Chinese Journal of Blood Purification ›› 2025, Vol. 24 ›› Issue (07): 548-553.doi: 10.3969/j.issn.1671-4091.2025.07.002

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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

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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