Assessment of patients referred to urgent start peritoneal dialysis: when does the nurse contraindicate?

Abstract Introduction: Urgent-start peritoneal dialysis (US-PD) has been used worldwide with very positive results. The prior assessment of candidates for this therapy by a nurse can favor the success of the therapy. Objectives: To identify the profile of patients who are candidates for US-PD, the causes of contraindication of the method by the nurse and their permanence in the method after 30 days, as well as the growth of the service after implementing the program. Methods: We retrospectively analyzed the forms used to assess candidates for US-PD applied by nurses between May 2017 and August 2019 in a clinic in Santa Catarina. We analyzed information on demographic profile, reasons for contraindication and permanence in the method after 30 days, as well as service growth after the program was implemented. Results: Of the 215 patients indicated for US-PD, 51% were male, 55% were under 60 years old, 51% had diabetes mellitus and 89% were hypertensive. Of these, 173 (80%) patients had the nurse’s approval for PD. The only cause contraindicated was the inability to self-care associated with the lack of family support. In the first 30 days after the assessment, 89% of the patients who started PD remained on it. During the study period, the PD service grew by 91%. Conclusion: During the study period, a fifth of patients referred to US-PD received contraindication by nursing due to self-care inability associated with the lack of family support. After 30 days, 89% of the patients remained on it.

【摘要】紧急启动腹膜透析（Urgent-start peritoneal dialysis, US-PD）目前已在全球范围内应用并取得了良好的临床疗效。由护士对该疗法的候选患者进行预先评估，有助于提升该疗法的实施成功率。
研究目的：明确紧急启动腹膜透析候选患者的人群特征，识别护士判定该疗法禁忌证的原因，以及患者接受该疗法30天后的留存情况，同时评估该项目实施后相关诊疗服务的增长情况。
研究方法：回顾性分析2017年5月至2019年8月间，巴西圣卡塔琳娜州某诊所内护士用于评估紧急启动腹膜透析候选患者的评估表单。本研究分析内容包括患者的人口学特征、疗法禁忌证判定原因、患者接受疗法30天后的留存情况，以及项目实施后相关诊疗服务的增长数据。
研究结果：本研究共纳入215名被推荐接受紧急启动腹膜透析的患者，其中51%为男性，55%的患者年龄低于60岁，51%的患者合并糖尿病，89%的患者合并高血压。其中173名（80%）患者获得了护士的腹膜透析准入许可。唯一的禁忌证原因为患者无法进行自我照护且缺乏家庭支持。在评估后的前30天内，89%启动腹膜透析的患者仍坚持该疗法。研究期间，腹膜透析诊疗服务量增长了91%。
研究结论：本研究周期内，五分之一被推荐接受紧急启动腹膜透析的患者因无法自我照护且缺乏家庭支持，被护士判定为疗法禁忌证。接受疗法30天后，89%的患者仍坚持该治疗方案。