药物治疗方案复杂性对血液透析患者相关及临床结局的影响。

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Hemodialysis International Pub Date : 2025-02-23 DOI:10.1111/hdi.13214

Jing Xin Goh, Wubshet Tesfaye, Connie Van, Kamal Sud, Shrey Seth, Surjit Tarafdar, Ronald L. Castelino

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引用次数: 0

摘要

导读：在不同情况下，药物治疗方案复杂性对接受血液透析（HD）的肾衰竭患者预后的影响数据有限。本研究旨在量化药物治疗方案的复杂性，并评估其对机构和家庭hd治疗患者的患者相关和临床结果的影响。方法：本研究的目标是在澳大利亚一个大型大都市透析中心接受HD的患者。通过对电子病历的回顾性审计记录基线数据和住院情况，同时前瞻性地收集其他结果数据。采用65项用药方案复杂性指数（MRCI）评估用药方案复杂性。服药依从性用四项莫里斯基-格林-莱文量表（MGLS）进行评估，如果参与者对任何问题回答“是”，则认为他们没有坚持服药。EQ- 5d - 5l和EQ VAS评分用于评估健康相关生活质量（HRQoL），得分越高表示健康状况越好。结果：174名符合条件的成年人中，145名（80名基于机构和65名家庭hd）患者参与了研究。设施HD和家庭HD的参与者以男性为主（分别为65%和75.4%），平均年龄分别为62±13岁和56±12岁。家庭HD参与者的MRCI中位数高于设施HD参与者[分别为26.0 （IQR 20.6-33.0）和20.8 (IQR 13.6-28.4)]；p = 0.005]。虽然不依从率没有显著差异，但家庭HD参与者的EQ-5D-5L得分更高[分别为0.917 （IQR 0.745-0.984）比0.798 (IQR 0.302-0.956)；p = 0.006]和EQ VAS [60 (IQR 50-75) vs. 50 (IQR 40-70)；p = 0.034]。家庭HD参与者在前1年（IQR 0-1）和1年（IQR 0-1）的住院次数也分别较少；p = 0.042)。讨论：家庭HD患者用药方案的复杂性高于医院HD患者，这可能是由于几种肠外药物的剂量管理责任发生了变化。尽管复杂性更高，但家庭HD患者的结果更好，包括HRQoL和住院治疗。

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The Impact of Medication Regimen Complexity on Patient-Related and Clinical Outcomes in Patients Undergoing Hemodialysis

Introduction

There is limited data on medication regimen complexity on outcomes in patients with kidney failure receiving hemodialysis (HD) in different settings. This study aims to quantify medication regimen complexity and assess its impact on patient-related and clinical outcomes in facility-based and home-based HD-treated patients.

Methods

This study targeted patients undergoing HD at a large metropolitan dialysis center in Australia. Baseline data and hospitalizations were recorded through a retrospective audit of electronic medical records, while other outcome data were collected prospectively. Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI). Medication adherence was evaluated with the 4-item Morisky-Green-Levine Scale (MGLS), whereby participants were deemed not adherent if they responded “yes” to any of the questions. EQ-5D-5L and EQ VAS scores were used to assess health-related quality of life (HRQoL) with higher scores indicating better health.

Findings

Of 174 eligible adults, 145 (80 facility-based and 65 home HDs) patients participated. Participants of both facility-based and home HD were predominantly men (65% and 75.4%, respectively) with a mean age of 62 ± 13 years and 56 ± 12 years, respectively. Home HD participants had a higher median MRCI than those on facility-based HD [26.0 (IQR 20.6–33.0) vs. 20.8 (IQR 13.6–28.4), respectively; p = 0.005]. While there was no significant difference in the non-adherence rate, home HD participants had higher scores for both EQ-5D-5L [0.917 (IQR 0.745–0.984) vs. 0.798 (IQR 0.302–0.956), respectively; p = 0.006] and EQ VAS [60 (IQR 50–75) vs. 50 (IQR 40–70), respectively; p = 0.034]. Home HD participants also had a fewer number of hospitalizations in the prior (1 year 0 (IQR 0–1) vs. 1 (IQR 0–1), respectively; p = 0.042).

Discussion

The higher complexity of the medication regimen for home HD compared to facility-based HD participants may be due to the shift in dose administration responsibility of several parenteral medications. Despite the higher complexity, home HD patients had better outcomes, including HRQoL and hospitalizations compared to facility-based HD patients.

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.