Nonadherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS
Nonadherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS
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DOI：
10.1046/j.1523-1755.2003.00064.x
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发表时间：
2003-07-01
影响因子：
19.6
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Saran, R;Bragg-Gresham, JL;Port, FK
背景血液透析患者的非依从性损害了透析输送，这可能影响患者的发病率和死亡率。透析结果和实践模式研究（DOPPS）提供了一个独特的机会，审查这个问题及其决定因素在全球范围内。使用DOPPS（一项国际性、观察性、前瞻性血液透析研究）的数据对不依从性进行了研究。如果患者每月跳过一个或多个疗程，每月缩短一个或多个疗程超过10分钟，血清钾水平>6.0 mEq/L，血清磷酸盐水平>7.5 mg/dL（>2.4 mmol/L），或透析间期体重增加（IDWG）>体重的5.7%，则认为患者不依从。使用逻辑回归确定不依从的预测因素。生存分析采用考克斯比例风险模型调整病例组合。跳过治疗与死亡率增加相关[相对危险度（RR）= 1.30，P = 0.01]，过量IDWG（RR 1.12，P = 0.047）和高磷酸盐水平（RR = 1.17，P 0.001）也是如此。跳过也与住院时间增加有关（RR = 1.13，P = 0.04），高磷酸盐水平也与此有关（RR = 1.07，P = 0.05）。较大的设施规模（每10例患者）与跳跃（OR = 1.03，P 0.06）、缩短（OR = 1.03，P = 0.05）和IDWG（OR 1.02，P = 0.07）的比值比（OR）较高相关。高培训工作人员工作时间百分比的增加与较低的跳过OR相关（OR = 0.84/10%，P = 0.02）;营养师的存在与较低的过量IDWG相关（OR = 0.75，P = 0.08）。不依从与死亡风险增加（跳过治疗、过量IDWG和高磷酸盐）和住院风险（跳过治疗、高磷酸盐）相关。某些患者/机构特征也与不依从性相关。
Background. Nonadherence among hemodialysis patients compromises dialysis delivery, which could influence patient morbidity and mortality. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to review this problem and its determinants on a global level.Methods. Nonadherence was studied using data from the DOPPS, an international, observational, prospective hemodialysis study. Patients were considered nonadherent if they skipped one or more sessions per month, shortened one or more sessions by more than 10 minutes per month, had a serum potassium level of >6.0 mEq/L, a serum phosphate level of >7.5 mg/dL (>2.4 mmol/L), or interdialytic weight gain (IDWG) >5.7% of body weight. Predictors of nonadherence were identified using logistic regression. Survival analysis used the Cox proportional hazards model adjusting for case-mix.Results. Skipping treatment-was associated with increased mortality [relative risk (RR) = 1.30, P = 0.01], as were excessive IDWG (RR 1.12, P = 0.047) and high phosphate levels (RR = 1.17, P 0.001). Skipping also was associated with increased hospitalization (RR = 1.13, P = 0.04), as were high phosphate levels (RR = 1.07, P = 0.05). Larger facility size (per 10 patients) was associated with higher odds ratios (OR) of skipping (OR = 1.03, P 0.06), shortening (OR = 1.03, P = 0.05), and IDWG (OR 1.02, P = 0.07). An increased percentage of highly trained staff hours was associated with lower OR of skipping (OR = 0.84 per 10%, P = 0.02); presence of a dietitian was associated with lower OR of excessive IDWG (OR = 0.75, P = 0.08).Conclusion. Nonadherence was associated with increased mortality risk (skipping treatment, excessive IDWG, and-high phosphate) and with hospitalization risk (skipping, high phosphate). Certain patient/facility characteristics also were associated with nonadherence.