ObjectiveTo investigate the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease (CKD).MethodsA total of 336 patients with CKD were investigated by a general data questionnaire, the CKD Self-care Behavior Scale, Social Support Scale, Generalized Anxiety Self-assessment Scale, and 9-item Patients Health Questionnaire through WeChat platform, and the influencing factors of self-care behavior were explored by binary logistic regression analysis.ResultsThe median score of self-care behavior of CKD patients without dialysis was 60, and the patients with median and high level of self-care behavior accounted for 97.6%. The score of self-care behavior of CKD patients without dialysis was positively correlated with the total score of social support (r=0.210, P<0.001), objective support score (r=0.127, P=0.020), subjective support score (r=0.195, P<0.001), and social support utilization score (r=0.164, P=0.002), and negatively correlated with the anxiety score (r=–0.132, P=0.015), depression score (r=–0.230, P<0.001), body mass index (r=–0.181, P=0.001), and systolic blood pressure (r=–0.168, P<0.001). The results of binary logistic regression analysis showed that the influencing factors of non-dialysis CKD patients’ self-care behavior were gender [(odds ratio, OR)=2.179, 95% confidence interval, CI (1.134, 4.187), P=0.019], systolic blood pressure [OR=0.967, 95%CI (0.947, 0.987), P=0.002], and depression score [OR=0.844, 95%CI (0.765, 0.931), P=0.001].ConclusionsThe self-care behavior of CKD patients without dialysis is at the median and high level. Healthcare workers can improve the self-care behavior of CKD patients by reducing their negative emotions such as depression, and guiding patients to carry out blood pressure management, to delay the progress of the disease.
【摘要】 目的 探索持续非卧床腹膜透析（CAPD）患者年龄与营养状况的关系，为营养教育提供指导。 方法 对2007年8月-2010年1月腹膜透析177例患者的临床资料进行回顾性分析，包括血红蛋白（HGB）、血清白蛋白（ALB）、年龄、体重指数（BMI）、腹膜平衡试验（PET）、尿素清除指数（Kt/V）、24 h尿蛋白、腹透液漏出蛋白、标准化每日蛋白质分解率（nPCR）等，分析年龄与营养状况的关系。 结果 老年组（≥60岁）和中青年组（lt;60岁）ALB分别为（31.54±5.91）、（33.24±4.75）g/L，老年组ALB较低（Plt;0.05）；老年组Kt/V值1.95±0.63和HGB水平（95.25±22.89） g/L均高于青年组（Plt;0.05）。两组患者营养不良与BMI、PET、每日蛋白漏出总量、nPCR无关。 结论 CAPD老年患者（≥60岁）更容易发生营养不良，且老年组低蛋白血症与透析充分性无明显关系。故应加强老年CAPD患者的饮食营养管理指导，设计合理的饮食。【Abstract】 Objective To investigate the relationship between age and nutrition status of the patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and provide instructions for nutrition education. Methods We retrospectively analyzed the clinical data of 177 patients having undergone CAPD in the Department of Nephrology of West China Hospital between April 2007 and January 2010. Clinical parameters collected included hemoglobin (HGB), serum albumin (ALB), age, body mass index (BMI), results of the peritoneal equilibrium test (PET), urea clearance index (Kt/V), 24-hour urinary protein, protein loss in the peritoneal dialysate, normalized protein catabolic rate (nPCR). Relationship between age and nutrition status in these patients were analyzed. Results Plasma albumin was (31.54±5.91) g/L and (33.24±4.75) g/L respectively in patients of or older than 60 years old (the elderly group) and in patients younger than 60 years old (the younger group). Compared with the younger group, patients in the elderly group had lower ALB (Plt;0.05), but higher Kt/V 1.95±0.63 and hemoglobin level (95.25±22.89) g/L (Plt;0.05). In addition, malnutrition in both groups was not associated with BMI, PET results, daily protein loss in the peritoneal dialysate or nPCR. Conclusions Patients of or older than 60 years old undergoing CAPD are more likely to develop malnutrition, indicating that hypoalbuminemia is not associated with dialysis inadequacy. We advocate enhancing diet nutrition education in elderly CAPD patients and providing them with balanced diet regime.
