Barriers in adequacy goals in peritoneal dialysis:evaluation of a cohort with negative selection bias

Abstract

Our study aimed to evaluate PD patients by tracing a sociodemographic profile and jointly evaluating the clinical and laboratory parameters of dialysis adequacy, as well as outcomes. A prospective cohort study in the Juiz de Fora Federal University Hospital dialysis unit in Brazil between July 2021 and July 2022. The sociodemographic, clinical, laboratory data and adherence were assessed. The Short Assessment of Health Literacy for Portuguese-speaking Adults score, a score of perception of social support, a tool for evaluating QoL (SF-12), and Malnutrition Inflammation Score (MIS) were performed. The primary outcomes were death and QoL, whereas technique failure and hospitalization were secondary. Fifty-six patients in automated peritoneal dialysis modality were evaluated (73.2% prevalent and 26.8% incident). The majority were women (61.2 ± 13.9 years old), white, illiterate and with low income. All patients were hypertensive, one-third had diabetes mellitus (DM) and 76.8% were compliant. The definition of goals was the patient stayed within the normal range within 80% of the following time. The adequacy goals of blood pressure (30.4%) and phosphorus (28.6%) were the most difficult to achieve. Among the primary outcomes, the physical component of the SF-12 was negatively associated with higher MIS, and the mental component of the SF-12 was negatively correlated with higher age. There was no significant difference in death as an outcome. The factors that were associated with the achievement of goals were age, previous nephrological follow-up, dementia, DM, and adherence.

Keywords

• peritoneal dialysis
• chronic kidney failure
• kidney replacement therapy
• azotemia
• barriers to access to health care