Abstract

AimsTo investigate whether education level of family members predicts all-cause and cardiovascular death and initial-episode peritonitis in patients on peritoneal dialysis (PD).MethodsA total of 2264 patients on chronic PD were collected from seven centers affiliated with the Socioeconomic Status on the Outcome of Peritoneal Dialysis (SSOP) Study. All demographic, socioeconomic and laboratory data of patients and the education level of all family members were recorded at baseline. Multivariate Cox regression was used to calculate the hazard ratio (HR) of all-cause and cardiovascular mortality, and initial-episode peritonitis with adjustments for recognized traditional factors.ResultsThere were no significant differences in baseline characteristics between patients with (n = 1752) and without (n = 512) complete education information. According to the highest education level of patients' family, included 1752 patients were divided into four groups, i.e. elementary or lower (15%), middle (27%), high (24%) and more than high school (34%). The family highest education (using elementary school or lower group as reference, hazard ratio and 95% confidence interval of middle school group, high school group and more than high school group was 0.68[0.48–0.96], 0.64[0.45–0.91], 0.66[0.48–0.91], respectively) rather than their average education level or patients' or spouse's education was significantly associated with the higher mortality. Neither patients' nor family education level did correlate to the risk for cardiovascular death or initial-episode peritonitis.ConclusionsFamily members' education level was found to be a novel predictor of PD outcome. Family, as the main source of health care providers, should be paid more attention in our practice.

Highlights

  • Peritoneal dialysis (PD) has been utilized as one of the main renal replacement therapies since the 1980s

  • Socioeconomic status (SES) has been indicated as a key predictor through multi-center PD cohort studies from various countries. These studies indicate that socioeconomic status (SES) evaluated by individual education[2] and income[3], housing status[4], remote location[5,6], or social support[7,8,9,10,11] play the critical role in the outcomes of dialysis patients

  • We aimed to investigate associations between education level of PD patients’ family members and outcome events, including all-cause and cardiovascular death and firstepisode peritonitis through a large-scale multi-center retrospective cohort study, which will be helpful for unpacking the black box of the family education-outcome puzzle for PD population

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Summary

Introduction

Peritoneal dialysis (PD) has been utilized as one of the main renal replacement therapies since the 1980s. Socioeconomic status (SES) has been indicated as a key predictor through multi-center PD cohort studies from various countries. These studies indicate that SES evaluated by individual education[2] and income[3], housing status[4], remote location[5,6], or social support[7,8,9,10,11] play the critical role in the outcomes of dialysis patients. Based on the inverse relationship between individual SES and mortality from our large-scale multi-center retrospective PD cohort study[3], we would further explore the association of social support and PD outcome

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