% confidence Intervals) 0.31 (0.17 to 0.56) and 0.50 (0.28 to 0.90), respectively. The number and severity of comorbid conditions at the onset of ESRD is significantly lower In patients choosing PD, independent of other factors influencing modality selection. The increased survival of PD patients reported in recent studies may simply reflect the self- or physician-directed selection of healthier patients to PD. Adjustment for case-mix differences In patients treated with PD versus HD is essential to the assessment of the independent effect of the dialysis modality on outcomes. (C) 2002 by the National Kidney Foundation, Inc.