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Goal, as a "latin" prefix, refers to the concept of “beyond” and implies the difficulty of achieving it. For patients with chronic kidney disease on peritoneal dialysis, the most current concept refers to achieving patient-centered goals to improve quality of life. The objective of our study is to identify the barriers encountered in achieving goals so that we can outline strategies to improve our clinical practices.
Prospective cohort study with incident and prevalent peritoneal dialysis patients over 18 years old from July 2021 to July 2022, in a university dialysis center that is a reference for around one million inhabitants in 37 counties. Sociodemographic, clinical, laboratory variables, peritoneal equilibrium test (PET), KtV, nutritional score, quality of life, social support and health literacy were evaluated. The outcomes observed were mortality, method failure and hospitalizations. The variables were collected monthly and the patient was considered to have reached the goal if he remained within the parameters for 80% of the period. Afterwards, a descriptive analysis of the sample was carried out and we compared, using bivariate analysis and generalized linear regression, those patients who were on target versus outside it, as well as those who presented or did not present the outcomes. We adopted a 95% confidence interval and used SPSS 21.0 software.
56 patients were evaluated (41 prevalent and 15 incident), 51.8% women, age 61.2 ± 13.9 years, 62.5% white. Death occurred in 13 patients (23.2%), one had a transplant (1.6%) and 9 had failed technique (16%), being referred for hemodialysis, with 32 hospitalizations (57.1%) occurring during the period. The most difficult laboratory and clinical goals to achieve were, respectively, phosphorus (28.6%) and blood pressure (30.4%)(Figure 1). The most frequent barriers were low adherence that was associated with worse KtV (p=0.008) and blood pressure (p=0.05). Lower health literacy was associated with difficulties in reaching albumin (p=0.06) and glucose (p=0.096) targets. Obesity was related to a lower parathyroid hormone target (p=0.02). Older age was associated with worse phosphorus goals (p=0.027) and alkaline phosphatase (p=0.07). Deaths were more related to not reaching the targets for potassium (p=0.054), hemoglobin (p=0.09) and albumin (p=0.10).
The goals are evaluated in accordance with those recommended by the International Society of Peritoneal Dialysis and measures to overcome avoidable barriers must be taken in order to minimize potential unfavorable outcomes.