背景:社会经济和文化障碍对晚期慢性肾脏病(ACKD)肾脏替代疗法(RRT)技术选择的影响几乎没有探讨,这会产生不公平的问题,在医疗保健中经常被忽视。这项研究的目的是确定影响西班牙晚期慢性肾脏病(ACKD)咨询中RRT选择的“非医学”障碍。
方法:回顾性分析,包括2009年至2020年在三级医院接受ACKD会诊的患者总数。纳入ACKD咨询始于资格测试和决策过程,由受过专门训练的护士进行。研究考虑的变量是:年龄,性别,CKD的病因,对日常生活基本活动(Barthel量表)和日常生活工具活动(Lawton和Brody量表)的依赖程度,西班牙与外国国籍,社会经济水平和语言障碍。社会经济水平是根据患者所属的初级保健中心的家庭和卫生区进行推断的。
结果:在研究期间,共有673人参加了ACKD会诊,其中400人(59.4%)选择血液透析(HD),156(23.1%)用于腹膜透析(PD),4例(0.5%)为早期活体供肾移植(LDRT)和113例(16.7%)选择守旧照护(CC)。选择PD作为选择的RRT技术(与HD)与社会经济水平高的人(38.7%与22.5%)(p=0.002),西班牙国籍(91%vs.77.7%)(p<0.001),较低的语言障碍(0.6%对10.5%)(p<0.001),在Barthel量表(97.4vs92.9)以及Lawton和Brody量表(7vs6.1)上得分较高(p<0.001)。在两种技术的选择上,年龄和性别都没有显着差异。选择CC的患者年龄明显较大(81.1vs67.7岁;p<0.001),依赖性更强(p<0.001),女性比例较高(49.6%vs35.2%;p=0.006),西班牙人比例较高(94.7%vs81%,p=0.001)与其他技术(PD和HD)的选择有关。社会经济水平并不影响CC的选择。
结论:尽管有规范的决策过程,有社会经济地位等因素,迁移,影响所选择RRT类型的人口的语言障碍和依赖性。为了解决这些可能导致不公平的方面,需要跨学科团队的跨部门和多层次干预,包括,其中,社会工作者,提供更全面和以人为中心的评估。
The influence of socioeconomic and cultural barriers in the choice of renal replacement therapy (RRT) techniques in advanced chronic kidney disease (ACKD) has been scarcely explored, which can generate problems of inequity, frequently unnoticed in health care. The aim of this study is to identify the \"non-medical\" barriers that influence the choice of RRT in an advanced chronic kidney disease (ACKD) consultation in Spain.
Retrospective analysis including the total number of patients seen in the ACKD consultation in a tertiary hospital from 2009 to 2020. Inclusion in the ACKD consultation began with an eligibility test and a decision-making process, conducted by a specifically trained nurse. The variables considered for the study were: age, sex, etiology of CKD, level of dependence for basic activities of daily living (Barthel Scale) and instrumental activities of daily living (Lawton and Brody Scale), Spanish versus foreign nationality, socioeconomic level and language barrier. The socioeconomic level was extrapolated according to home and health district by primary care center to which the patients belonged.
A total of 673 persons were seen in the ACKD consultation during the study period, of whom 400 (59.4%) opted for hemodialysis (HD), 156 (23.1%) for peritoneal dialysis (PD), 4 (0.5%) for early living donor renal transplantation (LDRT) and 113 (16.7%) chose conservative care (CC). The choice of PD as the chosen RRT technique (vs. HD) was associated with people with a high socioeconomic level (38.7% vs. 22.5%) (p = 0.002), Spanish nationality (91% vs. 77.7%) (p < 0.001), to a lower language barrier (0.6% vs 10.5%) (p < 0.001), and to a higher score on the Barthel scale (97.4 vs 92.9) and on the Lawton and Brody scale (7 vs 6.1) (p < 0.001). Neither age nor sex showed significant differences in the choice of both techniques. Patients who opted for CC were significantly older (81.1 vs 67.7 years; p < 0.001), more dependent (p < 0.001), with a higher proportion of women (49.6% vs 35.2%; p = 0.006) and a higher proportion of Spaniards (94.7% vs 81%, p = 0.001) in relation to the choice of other techniques (PD and HD). Socioeconomic level did not influence the choice of CC.
Despite a regulated decision-making process, there are factors such as socioeconomic status, migration, language barrier and dependency of the population that influence the type of RRT chosen. To address these aspects that may cause inequity, an intersectoral and multilevel intervention is required with interdisciplinary teams that include, among others, social workers, to provide a more holistic and person-centered assessment.