Data from: Lower education level is a risk factor for peritonitis and technique failure but not a risk for overall mortality in peritoneal dialysis under comprehensive training system

Background: Lower education level could be a risk factor for higher peritoneal dialysis (PD)-associated peritonitis, potentially resulting in technique failure. This study evaluated the influence of lower education level on the development of peritonitis, technique failure, and overall mortality.
Methods: Patients over 18 years of age who started PD at Seoul National University Hospital between 2000 and 2012 with information on the academic background were enrolled. Patients were divided into three groups: middle school or lower (academic year ? 9, n = 102), high school (9 < academic year ? 12, n = 229), and higher than high school (academic year > 12, n = 324). Outcomes were analyzed using Cox proportional hazards models and competing risk regression.
Results: A total of 655 incident PD patients (60.9% male, age 48.4 ± 14.1 years) were analyzed. During follow-up for 41 (interquartile range, 20-65) months, 255 patients (38.9%) experienced more than one episode of peritonitis, 138 patients (21.1%) underwent technique failure, and 78 patients (11.9%) died. After adjustment, middle school or lower education group was an independent risk factor for peritonitis (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.10-2.36; P = 0.015) and technique failure (adjusted HR, 1.87; 95% CI, 1.10-3.18; P = 0.038), compared with higher than high school education group. However, lower education was not associated with increased mortality either by as-treated (adjusted HR, 1.11; 95% CI, 0.53-2.33; P = 0.788) or intent-to-treat analysis (P = 0.726).
Conclusions: Although lower education was a significant risk factor for peritonitis and technique failure, it was not associated with increased mortality in PD patients. Comprehensive training and multidisciplinary education may overcome the lower education level in PD.

背景：受教育程度较低可能是腹膜透析（peritoneal dialysis, PD）相关性腹膜炎发生率升高的危险因素，进而可能导致透析技术失败。本研究旨在探讨受教育程度较低对腹膜炎发生、透析技术失败及全因死亡率的影响。
方法：本研究纳入2000年至2012年间在首尔国立大学医院起始腹膜透析、且具备学历背景信息的18岁以上患者。根据受教育程度将患者分为三组：初中及以下（受教育年限≤9年，n=102）、高中（9年<受教育年限≤12年，n=229）及高中以上（受教育年限>12年，n=324）。采用考克斯比例风险模型（Cox proportional hazards models）与竞争风险回归（competing risk regression）分析结局指标。
结果：本研究共纳入655例新发腹膜透析患者（男性占60.9%，年龄48.4±14.1岁）。随访时间的中位数为41个月（四分位数间距（interquartile range）：20~65个月），期间255例患者（38.9%）发生≥1次腹膜炎，138例患者（21.1%）出现透析技术失败，78例患者（11.9%）死亡。校正混杂因素后，与高中以上学历组相比，初中及以下学历组是腹膜炎（校正后风险比（hazard ratio, HR）=1.61；95%置信区间（confidence interval, CI）=1.10~2.36；P=0.015）与透析技术失败（校正后HR=1.87；95%CI=1.10~3.18；P=0.038）的独立危险因素。然而，无论是按实际治疗分析（as-treated，校正后HR=1.11；95%CI=0.53~2.33；P=0.788）还是意向治疗分析（intent-to-treat analysis，P=0.726），低学历均未与死亡率升高相关。
结论：尽管低学历是腹膜炎与透析技术失败的重要危险因素，但与腹膜透析患者的死亡率升高无显著关联。针对腹膜透析患者的综合培训与多学科教育或可弥补低学历带来的不足。