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Preventive effect of continuous quality improvement on the malnutrition, inflammation, peritoneal dialysis adequacy and cardiovascular events in elderly peritoneal dialysis patients / 中华老年医学杂志
Chinese Journal of Geriatrics ; (12): 954-959, 2013.
Artigo em Chinês | WPRIM | ID: wpr-442778
ABSTRACT
Objective To investigate the preventive effect of continuous quality improvement(CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving framework called the PDCA cycle (plan,do,check and act).The dialysis adequacy,nutritional status,inflammation and cardiovascular events were analyzed before and after PDCA.Results Compared with before PDCA,the proportion of patients with Kt/V≥1.7 and urea kinetics (Kt/V) level were increased after PDCA [71.8% vs.93.75%,(1.97±0.36) vs.(2.08±0.33),both P< 0.05].Serum levels of albumin (ALB),prealbumin (PAB) and serum carbon dioxide combining power (CO2 CP) were increased after PDCA (all P<0.05).The proportion of patients with ALB≥40 g/L was increased after PDCA as compared with before PDCA (9.4% vs.31.3%,P<0.05).The nutritional variables including mid-arm circumference (MAC),triceps skinfold thickness (TSF),mid arm muscle circumference (MAMC),and lean body mass (LBM),lean body mass percentage (LBM%),normalized protein equivalent of total nitrogen appearance (nPNA),handgrip strength were improved after PDCA (P< 0.05).High sensitivity C-reactive protein (hs-CRP) level and the proportion of patients with hs-CRP>3 mg/L were decreased after PDCA as compared with before PDCA [(8.65±6.22) mg/L vs.(5.37±4.33) mg/L,53.1% vs.25%,both P<0.05].The incidence of peritoneal dialysis related peritonitis was reduced obviously from 1 case every 25.4 months to 1 case every 78.1 months after PDCA (P < 0.05).The hospitalization rate due to cardiovascular events was decreased after PDCA as compared with before PDCA (25% vs.3.13%,P<0.05).Conclusions CQI may significantly improve the malnutrition,inflammation and dialysis adequacy,and reduce the hospitalization rate due to cardiovascular events in elderly patients undergoing peritoneal dialysis.

Texto completo: DisponíveL Índice: WPRIM (Pacífico Ocidental) Idioma: Chinês Revista: Chinese Journal of Geriatrics Ano de publicação: 2013 Tipo de documento: Artigo

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Texto completo: DisponíveL Índice: WPRIM (Pacífico Ocidental) Idioma: Chinês Revista: Chinese Journal of Geriatrics Ano de publicação: 2013 Tipo de documento: Artigo