Data from: Self-cannulation for haemodialysis: patient attributes, clinical correlates and self-cannulation predilection models

Background and objectives: With emerging evidence in support of home haemodialysis (HHD), patient factors which determine uptake of the modality need to be better understood. Self-cannulation (SC) is a major step towards enabling self-care ‘in-centre’ and home HD and remains the foremost barrier to its uptake. Human factors governing this aspect of HD practice are poorly understood. The aim of this study is to better understand self-cannulation preferences and factors which define them in end stage renal disease (ESRD). Design: In this multicentre study, 508 of 535 patients from predialysis (Group A: n=222), in-centre (Group B: n= 213), and home HD (Group C: n= 100) responded to a questionnaire with 3 self-cannulation questions. Simultaneously, data on clinical, cognitive and psychosocial variables were ascertained. The primary outcome measure was ‘perceived ability to self-cannulate AV access’. Predictive models were developed using logistic regression analysis. Results: 36.6% of predialysis patients (A) and 29.1% of the ‘in-centre’ haemodialysis patients (B) felt able to consider SC for HD. Technical-skills related apprehension was highest in Group B (14.4%) patients. Response to routine venepuncture and the types of SC concerns were significant predictors of perceived ability to self-cannulate. There was no significant difference in concern for pain across the groups. In multivariable regression analysis, age, education level, 3MS score, hypoalbuminemia in Groups B & C and additionally, attitude to routine phlebotomy and the nature of specific concern for self-cannulation in Groups A, B and C, are significant predictors of SC preference. The unadjusted c-statistics of models 1 (derived from Group A and validated on A) and 2 (derived from B+C and validated on B), are 0.76(95% CI 0.69, 0.83) and 0.80 (95% CI 0.74, 0.87) respectively. Conclusions: There is high prevalence of perceived ability to self-cannulate. Modifiable SC concerns exist in ESRD. The use of predictive models to objectively define and target education and training strategies could potentially impact on HD self-management and future uptake of home HD.背景与目的：随着支持家庭血液透析（home haemodialysis, HHD）的证据不断涌现，亟需更深入地阐明影响该治疗方式采用率的患者相关因素。自我血管穿刺（self-cannulation, SC）是实现中心内及居家血液透析自我护理的关键步骤，同时也是阻碍该技术推广的首要障碍。目前，人们对血液透析实践中这一环节的人为影响因素仍知之甚少。本研究旨在更全面地了解终末期肾病（end stage renal disease, ESRD）患者的自我血管穿刺意愿及其相关决定因素。 研究设计：本项多中心研究共纳入535例患者中的508例，分为3组：透析前队列（A组，n=222）、中心内血液透析队列（B组，n=213）以及居家血液透析队列（C组，n=100）。所有受试者均完成包含3个自我血管穿刺相关问题的调查问卷，同时收集其临床、认知及社会心理变量数据。本研究的主要结局指标为“自我穿刺动静脉通路的感知能力”，并通过逻辑回归分析构建预测模型。 结果：36.6%的透析前患者（A组）与29.1%的中心内血液透析患者（B组）表示愿意考虑接受血液透析自我穿刺。B组患者中以技术技能相关顾虑最为突出（占比14.4%）。对常规静脉穿刺的反应类型以及自我血管穿刺的顾虑类型，均为自我穿刺感知能力的重要预测因素。各组间对疼痛的顾虑程度无显著差异。多变量回归分析结果显示，年龄、受教育程度、3MS评分、B组与C组的低白蛋白血症，以及A、B、C三组患者对常规静脉采血的态度与自我血管穿刺具体顾虑的性质，均为自我血管穿刺意愿的显著预测因素。模型1（基于A组构建并在A组内验证）与模型2（基于B+C组构建并在B组内验证）的未校正c统计量分别为0.76（95%置信区间：0.69, 0.83）与0.80（95%置信区间：0.74, 0.87）。 结论：终末期肾病患者的自我血管穿刺感知能力拥有较高的患病率。患者存在可干预的自我血管穿刺相关顾虑。通过构建预测模型客观明确干预目标，并针对性开展教育与培训策略，或可对血液透析自我管理及未来家庭血液透析的推广应用产生积极影响。