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