The correlation between first-year outpatient follow-up frequency and outcome of patients with continuous ambulatory peritoneal dialysis

Objective To investigate the correlation of clinical follow-up frequency with prognosis of patients with continuous ambulatory peritoneal dialysis (CAPD). Methods The subjects of this study were patients who carried out peritoneal dialysis catheterization at the First Hospital of Wuhan during January 1, 2014~May 31, 2015. Based on the distribution characteristics of first-year outpatient follow-up frequency, the patients were divided into low frequency group (>5 months/time), intermediate frequency group (3.3~5 months/time), and high frequency group (<3.3 months/time). Demographic data, baseline biochemical indicators, clinical outcomes, technical survival outcomes, and peritonitis occurrence were compared between groups. Results (1)The proportion of medical insurance, educational level, body mass index, weekly urea nitrogen clearance rate (total Kt/V), hemoglobin (Hb), albumin (Alb) and systolic blood pressure (SBP) in the high frequency group were better than those in the middle and low frequency groups (P<0.05). (2)The Kaplan-Meier curves showed that the survival and technical survival of patients receiving high frequency follow-up were higher than those receiving low frequency follow-up, with the differences of no statistical significance. By proportional risk regression model (Cox regression model) and competitive risk model (competitive risk model), it was found that there was no significant correlation between follow-up frequency and survival and technical survival. (3)Univariate Cox regression showed that follow-up frequency (OR=0.151, P<0.05), albumin (OR=0.860, P<0.05), and uric acid (OR=0.996, P<0.05) were associated with the occurrence of peritonitis. Multivariate regression analysis showed that follow-up frequency had statistically significant effect on peritonitis occurrence (OR=0.216, P<0.05). The subject work characteristic curve (ROC) showed that the sensitivity and specificity of peritonitis occurrence were 86.1% and 54.8% respectively when the follow-up interval was 3.58 months/time.Conclusions The patients with good economy, high education level and good general conditions are prone to have high follow-up frequency. First year high-frequency follow-up (interval<3.3 months/time) is an independent protective factor for peritonitis. The patients who carry out high frequency follow-up during the first year of peritoneal dialysis, especially those with a follow-up interval longer than 3.58 months/time, are at greater risk of peritonitis which may lead to poor long-term clinical outcomes. Therefore, healthcare professionals should be strengthen education for some particular patients, and urge them to conduct follow-up actively in the later stage.