| Research background and purpose:The spectrum of human diseases has changed dramatically over the past 30 years as the living environments and lifestyles have changed.The incidence of end-stage renal disease(ESRD)is also increasing worldwide.Due to the limit of renal graft,renal replacement therapy(RRT)is still dominated by hemodialysis(HD)and peritoneal dialysis(PD).PD has been increasingly recognized as an effective alternative treatment for ESRD due to its unique advantages,and has gradually been accepted by more and more ESRD patients.As most of the PD patients dialysis themselves at home,one of the key factors for the success of PD is patient management.This study analyzed some of the key quality indicators of PD in a single center that applied different patient management modes during year 2016 and 2021.The purpose of the study was to find a better,more suitable patient management model for peritoneal dialysis therapy and improve the prognosis of PD patients.Materials and Methods:A total of 237 patients undergoing peritoneal dialysis in the First Affiliated Hospital of Chengdu Medical College from January 2016 to December 2021 were selected.Peritoneal dialysis patients were managed with different patient management modes during this period,namely hierarchical management(mode A),integrated disease-specific management(mode B)and "Internet +" based integrated management(mode C).Patients’ clinical data including demographic data,blood biochemistry,the incidence of peritonitis,time on PD treatment for those dropout patients,hospitalization rate,etc were collected and analyzed.Results:1、Among the 237 PD patients,127 were male(53.59%)and 110 were female(46.41%),with an average age of 51.96±16.40 years.Among the primary diseases leading to end-stage renal disease,115 were primary glomerulonephritis(48.52%),59 were diabetic nephropathy(24.89%),and 40 were hypertensive nephropathy.Other causes accounted for 23 cases(9.71%).In terms of peritonela transport rate,there were15 cases of high transport(6.30%),100 cases of high average transport(42.20%),86 cases of low average transport(36.29%)and 36 cases of low transport(15.21%).At the end of December 2021,42.19%,26.58%,24.48%,5.06% and 1.69% of the patients were on maintenance peritoneal dialysis,dead,transfered to hemodialysis,recieved kidney transplantation and lost follow up,respectively.2、There were statistically significant differences in the percentage of patients achieving target total Kt/ V and total Ccr under the three different management modes(P=0.031,P=0.001).However,there was no significant difference in blood pressure(BP)control among the three different management modes(P=0.768).There was no significant difference in the anemia control among the three different management modes(P=0.886).There was no significant difference in nutritional indexes among the three different management modes(P=0.117).There was no statistical significance in calcium(Ca),phosphorus(P)and parathyroid hormone(PTH)control among the three different management modes(P=0.190,P=0.572,P=0.848).The incidence of peritonitis was significantly lower when the "Internet +" based integrated management model was applied as compared to the two other models(P=0.001,P=0.002).3、There was no significant difference in the dropout rate(DOR)among the three groups under different management modes(P=0.453).However,the TOT was significantly longer the when the "Internet +" based integrated management model was applied as compared to the two other models(P=0.011).The average length of hospitalization was alos significantly lower when the "Internet +" based integrated management model was applied as compared to the two other models(P=0.000).Conclusions:1 、 The main cause of ESRD in peritoneal dialysis patients was chronic glomerulonephritis in our center,followed by diabetic nephropathy and hypertensive nephropathy.Most of the PD patients have high-average and low-average peritoneal transport rate,Transfer to hemodialysis and death were the two main causes of patient dropout.2、The integrated patient management mode based on "Internet +" may be more suitable for some of the key PD quality indicators such as the percentage of patients achieving target total Kt/ V and total Ccr,incidence of peritonitis,while the effects on blood pressure,nutrition,calcium and phosphorus metabolism did not altered.3、The use of "Internet +" integrated care management model may prolong the use of peritoneal dialysis and reduce the length of hospital stay in PD patients,which may indicate certain economic benefits of this therapy.4、Through six years of continuous quality improvement,the center has achieved certain quality effects in the management of peritoneal dialysis,which provides a certain realistic basis for the treatment and management of peritoneal dialysis patients and the improvement of patients’ prognosis. |
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