Is Frequency of Patient–Physician Clinic Contact Important in Peritoneal Dialysis Patients?

Abstract

In a single-center retrospective cohort study, we investigated whether the frequency of clinic patient-physician contact (PPC) correlates with quality of care and can predict outcome in peritoneal dialysis (PD) patients. We enrolled 307 incident PD patients who started PD from July 2002 to February 2007. All patients who visited the clinic at least once every 6 months and who lived for at least 6 months were followed until death, transfer to hemodialysis, renal transplantation, or February 2008 (censor date). Throughout the study period, an integrative follow-up strategy was used, including PPC and three other modes of contact between patients and non-physicians. Patients' PPC frequency was divided into 3 categories: high frequency (monthly or more often), intermediate frequency (every 1-3 months), and low frequency (every 3-6 months). Baseline demographic and biochemical data were collected. Indices of diet, dialysis adequacy, biochemistry, and nutrition were measured at every visit and then calculated as mean values. We followed the 307 patients for a mean of 31.45 +/- 13.62 months (range: 12-64 months). By PPC frequency, 127 patients (41.3%) were in the high-frequency group; 136 (44.3%), in the intermediate-frequency group; and 44 (14.3%), in the low-frequency group. We observed no difference of baseline demographic and biochemical data between the three groups (p > 0.05). Patients in the low-frequency group had lower mean hemoglobin and total urea clearance rates, but higher serum phosphate than did patients in the intermediate- or high-frequency groups (p < 0.05). Mean indices of nutrition, including serum albumin, daily protein and energy intake, and lean body mass were not different between the three groups (p > 0.05). Frequency of PPC did not show an effect on the survival of PD patients (p = 0.37 by Kaplan-Meier plot). Age (p = 0.002), Charlson comorbidity score (p = 0.001), and pre-dialysis albumin (p = 0.019) were independent negative risk factors for death in multivariate Cox proportional hazard models, which were adjusted for sex, PPC frequency, baseline hemoglobin, and glomerular filtration rate. Frequency of PPC did not predict outcome in PD patients after an integrative care strategy was implemented. Control of anemia and hyperphosphatemia needs to be strengthened in patients with a low frequency of PPC.