Turkiye Klinikleri Journal of Internal Medicine

.: ORIGINAL RESEARCH
The Effects of Socio-Economic Status and Medical Treatments on Mortality in Long Term Peritonal Dialysis Patients: Retrospective Cross-Sectional Research
Sosyoekonomik Durumun ve Tıbbi Tedavinin Uzun Dönemde Periton Diyaliz Hastalarında Mortalite Üzerine Etkisi: Retrospektif Kesitsel Araştırma
Refika BÜBERCİa, Semahat KARAHİSAR ŞİRALİa, Murat DURANAYa
aClinic of Nephrology, Ankara Training and Research Hospital, Ankara, Türkiye
Turkiye Klinikleri J Intern Med. 2023;8(1):25-34
doi: 10.5336/intermed.2022-92907
Article Language: EN
Full Text
ABSTRACT
 Objective: Despite technical advances in peritoneal dialysis (PD), mortality rates are still very high. Factors affecting mortality have been the aim of many studies. However, there are not enough studies investigating the effects of socio-economic status (SES) and medical treatments on mortality. The aim of our study is to investigate the long-term effects of SES and medical treatments on mortality in PD patients. Material and Methods: The study included 145 patients. Demographic characteristics, laboratory data, and medical treatments were recorded. Three main variables play a role in the SES indices. These variables are education, income level and occupation. These variables were questioned in PD patients. Cox regression analysis was used to determine the factors affecting mortality. Results: The mean age of the patients was 57.51±15.73 years, and 14% had a low income level. After 3.8±3.6 years of follow-up, 27.6% of the patients had died. The income level was lower, the tendency to infection was higher in the non-survivor group. There was no difference between survivor and non-survivor group in terms of gender, age, marital status, PD duration. Factors affecting mortality were low income [hazard ratio (HR): 2.272, 95% confidence interval (CI): 1.12-4.812, p=0.001], using high peritoneal dialysate glucose concentration solution, and low use of phosphorusbinding drugs and calcitriol (HR: 2.812, 95% CI: 1.160-6.818 and HR: 3.632, 95% CI: 1.665-7.291, p=0.001, respectively). Conclusion: Low income level in PD patients increases mortality by creating a tendency to infections. Lack of volume control and malnutrition are other factors affecting mortality.

Keywords: Hypervolemia; malnutrition; mortality; peritoneal dialysis; socio-economic status
ÖZET
 Amaç: Periton diyalizinde teknik gelişmelere rağmen mortalite oranları hâlâ yüksektir. Mortaliteyi etkileyen faktörler birçok çalışmanın amacı olmuştur. Ancak sosyoekonomik düzeylerin (SED) ve tıbbi tedavinin mortalite üzerine etkisi ile ilgili yeteri kadar araştırma yapılmamıştır. Bu çalışmanın amacı, SED ve tıbbi tedavinin uzun dönemde periton diyaliz hastalarında mortalite üzerine etkisini araştırmaktır. Gereç ve Yöntemler: Çalışmaya 145 hasta alındı. Demografik özellikler, tıbbi tedaviler ve laboratuvar verileri kaydedildi. SED endekslerinde 3 ana değişken rol oynamaktadır. Bu değişkenler eğitim, gelir düzeyi ve meslektir. Bu değişkenler, periton diyaliz hastalarında tek tek sorgulandı. Mortaliteyi etkileyen faktörlerin tespiti için Cox regresyon analizinden yararlanıldı. Bulgular: Hastaların yaş ortalaması 57,51±15,73 yıl olup, %14'ü düşük gelir düzeyine sahipti. Hastaların %27,6'sı 3,8±3,6 yıllık takip sonrası öldü. Yaşamayan hasta grubunda gelir düzeyi daha düşük ve enfeksiyona eğilim daha fazlaydı. Yaşayan ve yaşamayan hasta gruplar arasında yaş, cinsiyet, medeni durum ve periton diyaliz süresi açısından anlamlı bir fark yoktu. Mortaliteyi etkileyen faktörler ise düşük gelir düzeyi 'tehlike oranı [hazard ratio (HR)]: 2,272, %95 güven aralığı [confidence interval (CI)]: 1,12-4,812, p=0,001', yüksek glukoz konsantrasyonlu periton diyaliz solüsyonu kullanma, fosfor bağlayıcı ajan ve kalsitriol kullanımının az olmasıydı (sırasıyla HR: 2,812, %95 CI: 1,160-6,818 ve HR: 3,632, %95 CI: 1,665-7,291, p=0,001). Sonuç: Periton diyaliz hastalarında düşük gelir düzeyine sahip olmak, enfeksiyona eğilim yaratarak mortaliteyi etkilemektedir. Volüm durumunu yeteri kadar kontrol altına alamama ve malnütrisyon mortaliteyi etkileyen diğer faktörlerdir.

Anahtar Kelimeler: Hipervolemi; malnütrisyon; mortalite; periton diyalizi; sosyoekonomik düzey
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