| Purpose：Hemodialysis is very important to the end-stage renal diseasepatients to sustain life,which bring huge economic burden and emotionalburden to the family and the society.With the development of society and cityresidents medical insurance and new agricultural cooperative medicalinsurance systems improve constantly and people’s living standard risesceaselessly.Thus, the number of hemodialysis patients who can survive isincreasing quickly and also the patients can live longer than before. However,due to the irreversible of the disease and long-term receiving maintenancehemodialysis treatment,such patients are often faced with huge mental andeconomic pressures and changes of lifestyle,including the threat ofcomplications,physiological function decline, repeated hospitalization,unemployment,borrowing money to see a doctor,the loss of social relationsand social support,strict diet control,medication,losing confidence in life andso on.So the impact of all these factors on the disease itself and the quality oflife can not be ignored.At present,there is no specific information on clinical comparisoninvestigation about the differences of urban and rural hemodialysis patients intreatment,quality of life,economic burden,and psychological status.So thispaper involves the existing maintenance hemodialysis patients fromNovember2010to October2011,of whom101patients were from twothird-grade class-A hospitals and125patients were from three two-gradecounty hospitals in Hebei Province.According to this questionnaire,we can geta comprehensive understanding of maintenance hemodialysis patients andpreliminary comparison of urban and rural patients in the medical,economic,psychological and other aspects. Subjects and methods:From November2010-2011October,101patientsfrom two third-grade class-A hospitals (the third hospital of He Bei medicaluniversity and the People’s Hospital of Xingtai)and125patients from threetwo-grade county hospitals(Traditional Chinese and Western medicine hospitalof Ningjin,Gaocheng County Hospital and People’s Hospital of Zhaoxian) inHebei Province.We collect data such as common information,vascular accesssituation,economic and psychological situation by means of having aface-to-face communication between researchers and patients so they can beguided to fill in the questionnaire by using the uniform explanation language.The data was processed by statistical software SPSS17.0,and had statisticalsignificant difference when probability value was less than0.05.Results: The general contrast of urban and rural patients:①There is nosignificant difference in age,gender,dialysis age and dialysis frequency ofurban and rural patients.The frequency of urban patients is mostly2times perweek and3times per week,respectively,accounting for41.6%and33.7%,about the rural patients are mostly2times per week and3times per2weeks,accounting for63.2%and12.8%respectively;The educational level of urbangroup was significantly higher than that of the rural group,and there are still22cases of illiterate in rural groups (17.6%);The resident home population ofthe urban group are3±2,while the rural group are4±3.It turns out the ruralgroup has the extended family;The average distance from home to the dialysiscenter is10±28km in urban group,while the rural group is15±20km (P<0.05), so we can conclude that the distance from home to the dialysis centeris farther;Most primary disease of urban and rural patients are the primaryglomerular disease,respectively for30cases (29.7%) in urban patients and36cases (28.8%) in the rural patients,but25cases (20%) of the rural group do notknow their original disease,which is significantly more than the urban group.②Urban-rural comparison at the clinic: most urban and rural patients’s serumcreatinine had increased the first time they saw a doctor,accounting for62.4%,76.8%respectively;the hospitals where urban group of patients diagnosed withchronic kidney disease and doctors informed them of hemodialysis treating were provincial,municipal ones.The majority of patients receivinghemodialysis were selected directly by doctors,accouting for56cases (55.4%),and30of the urban patients made a choice after a comprehensiveunderstanding of a variety of renal replacement treatment (29.7%).Afterhaving been told that they need dialysis treatment,40cases (39.6%) beganhemodialysis within a week.The most important reason why they delayeddialysis was because of the hospitalization medical arrangements,accountingfor41cases (40.6%);The hospital where rural group of patients diagnosedwith chronic kidney disease and doctors informed them of hemodialysistreating are county,provincial hospitals,the majority patients receivinghemodialysis were selected directly by doctors,accouting for100patients(80%),and22of the rural patients made a choice after a comprehensiveunderstanding of a variety of renal replacement treatment (17.6%),after beingtold that they need dialysis treatment,47cases (37.6%) began hemodialysiswithin a month,and the overriding reason they delayed dialysis was because ofthe huge pressure of economy,accouting for41cases (32.8%),(P <0.05),There were significant statistical differences.When the rural patients saw adoctor,most of them had increased serum creatinine.They often diagnosed incounty hospitals,and then referral to the provincial hospitals for treatment.Most of rural patients do not quite understand the ways of dialysis,and makethe hemodialysis decisions by the doctors.When the doctors suggested themreceiving hemodialysis,they delayed it because of the huge economic pressure;The majority of urban and rural patients were emergency dialysis due to theseriously complications,accouting for65cases(64.4%)and75cases(60%)respectively;③Comparison of vascular access:65patients (64.4%)fromurban group were not informed to establish vascular access in advance beforehemodialysis.Among the36patients who were told to establish AVF,only15patients followed prescription.106patients (84.8%)from rural group were notinformed to establish vascular access in advance before hemodialysis.Amongthe19patients who were told to