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】低学历可能是腹膜透析（peritoneal dialysis, PD）相关腹膜炎发生率升高的危险因素，甚至可能引发透析技术失败。本研究旨在探讨低学历对腹膜炎发生、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。按照受教育年限将受试者分为三组：初中及以下组（受教育年限≤9年，n=102）、高中组（9年<受教育年限≤12年，n=229）及高中以上组（受教育年限>12年，n=324）。采用Cox比例风险模型与竞争风险回归分析研究结局。
【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）并进行分析。中位随访时间为41个月（四分位数间距：20~65个月），期间255例患者（38.9%）发生≥1次腹膜炎事件，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，与高中以上组相比，初中及以下组是腹膜炎（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。但无论采用实际治疗（as-treated）分析（校正后HR=1.11，95%CI=0.53~2.33，P=0.788）还是意向治疗（intent-to-treat）分析（P=0.726），低学历均未与死亡率升高存在关联。
【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，但在腹膜透析患者中，低学历并未与死亡率升高相关。通过综合培训与多学科教育，或可弥补低学历患者在腹膜透析管理中的不足。