慢性血液透析患者积极性与疗效的关系:一项回顾性纵向观察研究。

IF 3.2 Q1 UROLOGY & NEPHROLOGY
Kidney360 Pub Date : 2024-09-30 DOI:10.34067/KID.0000000591
Tejas Gopal, Shijie Chen, Eric Weinhandl, Wael F Hussein
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引用次数: 0

摘要

背景:患者积极性被定义为个人管理自身健康和医疗保健的准备程度、意愿和能力,它与健康行为和治疗效果的改善有关。接受中心血液透析(HD)的患者积极性较低,但患者积极性与透析患者临床结果的关系尚不清楚。我们研究了患者积极性与血液透析患者预后之间的关系:该队列包括一家中等规模透析服务提供商的 10 家机构中 925 名普遍存在的中心内 HD 患者。所有在之前的研究中完成了患者激活测量13项(PAM-13)调查的患者都被纳入其中,他们的记录与电子医疗系统中的数据进行了交叉对比。调查完成后,对患者进行了为期 180 天的随访,主要结果包括:(1) 死亡时间;(2) 住院时间。PAM 调查完成前一个月和完成后一个月的不依从标记作为次要结果进行研究,包括 (1) 血清钾 >5.0 mEq/L;(2) 血清磷 >5.5 mg/dL;(3) 因缺席(非住院)而错过透析治疗;(4) 两次透析间体重增加 >4.0%。拟合了单变量和调整回归模型,以估计 PAM-13 评分每增加 3 分与相关结果的关系;调整因素包括年龄、性别、透析年份、血清白蛋白、糖尿病和住院史:PAM得分每增加3分,死亡风险降低(单变量HR=0.89,95% CI:0.84-0.94;调整后HR=0.90,95% CI:0.85-0.96),但与住院无关(单变量HR=0.99,95% CI:0.96-1.02;调整后HR=0.99,95% CI:0.96-1.02)。在未经调整的分析中,得分越高,血磷水平越高的几率越大,但在调整模型中,得分越高,血磷水平越高的几率越大,但在调整模型中,得分越高,血磷水平越高的几率越大。在单变量分析和调整分析中,PAM 分数每增加 3 分与任何其他次要结果之间均无明显关系:结论:在一组流行的、中心内的血液透析患者中,低激活度与死亡率有关,但与住院或不依从性测量无关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Associations of Patient Activation with Outcomes Among Patients on Chronic Hemodialysis: A Retrospective, Longitudinal, Observational Study.

Background: Patient activation, defined as an individual's readiness, willingness, and ability to manage their own health and health care, is associated with healthy behaviors and improved outcomes. Patients undergoing in-center hemodialysis (HD) have low activation, but the association of patient activation with clinical outcomes among dialysis patients is unclear. We investigated the association between patient activation and outcomes in HD patients.

Methods: This cohort included 925 prevalent, in-center HD patients among 10 facilities in a mid-sized dialysis provider. All patients who completed the Patient Activation Measure 13-item (PAM-13) survey during a previous study were included, and their records were cross-referenced with data from the electronic heath system. Patients were followed for 180 days after completion of the survey for the primary outcomes of time to (1) death and (2) time to hospitalization. Markers of non-adherence during the month before and the month after completion of the PAM survey were examined as secondary outcomes, including (1) serum potassium >5.0 mEq/L; (2) serum phosphorus >5.5 mg/dL; (3) missed dialysis treatment due to absence (not hospitalization); and (4) interdialytic weight gain >4.0%. Univariate and adjusted regression models were fit to estimate associations of a 3-point increment in PAM-13 score with the outcomes of interest; adjustment factors comprised age, sex, dialysis vintage, serum albumin, diabetes, and hospitalization history.

Results: A 3-point increment in PAM score was associated with lower hazard of death (univariate HR=0.89, 95% CI: 0.84-0.94; adjusted HR=0.90, 95% CI: 0.85-0.96), but not with hospitalization (univariate HR=0.99, 95% CI: 0.96-1.02; adjusted HR=0.99, 95% CI: 0.96-1.02). Higher scores were associated with increased odds of having high phosphorus levels in the unadjusted analysis, but this was attenuated and not significant in adjusted models. There were no significant relationships between a 3-point increment in PAM score and any of the other secondary outcomes in univariate and adjusted analyses.

Conclusion: In a cohort of prevalent, in-center HD patients, low activation was associated with mortality but not with hospitalization or measures of non-adherence.

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来源期刊
Kidney360
Kidney360 UROLOGY & NEPHROLOGY-
CiteScore
3.90
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