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Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study

BACKGROUND: Technique failure secondary to peritonitis is a grave impediment to remain in peritoneal dialysis (PD) therapy leading to high mortality. Multidisciplinary predialysis education (MPE) has shown improvement in outcomes of chronic kidney disease (CKD) patients. However, the legacy effects...

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Autores principales: Hsu, Cheng-Kai, Lee, Chin-Chan, Chen, Yih-Ting, Ting, Ming-Kuo, Sun, Chiao-Yin, Chen, Chun-Yu, Hsu, Heng-Jung, Chen, Yung-Chang, Wu, I-Wen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107258/
https://www.ncbi.nlm.nih.gov/pubmed/30138478
http://dx.doi.org/10.1371/journal.pone.0202781
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author Hsu, Cheng-Kai
Lee, Chin-Chan
Chen, Yih-Ting
Ting, Ming-Kuo
Sun, Chiao-Yin
Chen, Chun-Yu
Hsu, Heng-Jung
Chen, Yung-Chang
Wu, I-Wen
author_facet Hsu, Cheng-Kai
Lee, Chin-Chan
Chen, Yih-Ting
Ting, Ming-Kuo
Sun, Chiao-Yin
Chen, Chun-Yu
Hsu, Heng-Jung
Chen, Yung-Chang
Wu, I-Wen
author_sort Hsu, Cheng-Kai
collection PubMed
description BACKGROUND: Technique failure secondary to peritonitis is a grave impediment to remain in peritoneal dialysis (PD) therapy leading to high mortality. Multidisciplinary predialysis education (MPE) has shown improvement in outcomes of chronic kidney disease (CKD) patients. However, the legacy effects of MPE in PD patients remain unclear. METHODS: All patients who started PD at single hospital in 2007–16 were enrolled. The incidences of peritonitis and peritonitis-related mortality were compared between MPE recipients and non-recipients. The content of the MPE was standardized in accordance with the NKF/DOQI guidelines. Kaplan-Meier analysis and Cox proportional hazards model were applied to identify the prognostic factors associated with peritonitis-free survival. RESULTS: Of 398 PD patients, 169 patients had received MPE before starting PD. The patients of MPE group had a lower peritonitis rate [median (IQR) 0 (0.29) versus 0.11 (0.69) episodes/person-year, P< 0.001] and a lower percentage of peritonitis-related deaths (3.6% versus 8.7%, P = 0.04) compared with the non-MPE group. The median time to the first episode of peritonitis in the non-MPE and MPE groups was 33.9 months and 46.7 months, respectively (Cox-Mantel log rank test, P = 0.003). Cox regression analysis revealed that MPE assignment (HR: 0.594; 95% CI: 0.434–0.813, P< 0.001) were significant independent predictors for peritonitis-free survival. CONCLUSIONS: An efficient standardized MPE program may prolong the time to the first episode of peritonitis and reduce peritonitis rate, independent of age, gender, diabetes, hypertension, educational status and PD modality. Subsequently, decreased peritonitis-related death.
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spelling pubmed-61072582018-08-30 Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study Hsu, Cheng-Kai Lee, Chin-Chan Chen, Yih-Ting Ting, Ming-Kuo Sun, Chiao-Yin Chen, Chun-Yu Hsu, Heng-Jung Chen, Yung-Chang Wu, I-Wen PLoS One Research Article BACKGROUND: Technique failure secondary to peritonitis is a grave impediment to remain in peritoneal dialysis (PD) therapy leading to high mortality. Multidisciplinary predialysis education (MPE) has shown improvement in outcomes of chronic kidney disease (CKD) patients. However, the legacy effects of MPE in PD patients remain unclear. METHODS: All patients who started PD at single hospital in 2007–16 were enrolled. The incidences of peritonitis and peritonitis-related mortality were compared between MPE recipients and non-recipients. The content of the MPE was standardized in accordance with the NKF/DOQI guidelines. Kaplan-Meier analysis and Cox proportional hazards model were applied to identify the prognostic factors associated with peritonitis-free survival. RESULTS: Of 398 PD patients, 169 patients had received MPE before starting PD. The patients of MPE group had a lower peritonitis rate [median (IQR) 0 (0.29) versus 0.11 (0.69) episodes/person-year, P< 0.001] and a lower percentage of peritonitis-related deaths (3.6% versus 8.7%, P = 0.04) compared with the non-MPE group. The median time to the first episode of peritonitis in the non-MPE and MPE groups was 33.9 months and 46.7 months, respectively (Cox-Mantel log rank test, P = 0.003). Cox regression analysis revealed that MPE assignment (HR: 0.594; 95% CI: 0.434–0.813, P< 0.001) were significant independent predictors for peritonitis-free survival. CONCLUSIONS: An efficient standardized MPE program may prolong the time to the first episode of peritonitis and reduce peritonitis rate, independent of age, gender, diabetes, hypertension, educational status and PD modality. Subsequently, decreased peritonitis-related death. Public Library of Science 2018-08-23 /pmc/articles/PMC6107258/ /pubmed/30138478 http://dx.doi.org/10.1371/journal.pone.0202781 Text en © 2018 Hsu et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Hsu, Cheng-Kai
Lee, Chin-Chan
Chen, Yih-Ting
Ting, Ming-Kuo
Sun, Chiao-Yin
Chen, Chun-Yu
Hsu, Heng-Jung
Chen, Yung-Chang
Wu, I-Wen
Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study
title Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study
title_full Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study
title_fullStr Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study
title_full_unstemmed Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study
title_short Multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study
title_sort multidisciplinary predialysis education reduces incidence of peritonitis and subsequent death in peritoneal dialysis patients: 5-year cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107258/
https://www.ncbi.nlm.nih.gov/pubmed/30138478
http://dx.doi.org/10.1371/journal.pone.0202781
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