背景:作为初始PD策略的增量腹膜透析(incPD)代表了一种方便且节省资源的方法,但是它对病人的影响,医疗保健和环境尚未得到彻底评估。
方法:这项研究包括147名在1月1日在我们机构开始服用incPD的患者,2009年12月31日,2021年。适当的措施,腹膜通透性参数,腹膜炎发作,记录了住院和CAPD剂量处方增加的情况.与成本相关的节约,患者葡萄糖暴露,进行透析所需的时间,塑料废料,和用水量与全剂量PD治疗进行比较。
结果:在研究随访期间,11.9%的患者从增量剂量转变为全剂量PD。患者在12、24、36、48和60个月保持PD的累积概率为87.6、65.4、46.1、30.1和17.5%,分别。从1到2个交易所的中间过渡时间,从2到3和3到4个交流分别为5、9和11.8个月,分别。与全剂量PD相比,每天1、2和3次交换导致葡萄糖暴露减少20.4、14.8或8.3kg/患者年,免费终身收益为18.1、13.1或7.4天/患者年,费用减少8700、6300或3540欧元/患者年,塑料废物减少139.2、100.8或56.6千克/患者年,用水量下降了25,056、18,144或10,196L/患者年。
结论:与全剂量PD相比,incPD允许减少用于管理透析的时间,葡萄糖暴露,经济成本,塑料废料,和水的消耗。
Incremental peritoneal dialysis (incPD) as the initial PD strategy represents a convenient and resource-sparing approach, but its impact on patient, healthcare and environment has not been thoroughly evaluated.
This study includes 147 patients who started incPD at our institution between 1st January, 2009 and 31st December, 2021. Adequacy measures, peritoneal permeability parameters, peritonitis episodes, hospitalizations and increase in CAPD dose prescriptions were recorded. The savings related to cost, patient glucose exposure, time needed to perform dialysis, plastic waste, and water usage were compared to full-dose PD treatment.
During the study follow-up 11.9% of the patients transitioned from incremental to full dose PD. Patient cumulative probability of remaining on PD at 12, 24, 36, 48 and 60 months was 87.6, 65.4, 46.1, 30.1 and 17.5%, respectively. The median transition time from 1 to 2 exchanges, from 2 to 3 and 3 to 4 exchanges were 5, 9 and 11.8 months, respectively. Compared to full dose PD, 1, 2, and 3 exchanges per day led to reduction in glucose exposure of 20.4, 14.8 or 8.3 kg/patient-year, free lifetime gain of 18.1, 13.1 or 7.4 day/patient-year, a decrease in cost of 8700, 6300 or 3540 €/patient-year, a reduction in plastic waste of 139.2, 100.8 or 56.6 kg/patient-year, and a decline in water use of 25,056, 18,144 or 10,196 L/patient-year.
In comparison with full-dose PD, incPD allows to reduce the time spent for managing dialysis, glucose exposure, economic cost, plastic waste, and water consumption.