OBJECTIVES:Home haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients' learning styles are associated with differing risk of adverse events in both home HD and PD patients. DESIGN:Retrospective cohort study. SETTING:Tertiary care hospital in Toronto, Ontario, Canada. PARTICIPANTS:One hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study. INTERVENTIONS:Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles. PRIMARY AND SECONDARY OUTCOME MEASURES:Home HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles. RESULTS:Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694). CONCLUSIONS:Different learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.

译文

目标:过去几年,家庭血液透析(HD)和腹膜透析(PD)的使用率在全球范围内有所增长。然而,家庭透析及其伴随的技术复杂性和不良事件的风险继续为广泛采用带来挑战。我们检查了家庭HD和PD患者中患者学习方式的差异是否与不良事件发生风险的不同相关。
设计:回顾性队列研究。
地点:加拿大安大略省多伦多的三级医疗医院。
参与者:入选了118位普遍的成年人(≥18岁)家庭透析患者(40位PD和78位家庭HD)。本研究不包括接受家庭透析少于6个月或接受家庭护理透析的患者。
干预措施:已入组的患者完成(VARK)视觉,听觉,阅读写作和动觉问卷,以确定学习方式。
主要和次要指标:在完成家庭透析培训后的6个月内发现家庭HD和PD不良事件。然后将事件发生率分层,并根据学习风格进行比较。
结果:30例患者共发生53例不良反应。我们使用逻辑回归分析来确定单个不良事件的未调整和调整后的OR。非视觉学习者发生不良事件的可能性高4.35倍(p = 0.001)。在调整了年龄,性别,透析方式,培训时间,透析时间,先前的肾脏替代治疗,视觉障碍,教育和识字能力之后,非视觉学习者的不良事件发生率仍然是视觉学习者的四倍(p = 0.008) )。对家庭高清患者的亚组分析显示,非视觉学习者中发生不良事件的可能性更高(OR 11.1; p = 0.003),而PD患者呈现非视觉学习者中发生不良事件的趋势(OR:1.60; p = 0.694)。 )。
结论:家庭透析患者存在不同的学习方式。在完成培训的前6个月内,视觉学习方式与家庭透析患者的不良事件较少相关。必须通过学习方式来个性化家庭透析培训。

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