拉萨维持性血液透析患者肾移植意愿调查研究

Investigation on kidney transplantation intention of maintenance hemodialysis patients in Lhasa

目的 了解拉萨地区维持性血液透析患者的肾移植意愿及其影响因素.方法 选择2019年4月5日至2019年4月12日期间在西藏自治区人民医院血液净化中心进行维持性血液透析的患者102例参加的横断面调查.所使用的问卷是根据之前发表的文献进行编制,使用多元Logistic回归分析确定肾移植意愿的影响因素.结果 入选患者98例了解肾移植(96.1%),35例维持性透析患者有肾移植意愿(34.3%).调整了混杂因素后,潜在受者的年龄的增长(比值比为0.9,95%CI:0.8~0.9,P<0.001)、已婚状态(比值比为0.1,95%CI:0~0.5,P=0.010)、糖尿病肾病(比值比为0,95%CI:0~0.2,P=0.001)均是肾移植意愿的负面影响因素,并发现41岁是肾移植意愿降低的一个关键转折点.较高的受教育程度(比值比为8.2,95%CI:2.9~22.7,P<0.001)是促进选择肾移植的因素.在职状态(比值比为3.1,95%CI:0.9~10.9,P=0.085,交互作用检验P=0.0133)可能是促进选择肾移植的因素.与肾小球肾炎患者相比,多囊肾患者(比值比为6.0,95%CI:1.0~35.9,P=0.050,交互作用检验P=0.0007)与肾病综合征患者(比值比为1.8,95%CI:0.4~8.4,P=0.485,交互作用检验P=0.0007)可能更愿意选择接受肾移植.结论 在拉萨地区的维持性血液透析患者中,除年龄的增长外,潜在受者对肾移植预后较为落后和偏差的认知是不愿意选择肾移植的重要原因.我们建议开发基于多学科和新媒体的标准化、患者可理解、和基于循证的CKD患者肾脏替代治疗信息系统,以促进西藏CKD患者获得正确的各种肾脏替代治疗预后的信息,以便促进患者能够做出获益更大的治疗决定.

Objective To understand the kidney transplant intention of maintenance hemodialysis patients in Lhasa and its influencing factors.Methods A cross-sectional survey of patients undergoing maintenance hemodialysis at the hemodialysis center of the people′s hospital of the Tibet autonomous region during the period of April 5,2019,to April 12,2019,was selected(n=102).The questionnaires used were based on previously published literature,and multivariate Logistic regression analysis was used to determine the influencing factors of kidney transplantation intention.Results Among the enrolled patients,98(96.1%)were aware of kidney transplantation,and 35(34.3%)of maintenance hemodialysis patients had the intention of kidney transplantation.After adjusting for confounding factors,the increase in age of potential recipients(OR=0.9,95%CI:0.8-0.9,P<0.001),married status(OR=0.1,95%CI:0-0.5,P=0.010),and history of diabetes(OR=0,95%CI:0-0.2,P=0.001)were all negative influencing factors for kidney transplant intention,and it was found that age 41 was a critical turning point for decreased kidney transplant intention.Higher education(OR=8.2,95%CI:2.9-22.7,P<0.001)was a factor that promoted the choice of kidney transplantation.In-service status(OR=3.1,95%CI:0.9-10.9,P=0.085,interaction test P=0.0133)may be a factor promoting the selection of kidney transplantation.Compared with patients with glomerulonephritis,patients with polycystic kidney disease(OR=6.0,95%CI:1.0-35.9,P=0.050,interaction test 0.0007)and nephrotic syndrome patients(OR=1.8,95%CI:0.4-8.4,P=0.485,interaction test 0.0007)may be more willing to receive renal transplantation.Conclusion This study demonstrated that among maintenance dialysis patients in the Lhasa area,in addition to the increase of age,the poor and biased perception of the prognosis of potential recipients of kidney transplantation was an important reason for their reluctance to choose kidney transplantation.We recommend the development of a standardized,patient-understandable,and evidencebased renal replacement therapy information system for CKD patients based on multidisciplinary and new media to facilitate accurate information on the prognosis of various renal replacement therapies for CKD patients in Tibet so that patients can make more beneficial treatment decisions.