ObjectiveTo investigate the health literacy level and its influencing factors among follow-up patients with chronic kidney disease (CKD).MethodsFrom March to August 2018, 248 patients from the CKD Follow-up Management Center, West China Hospital, Sichuan University were included. Basic information questionnaire and chronic diseases health literacy scale were used. Analysis of variance and t test were used in univariate analysis, and multiple linear stepwise regression was used in multivariate analysis, to explore the influencing factors of health literacy score.ResultsThe average health literacy score of the 248 CKD patients (97.24±12.22) were in medium to low level. Listed from high to low, the score of each dimension was: ability to obtain information (4.24±0.50), willingness to improve health (4.17±0.66), competence to communicate and interact with others (3.95±0.59), and willingness to support financially (3.41±1.10). The result of multiple linear stepwise regression showed that whether followed up on time, families’ monthly income per capita, and the patients’ age were independent influencing factors of health literacy score (P<0.05).ConclusionsThe health literacy level of follow-up patients with CKD remains to be improved. Medical personnel should pay attention to whether patients with CKD are followed up on time, make targeted intervention, and improve the self-management of patients so as to delay the disease progress of CKD.
ObjectiveTo explore the nutritional status of inpatients with chronic kidney disease (CKD) and analyze the factors affecting nutritional risk, to provide theoretical basis for further nutritional support.MethodsConvenience sampling method was adopted to select 719 inpatients with CKD as research subjects in a tertiary hospital in Chengdu, Sichuan Province from January to March 2018. Nutritional Risk Screening 2002 was used for nutritional risk screening, and chi-square test, t test, one-way analysis of variance, and multiple linear regression analysis were used to explore the influencing factors of nutritional risk.ResultsAmong the 719 cases, whose average nutritional risk score was 1.79±1.11, 158 cases had nutritional risk, accounting for 22.0%. There were statistically significant differences in nutritional risk score between patients of age<60 years and ≥60 years, between males and females, between patients with CKD stage 1-3 and stage 4-5, between patients with serum albumin level <30 g/L and ≥30 g/L, and between patients with and without anaemia (P<0.05). The results of multiple linear regression analysis showed that the nutritional risk score of CKD patients was negatively correlated to serum albumin level (P=0.016), positively correlated to age (P<0.001), and higher in females than that in males (P=0.001).ConclusionsInpatients with CKD have a higher nutritional risk, with age, gender and serum albumin as the main influencing factors. Based on the above factors, the medical staff should continue to take targeted intervention measures to assess the nutritional status of CKD inpatients early and conveniently, so as to provide scientific basis for further nutritional support and nutritional nursing.
Objective To investigate the change of pathogenic distribution and drug resistance in peritoneal dialysis associated peritonitis (PDAP). Methods The clinical data of all the patients undergoing continuous ambulatory peritoneal dialysis and suffered from PDAP between January and December in 2014 was retrospectively collected, and the pathogens, drug resistance, outcomes and underlying causes were analyzed. Results A total of 64 patients had 72 cases of PDAP. Only 36 strains (50.0%) had positive culture results, among which 24 strains (66.7%) were Gram-positive bacteria strains, 7 strains (19.4%) were Gram-negative bacteria strains, and 5 strains (13.9%) were fungi. For Gram-positive bacteria strains, the resistance rates to vancomycin, linezolid and rifampicin were all 0%; the resistance rate to levofloxacin, gentamycin and cefazolin was 14.3%, 26.3% and 50.0%, respectively. For Gram-negative bacteria strains, the resistance rates to amikacin and imipenem were both 0%; the resistant rate to gentamycin, ceftazidime, levofloxacin and ampicillin was 28.6%, 28.6%, 42.9% and 100.0%, respectively. Conclusions The pathogenic spectrum and drug resistance in PDAP have been markedly changed. Selection of antibiotics should be chosen according to the characteristic of the pathogenic spectrum and drug resistance of each center. Great effort is still needed to improve the culture positive rate of the effluent dialysate and to improve the recovery rate of peritonitis.