establish AVF,only4patients followedprescription (P <0.05).Most rural patients had not been informed to establish vascular access in advance and didn’t follow the doctor’s advice for thepatients who had been informed,comparing with the urban patients.The firstvascular access used for hemodialysis in the majority of patients weretemporary central venous catheter,and most of the urban patients were usinginternal jugular venous catheters,accounting for60cases (69%),and themajority of the rural patients were using the femoral venous catheters,accounteing for55(67%).Vascular access used currently by all respondentswere arteriovenous fistula,but the rural group who used arteriovenous directpuncture for the first hemodialysis were far more than the urban group,accounting for60cases (48%);Most rural patients established long-termvascular access less than a month,accounting for57cases (56.4%),and forrural patients were less than a month and more than three months respectively,accounting for45cases (36%),and25cases (20%)(P <0.05), it points out thatit takes much longer for the rural patients to establish a long-term vascularaccess than the urban patients;The majority urban patients’s temporary centralvenous catheter indwelling time were two months,accounting for29cases(28.7%),and the rural patients’s were three months,accounting for26cases(20.8%);During the using process of temporary central venous catheter,70cases (69.3%) of urban patients did not replace the catheter,there were nocatheter dysfunction and bleeding,and the most complications of catheter wereinfection and blockage,accouting for five cases (5%)respectively.69cases(55.2%) of rural patients did not replace the catheter,and the mostcomplications were catheter infection,accouting for7cases (5.6%),(P <0.05).The primary temporary central venous catheter way of the rural patients werethe femoral venous catheters,which brought high catheter infection rate;Mostpatients bagan to use the arteriovenous fistula after four to six weeks from thesurgary,accouting for27cases (26.7%)and49cases (39.2%)respecively;theprimary cause to use the arteriovenous fistula both were judged by medicalpersonnel of two groups,accouting for80cases (79.2%),and87cases (69.6%)respectively;In the first month,the condition of the paitients who had receivedthe arteriovenous fistula in two groups were both stable and had no hematoma appearance,accouting for75cases (74.3%)and87cases (69.6%)respetively;the fistula application time in two groups were both ranged from one to fiveyears,accouting for29cases (28.7%) and51cases (40.8%)respectively,(P>0.05),the application of arteriovenous fistula of urban and rural patients has nosignificant statistics difference.④The comparison of the economicsituation:most of the net income of permanent residents in urban group in year2010were more than ten thousand yuan to fifty thousand or less than fiftythousand yuan,accounting for66cases (65.3%).There were61cases(60.4%)urban patients had to borrow money to see a doctor,and the majormedical insurance was City health insurance and Unit-based health insurance.Most of urban patients spent seventy to ninety thousand yuan for an annualmedical treat,accounting for40cases (39.6%);most of the net income ofpermanent residents in rural group in year2010were below ten thousand yuan,accounting for71cases (56.8%),there were98cases (78.4%)rural patients hadto borrow money to see a doctor,all125cases (100%)rural patients hadmedical insurance and110cases (88%) had new agricultural cooperativemedical insurance,and most of the rural patients spent forty to sixty thousandyuan for an annual medical treat,accounting for67cases (53.6%).(P <0.05),family net income of rural patients were significantly lower than the urbanpatients,and the number of the rural patients who had to borrow money to seea doctor is larger than that in urban patients.The majority of rural patients hadthe new agricultural cooperative medical insurance,but they always gave upthe regular medication and regular medical laboratory tests to reduce themedical cost,because,compared to their families’s net income,the cost was stilltoo heavy.⑤The contrast of the Living Conditions and the satisfaction of life:the majority of patients from two groups can strictly control the diet and havemedicine regularly;life satisfaction assessment of urban patients is5.030points on average,including16patients (15.8%) who graded zero,and theaverage score of rural patients was3.744points.There were41patients(32.8%)grading zero (P <0.05).We can draw a conclusion that rural patients generally had a lower life satisfaction,and the patients who lose heart in lifewere significantly more than the urban patients.Conclusion:1With the implementation of new agricultural cooperativemedical insurance policy and the establishment of the hemodialysis room inthe county-level medical institutions,the dialysis adequacy of rural patientscontinue to improve,and the dialysis age continue increasing,so that thedialysis status quo has significantly improved.2The awareness and medical standards of primary hospital medical staffon end-stage renal disease have improved significantly.Moreover rural patientscan discover kidney disease in time and receive timely treatment.But they stillhave problems on patients follow-up,on informing and establishing oflong-term vascular access in advance,shortage of temporary catheter’soperation and care,insufficiency in prevention and treatment ofcomplications,which result in longer retention time of temporary catheter andthe higher rate in infection.3Compared with urban patients,the rural patients were generally had badhealth consciousness and do not quite understand their disease.4Compared with urban patients,the rural patients had heavier economicstress,and lower life satisfaction.5The preparatory work of all patients were not sufficient.They couldn’tpsychologically accept dialysis treatment until emergency dialysis causingfrom severe symptoms was badly needed.Besides,they didn’t pre-establish along-term path and so on. |
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