Analysis Of Dialysis Adequacy,cognitive Function And Quality Of Life In CAPD Patients:A Mixed Study

China has the highest number of chronic kidney disease（CKD）patients worldwide.Peritoneal dialysis（PD）,especially continuous ambulatory peritoneal dialysis（CAPD）,has become one of the main alternative therapies for the treatment of end-stage renal disease.Research has shown that the main cause of death in PD patients is the increase and exacerbation of comorbidities,which are caused by inadequate dialysis and directly affect the clinical prognosis of patients.According to a survey,for patients who have been on dialysis for more than 3 months,the proportion of insufficient dialysis is as high as 42%,and insufficient dialysis has become one of the main reasons for patients to withdraw from treatment.Meanwhile,research has found that the incidence of cognitive impairment among PD patients in China is about 2-3 times that of the general population,which seriously affects the quality of life of patients.How to effectively improve this situation has become an important issue in the field of kidney disease.Objectives:This study aimed to explore the trajectory of dialysis adequacy,cognitive function and quality of life in patients with CAPD at 3-time points of 1 year,and longitudinal analyze the relationship among dialysis adequacy,cognitive function and quality of life in CAPD patients.At the same time,combined with qualitative research to fully explore the deep reasons for the differences in dialysis adequacy in CAPD patients.In order to provide a theoretical basis for adjusting the dialysis regimen to reduce patients’cognitive impairment,improve their quality of life and clinical prognosis in clinical practice.Methods:A mixed study method was used in this study.From October 2021 to January 2023,patients who received CAPD treatment and were regularly followed up in the PD Center of the Nephrology Department of a tertiary hospital in Changchun were selected as the study objects.In the quantitative study phase,75 CAPD patients were evaluated over a longitudinal period for 1 point every 6 months,at baseline（T1）,6-months follow-up（T2）,and 12-months follow-up（T3）.Urea Clearance Index（Kt/V）was used to measure the patients’dialysis adequacy,Montreal Cognitive Assessment（Mo CA）was used to assess the patients’cognitive function,and Kidney Disease Quality of Life 36-Item Short Form Survey(KDQOL-36^TM)was used to evaluate patients’quality of life.Patients’demographic data and disease-related data were collected through the general data questionnaire and clinical electronic medical record system.Epi Data 3.1 and Excel2019 were used for data entry,and IBM SPSS 26.0 was used for data analysis and processing.The longitudinal trends of dialysis adequacy,cognitive function and quality of life of CAPD patients at 3-time points were determined by single factor repeated measure ANOVA.For data that did not satisfy the spherical hypothesis,the degrees of freedom were adjusted by the Greenhouse-Geisser method.Multiple comparison Bonferroni method was used to compare the difference of node scores at different times in pairs.Pearson correlation analysis was used to investigate the correlation between dialysis adequacy,cognitive function and quality of life in CAPD patients at 3-time points.In the qualitative study phase,phenomenological research methods in qualitative research were adopted,and the interview outline was formulated based on the Information-Knowledge-Attitude-Practice（IKAP）theory.One-to-one,semi-structured in-depth interviews were conducted with 18 representative study subjects.The acquired audio recordings were transcribed verbatim within 24 hours of the interview.Colaizzi’s7-step analysis method and NVivo 12.0 plus qualitative data analysis software were used to encode,classify and summarize the interview data,extract the commonness,and finally form the theme.Results:1.Quantitative study:（1）A total of 5 patients with CAPD were lost to follow-up during the 1-year follow-up period in this study,among which 3 patients changed their contact information,1 patient was transferred to a hospital,and 1 patient died.The actual effective sample size was 70 cases,the sample loss rate was 6.7%,and the tracking completion rate was 93.3%.（2）Dialysis adequacy of CAPD patients showed dynamic changes and gradually decreased over time,and the Kt/V of patients at T1,T2 and T3 time points were1.89±0.50,1.84±0.37 and 1.83±0.39,respectively.Univariate repeated measure analysis of variance showed that there were differences in dialysis adequacy levels among the 3-time points,but the differences were not statistically significant（P>0.05）.（3）The prevalence of cognitive dysfunction in CAPD patients gradually increased over time.The prevalence was 40.00%at T1,47.14%at T2,7.14%higher than that at T1,51.43%at T3,11.43%and 4.29%higher than that at T1 and T2,respectively.（4）The general cognitive function of CAPD patients gradually decreased over time,and the 3-time points T1（25.93±1.97）,T2（25.34±2.51）and T3（24.69±3.10）showed a progressive downward trend.Among the dimensions of cognitive function,visuospatial/executive,attention and delayed recall decreased the most significant（P<0.05）.By pairwise comparisons of the Bonferroni method,there were statistically significant differences in general cognitive function,visuospatial/executive,attention and delayed recall at 3-time points in CAPD patients（P<0.05）.（5）The general quality of life of CAPD patients gradually decreased over time,and the 3-time points of T1（55.27±10.22）,T2（50.67±9.51）and T3（46.44±9.62）showed a progressive downward trend.The 5 dimensions of quality of life decreased significantly（P<0.05）.After multiple comparison and pairwise comparison with Bonferroni method,the difference of general quality of life and all dimensions at 3-time points of CAPD patients were statistically significant（P<0.05）.（6）Dialysis adequacy of CAPD patients at T1,T2 and T3 time points was significantly positively correlated with general cognitive function,visuospatial/executive,attention and delayed recall（r=0.236～0.381,P<0.05）.（7）Dialysis adequacy of CAPD patients at T1 and T2 time points was significantly negatively correlated with general quality of life,Symptoms/Problems of Kidney Disease（SPKD）and Burden of Kidney Disease（BKD）（r=-0.236～-0.373,P<0.05）.The dialysis adequacy of CAPD patients at T3 time point was significantly positively correlated with Physical Component Summary（PCS）（r=0.246,P<0.05）.2.Qualitative study:Based on the IKAP theory,six themes were extracted from 3aspects of knowledge,attitude and behavior,namely,low level of health literacy,lack of individualized information,changes in mental resilience,increased sense of self-efficacy,increased need for social support,and restrictions in daily life.Conclusions:（1）Dialysis adequacy,cognitive function and quality of life of CAPD patients decreased gradually over time.（2）There was a significant positive correlation between dialysis adequacy and general cognitive function,visuospatial/executive,attention and delayed recall in CAPD patients at T1,T2 and T3 time points.And dialysis adequacy of CAPD patients at T1 and T2 time points was negatively correlated with general quality of life,SPKD and BKD,while dialysis adequacy at T3 time point was positively correlated with PCS.（3）The reason for the difference in dialysis adequacy of CAPD patients is closely related to the patients themselves.CAPD patients have many misunderstandings about dialysis adequacy,their attitudes towards dialysis adequacy are diverse,and their behavior towards dialysis adequacy is affected by many factors.（4）Through 1-year longitudinal tracking survey and qualitative interview results,it is suggested that clinical medical staff should implement dynamic monitoring and comprehensive management as early as possible,provide people-oriented and individualized nursing intervention measures,and improve the quality of dialysis,reduce the cognitive impairment of patients,improve the quality of life of patients and improve the clinical prognosis of patients by adjusting the dialysis program,so as to further maximize dialysis effect.