在扩张的时代,卫生服务领域的腹膜透析启动模式
Christopher D Knapp1,2, Shuling Li1, Chuanyu Kou1
1Hennepin Healthcare Research Institute, Chronic Disease Research Group, Minneapolis, MN.
Journal of the American Society of Nephrology : JASN
|January 21, 2026
概括
腹腔透析 (PD) 的使用在各个社区广泛扩大,最大的增加发生在以前PD利用率较低的地区. 这表明全国范围内改善了PD作为透析选择的可用性.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 腹腔透析 (PD) 在美国的使用表现出显著的区域和社会经济差异.
- 之前的研究表明,与低收入东北地区相比,富裕的西方社区的PD利用率更高.
- 该研究旨在确定最近PD使用的增加是否代表了扩大访问或在已经高使用地区的进一步增长.
研究的目的:
- 分析美国卫生服务区域 (HSAs) 中腹膜透析 (PD) 启动的趋势.
- 评估PD使用扩张是否扩大了这种模式的访问范围,还是集中在高利用率地区.
- 根据HSA的基线PD使用患病率来评估PD启动模式.
主要方法:
- 使用美国脏数据系统 (USRDS) 来获取2011-2020年患者数据.
- 根据2009-2010年的数据,将755个HSA分为"低","中",和"高"PD使用.
- 采用后勤回归来模拟PD启动几率的变化,按HSA PD使用类别随着时间的推移.
主要成果:
- 开始PD的几率在最初使用PD较低的HSA中最显著增加 (每5年调整的OR为1.49).
- 在中等 (调整的OR 1.37) 和高 (调整的OR 1.17) PD使用HSA中也观察到增加.
- 到2020年,超过一半 (51%) 的以前低PD利用率的HSA过渡到中等或高PD使用类别.
结论:
- 腹腔透析 (PD) 作为辅助透析方式的使用在以前不太常见的地区增长最为显著.
- PD使用的扩张似乎很普遍,这表明使用范围扩大,而不是仅仅在已建立的高使用地区使用率增加.
- 调查结果表明,在美国各个社区中,朝着更公平的PD接入的积极趋势.
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