| Objective:The increasing number of ESRD patients has brought a heavy financial burden to various countries,and the promotion of more cost-effective dialysis methods has become the choice of countries.China introduced a PD preference policy in 2012.As of December 31,2019,there were 632,653 HD patients and 103,348 PD patients in China.The number of patients receiving HD treatment is 6 times that of PD,which is comparable to other countries with similar policies.Compared with regions,the proportion of PD patients in China is still low.It is necessary to investigate the actual situation of PD promotion in China,explore the factors that affect the choice of dialysis methods for ESRD patients in China at this stage,and combine the successful experience of countries/regions to propose more targeted Suggestions and measures to promote the implementation and development of the PD policy.Method:A questionnaire survey was used to investigate all dialysis patients who had no contraindications to PD and HD when choosing the initial dialysis method with Wuhan Central Hospital as the designated hospital.Before making the questionnaire,we reviewed relevant domestic and foreign studies in detail to understand the possible factors that affect patients’ choice of initial dialysis methods,including economy,efficacy approval,distance from designated hospitals,time flexibility,family burden,PD-related operation mastery,doctors Opinions,pre-dialysis education situation and family support situation,and according to the characteristics of the two dialysis methods,respectively,appropriate adjustments were made to the content of the PD and HD questionnaires.Finally,conclusions were drawn through statistics and analysis,combined with successful experience,and recommendations were given.Results:100 questionnaires were distributed and 92 valid questionnaires were recovered.The average age is 60.4 years old,and 60 people have no occupation(65.2%).The average initial dialysis time is 2018.Primary disease: 2 people with type 2 diabetes(2.1%),68 people(73.9%)with essential hypertension,19 people(20.6%)with type 2 diabetes and essential hypertension,and 1 person(1.0%)with chronic nephritis,2 people(2.1%)did not fill in the primary disease.Factors for initial selection of PD: "Factor 1: Peritoneal dialysis costs less" 64people(69.6%)agree,"Factor 2: Good peritoneal dialysis effect" 71 people(77.1%),"Factor3: peritoneal dialysis does not require frequent “It’s easier to go to and from the hospital”agree with 75 people(81.5%),“Factor 4: Peritoneal dialysis makes the schedule between treatment and life more flexible” agree with 76 people(82.6%),“Factor 5: Peritoneal dialysis patients do not Too much extra care is needed,which reduces the burden of family members’ lives.” 76 people(82.6%)agree,“Factor 6: Peritoneal dialysis patients or caregivers are proficient in treatment operations” 85 people(92.3%)agree,“Factor 7 : 54people(58.6%)agreed with the doctor’s opinion completely;in terms of pre-dialysis education: “I knew about the disease and its prognosis before entering dialysis treatment”agreed with 80 people(86.9%),“have expected and already Prepare in advance(including psychological preparation,peritoneal dialysis catheterization,and preparation of caregivers)" I agree with 72 people(78.2%),"Patients or family members have understood the characteristics of the two dialysis treatment methods before dialysis" agree with 76 people(82.6%));Family support: 61 people(66.3%)high,29 people(31.5%)average,2 people(2.1%)poor.Hemodialysis questionnaire survey: 300 questionnaires were distributed and282 valid questionnaires were recovered.The average age is 61.7 years old,and 100 people have no occupation(35.5%).The average initial dialysis time was 2016.Primary disease: 33 people with type 2 diabetes(11.7%),38 people with essential hypertension(13.5%),11 people with type 2 diabetes and essential hypertension(4.0%),and 2 people with acute glomerulonephritis(0.7%),15 persons with chronic nephritis(5.3%),1 person with secondary nephritis(0.4%),6 persons with chronic obstructive nephropathy(2.1%),4 persons with polycystic kidney disease(1.4%),chronic renal failure(non-There were 63people(22.3%)with primary disease,8 people(2.8%)with uremia(non-primary disease),and 101 people(35.8%)without primary disease.Factors for initial selection of HD: “Factor1: Less expensive hemodialysis” agree with 89 people(31.6%),“Factor 2: Good hemodialysis effect” agree with 226 people(80.1%),“Factor 3: Convenient transportation,convenient and frequent 203 people(72.0%)agree with commuting to residence and designated hospitals,“Factor 4: Reasonable or compromised arrangements for dialysis treatment and life time” agree with 207 people(73.4%),“Factor 5: Hemodialysis patients can be alone Those who go to a hemodialysis center or have fixed caregivers do not cause too much family burden." 181 people(64.2%)agree," Factor 6: It is difficult to master the operation of peritoneal dialysis and want to get professional care " 56 people(19.9%)agree," Factor 7: Hemodialysis patients or caregivers agree more with the treatment and nursing level of the hemodialysis center,and have more confidence in the treatment " 222(78.7%)agree,and 218(77.3%)agree with “Factor 8: Fully listen to doctors’ opinions”);pre-dialysis education situation: " Knowledge about the disease and its prognosis before entering the dialysis treatment " agree with 136 people(48.2%)," anticipate the dialysis treatment and have prepared in advance(including psychological preparation,arteriovenous fistula)Surgery,long-term catheterization,caregiver preparation)” agree with 142(50.4%),“patients or family members have understood the characteristics of two dialysis treatment methods before dialysis” agree with 174(61.7%);family support status: high 201 People(71.3%),72people(25.5%)in general,and 9 people(3.2%)poor.Conclusion:In conclusion,we suggest that first of all,it is necessary to pay more attention to renal injury in patients with hypertension and diabetes.The progress of CKD can be delayed by early and regular physical health examination and health education.Secondly,PD treatment is more cost-effective.There is no need for regular treatment in dialysis centers,time flexibility,and more family burden reduction.These three characteristics can be used for the further promotion of PD.Publicizing PD can bring more benefits to improve patients’ quality of life.Moreover,PD treatment procedures are not the reason for patients to abandon PD.Physicians make biased recommendations when dealing with patients who lack the confidence,knowledge,and ability to self-manage.The professional treatment and nursing in the hemodialysis center replaces the daily self-management of patients,so the further promotion of PD needs to obtain the approval and support of Physicians,and second-level hospitals are more suitable for the further development of PD.Finally,well-designed pre-dialysis education plan and increased access to dialysis-related education are very important for the further promotion of PD,and family support is the premise for patients to adhere to PD treatment. |
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