中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (07): 548-553.doi: 10.3969/j.issn.1671-4091.2025.07.002

• 临床研究 • 上一篇    下一篇

标准化管理结合远程医疗后医疗服务可及性对腹膜透析患者临床不良预后的影响

王清华    张 勇    郭姗姗   申玉兰   马甜甜   杨志凯   付 纲   董 捷   

  1. 100034 北京，1北京大学第一医院肾内科 北京大学肾脏病研究所 卫健委肾脏疾病重点实验室 教育部
             慢性肾脏病防治重点实验室 中国医学科学院免疫介导肾病诊治创新单元
             101500 北京，2北京大学第一医院密云医院肾内科
             100080 北京，3北京市海淀医院(北京大学第三医院海淀院区)肾内科
  • 收稿日期:2025-03-20 修回日期:2025-04-28 出版日期:2025-07-12 发布日期:2025-07-12
  • 通讯作者: 付刚；董捷 E-mail:fugang126@126.com；jie.dong@bjmu.edu.cn
  • 基金资助:
    首都医学科技创新成果转化优促计划(YC202401QX0710)；北京大学第一医院创新转化孵育基金(2022CX09)；北京大学第一医院高质量临床研究专项(2022CR82)；中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-046)

Effect of health services accessibility on the clinical adverse outcomes of peritoneal dialysis patients after implementing standardized management combined with telemedicine services

WANG Qing-hua, ZHANG Yong,GUO Shan-shan, SHEN Yu-lan, MA Tian-tian, YANG Zhi-kai, FU Gang, DONG Jie   

  1. Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health, Ministry of Education; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, Chinal; 2Renal Division, Department of Medicine, Beijing Miyun District hospital, Beijing 101500, China ;  3Renal Division, Department of Medicine, Peking Haidian Hospital, Beijing 100080, China
  • Received:2025-03-20 Revised:2025-04-28 Online:2025-07-12 Published:2025-07-12
  • Contact: 100080 北京，3北京市海淀医院(北京大学第三医院海淀院区)肾内科；100034 北京，1北京大学第一医院肾内科 北京大学肾脏病研究所 卫健委肾脏疾病重点实验室教育部慢性肾脏病防治重点实验室 中国医学科学院免疫介导肾病诊治创新单元 E-mail:fugang126@126.com；jie.dong@bjmu.edu.cn

摘要： 目的  探讨实施标准化管理结合远程医疗服务后，医疗服务可及性指标对腹膜透析(peritoneal dialysis,PD)患者临床预后的影响。 方法 本研究是一项多中心前瞻性队列研究，纳入2016年1月1日─2019年4月30日北京3家医院PD患者，所有患者均使用腹膜透析互联网医疗管理平台管理。采用单因素和多因素COX比例风险模型或竞争风险模型，探寻医疗服务可及性3个维度对患者全因死亡、转血液透析(以下简称“转血透”)和首次发生腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis，PDAP)的影响。 结果 共纳入976例患者，中位随访时间31.0(17.0，49.0)月，3家PD中心组间医疗服务可及性变量均具有明显差异(Z/χ2值：45.843～165.628，均P＜0.001)。单因素分析中受教育程度、交通距离和交通时间对全因死亡风险影响具有显著性，但多变量校正后受教育程度(HR =1.299～1.364，P =0.238～0.468)、交通距离(HR =0.999，95% CI：0.992～1.007，P=0.831)和交通时间(HR =1.011，95% CI：0.951～1.075，P =0.727)对全因死亡风险无显著性影响。所有医疗服务可及性变量对转血透和首次发生PDAP风险无显著性影响。 结论 本研究提示开展PD标准化管理结合远程医疗后，区域内医疗服务可及性差距与患者不良预后没有明确相关性。

关键词: 腹膜透析, 医疗服务可及性, 标准化管理, 远程医疗, 死亡率, 转血液透析, 腹膜透析相关性腹膜炎

Abstract: Objective To investigate the effect of health services accessibility on the clinical adverse outcomes of peritoneal dialysis (PD) patients after implementing standardized PD management combined with telemedicine services. Methods This study was a multi-center prospective cohort study that included PD patients from three hospitals in Beijing between January 1, 2016, and April 30, 2019. All patients were managed using the Peritoneal Dialysis Telemedicine and Healthcare Management Platform (PDTAP). Univariate and multivariate Cox proportional hazards models or competing risks models were used to explore the effects of three dimensions of health services accessibility on all-cause mortality, hemodialysis transfer, and first-episode PD-related peritonitis. Results A total of 976 patients were enrolled in this study with a median follow-up of 29.0 (IQR 14.3～45.0) months. There were significant differences in all health services accessibility variables among the three PD centers (Z/χ² values: 45.843～165.628, all P＜0.001). In univariate analyses, education level, travel distance and travel time had significant effect on the risk of all-cause mortality, but after multivariate analysis education levels (HR 1.299～1.364, P=0.238～0.468), travel distance (HR 0.999, 95% CI 0.992～1.007, P = 0.831) and travel time (HR 1.011, 95% CI 0.951～1.075, P = 0.727) had no significant association with the risk of all-cause mortality. All health services accessibility variables were not associated with hemodialysis transfer or first-episode PD-related peritonitis. Conclusion This study suggests that there is no clear association between regional health services accessibility and adverse clinical outcomes for PD patients after the implementation of standardized PD management combined with telemedicine services.

Key words: Peritoneal dialysis, Health services accessibility, Standardized management, Telemedicine;mortality, Hemodialysis transfer, PD-related peritonitis

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