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发布于:2019-9-12 17:59:01  访问:16 次 回复:0 篇
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Unit. Distance to the nearest PD unit may influence PD patient
These are of particular importance as PD is usually considered a first-choice treatment for end-stage PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/27225050 renal GSK2194069 Biological Activity disease (ESRD) for patients living in remote areas to avoid relocation [15]. The independent predictors of increased peritonitis hazard were older age, Aboriginal and Torres Strait Islander racial origin, Maori and Pacific Islander racial origin, higher BMI and missing baseline peritoneal transport status. Receiving PD in a small-medium centre (second smallest quartile) was associated with a lower hazard of peritonitis than in the largest quartile.Microbiology of first peritonitis episodesA total of 6610 patients received PD in Australia during the study period (1 October 2003 to 31 December 2008) and were followed for 10470 patient-years (mean follow-up 1.58 years per patient). Their characteristics are depicted in Table 1. In this group, 6213 episodes of peritonitis occurred in 3128 (47 ) patients (range 1 to 15 episodes per patient). The overall rate of peritonitis was 0.59 episodes per pat.Unit. Distance to the nearest PD unit may influence PD patient outcome by impacting upon access to medical care, delayed diagnosis, delayed dialysate sample processing (leading to higher rates of culture negative peritonitis), compromised management PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26488313 due to the tyranny of distance and ultimately poorer outcomes. These are of particular importance as PD is usually considered a first-choice treatment for end-stage PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/27225050 renal disease (ESRD) for patients living in remote areas to avoid relocation [15]. Given that PD peritonitis is a major cause of PD technique failure, addressing the impact of remote residence on PD outcomes, particularly PD peritonitis, is an imperative issue to be addressed. The aim of the current study was to examine the effect of living distantly (100 km) from a PD unit on the risk, microbiology, treatment and/or clinical outcomes of PD-associated peritonitis in all Australian PD patients, as recorded in the ANZDATA registry. ResultsPopulation characteristicstheir nearest PD unit (distant group), while 6183 (94 ) lived <100 km (local group). Their baseline characteristics are shown in Table 1. Compared with local patients, distant PD patients were significantly more likely to be younger, Aboriginal and Torres Strait Islander peoples, have commenced dialysis at a lower level of estimated glomerular filtration rate (eGFR), have chronic lung disease and diabetes mellitus and not have a baseline peritoneal transport status recorded. Overall peritonitis rates in the distant and local groups were 0.77 (95 CI 0.70-0.85) and 0.58 (95 CI 0.57-0.60) episodes per patient-year, respectively (incidence rate ratio 1.32, 95 CI 1.20-1.46, p < 0.001). When the analysis was restricted to Caucasian patients, overall peritonitis rates in the distant and local groups were 0.67 (95 CI 0.59-0.76) and 0.59 (95 CI 0.57-0.61) episodes per patient-year, respectively (incidence rate ratio 1.14, 95 CI 1.00-1.30, p = 0.05).Peritonitis-free survivalTime to first peritonitis episode was significantly shorter in distant patients (Figure 1). Median (95 confidence interval) peritonitis-free survival rates were 1.34 (1.07-1.61) years and 1.68 (1.59-1.77) years, respectively (log rank score 10.6, p = 0.001).
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