狼疮肾炎腹膜透析患者的长期预后研究

目的 探讨狼疮肾炎(LN)腹膜透析(腹透)患者的长期预后.方法 入选1995年5月1日至2013年4月30日期间在本院开始腹透且资料完整的LN患者(n=33),同时入选与其年龄、性别、并发症匹配的非LN腹透患者(n=33)作为对照组.所有入选患者均随访至死亡、退出腹透、转其他中心或至研究终止.采用Kaplan-Meier生存分析和Log-Rank检验比较两组患者的生存率、技术生存率和无腹膜炎生存率.结果 腹透开始时,LN组患者的估算肾小球滤过率(eGFR)、抗双链DNA (anti-dsDNA)和高敏C反应蛋白(hs-CRP)水平均明显高于对照组(均P＜ 0.05).截至研究终止,LN组患者有13例(39.4％)死亡,8例(24.2％)转血液透析(血透),5例(15.2％)肾移植,2例(6.1％)转其他中心.LN组患者最常见的死亡原因是感染(9例,69.2％),其中又以腹膜炎最常见(6例,46.2％),而对照组患者最常见的死亡原因是心血管疾病(5例,83.3％).Kaplan-Meier分析显示LN组患者的1、3、5年患者生存率为82％、49％、49％,明显低于对照组(x2=8.455,P=0.004).LN组患者的技术生存率也明显低于对照组(x2=6.753,P=0.009).LN组腹膜炎发生率为1次/20.5病人月,而对照组腹膜炎发生率为1次/67.6病人月.LN组患者的无腹膜炎生存率显著低于对照组(x2=8.256,P=0.004).结论 LN腹膜透析患者的长期预后较差.腹膜炎是LN腹透患者死亡和技术失败的主要原因.     

血清25⁃羟基维生素D3水平与腹膜透析相关性腹膜炎的关联性分析

目的探讨血清25⁃羟基维生素D3[25⁃hydroxyvitamin D3,25(OH)D3]水平与腹膜透析(peritoneal dialysis,PD)相关性腹膜炎的关系,为防治腹膜炎提供新思路。方法本研究为单中心回顾性队列研究,选取2014年1月1日至2018年9月30日在中山大学附属第一医院PD中心进行规律PD且年龄≥18周岁、透析时间≥3个月的患者,排除有血液透析史、肾移植史、恶性肿瘤及全身感染性疾病的患者。收集入选患者的人口学资料和实验室检验数据。所有患者均随访至死亡、转为血液透析、肾移植、转至其他中心或随访终止日期(2018年12月31日)。根据PD患者的基线血清25(OH)D3水平三分位法分为低水平组[25(OH)D3≤12μg/L]、中水平组[12μg/L<25(OH)D3≤17μg/L]和高水平组[25(OH)D3>17μg/L]。应用多因素调整的Poisson回归模型分析血清25(OH)D3水平与腹膜炎发生的相关性。结果共有642例患者入选本研究,其中男性341例(53.12%),年龄为(47.58±14.10)岁,血清25(OH)D3为(13.83±6.41)μg/L,原发病以慢性肾小球肾炎为首(67.19%)。在中位42(19,59)个月的随访期内,有139例患者发生了共232次腹膜炎。校正了性别、年龄、白蛋白、体重指数(BMI)、钙磷乘积、全段甲状旁腺素(iPTH)、糖尿病史、Charlson指数以及药物使用,多因素Poisson回归分析结果显示,血清25(OH)D3中水平组和低水平组腹膜炎发生的危险性分别为高水平组的92%(95%CI 0.62~1.38,P=0.690)和1.74倍(95%CI 1.19~2.54,P=0.004),低水平组与高水平组之间的差异具有统计学意义。结论血清25(OH)D3水平与腹膜炎发生密切相关,低水平25(OH)D3是PD患者腹膜炎发生的独立危险因素。     

单中心腹膜透析患者掉队原因分析

目的分析腹膜透析(PD)患者掉队原因,讨论延长PD治疗时间的策略。方法回顾性分析2011年01月至2016年12月在苏北人民医院腹膜透析中心行持续非卧床腹膜透析(CAPD)中途掉队的患者67例,统计分析掉队原因。分析死亡组与非死亡组间在临床资料与实验室检查等方面有无差异。结果 67例患者,转血液透析32例(47. 8%),死亡26例(38. 8%),行肾脏移植9例(13. 4%)。技术失败(37. 5%)、透析不充分(34. 4%)与腹膜炎(12. 5%)是患者转血液透析的常见原因。心血管病(34. 6%)、脑血管病(30. 8%)与感染(11. 5%)是患者死亡的常见原因。死亡组中女性占比明显高于非死亡组(57. 7%vs 26. 8%,P 0. 05);死亡组患者平均年龄明显大于非死亡组[(56. 8±16. 2)岁vs(37. 7±12. 6)岁,P 0. 01];死亡组患者合并糖尿病比例明显高于非死亡组(26. 9%vs 7. 3%,P 0. 05);死亡组患者腹膜透析尿素清除率(Kt/V)明显低于非死亡组(1. 6±0. 2 vs 1. 8±0. 3,P 0. 01)。Logistic回归分析显示高龄(OR=1. 110,P 0. 01)、低Kt/V(OR=0. 006,P 0. 05)是PD患者死亡的危险因素。结论转血液透析和死亡是PD患者掉队的主要原因;技术失败和透析不充分是患者转血液透析最常见原因;心脑血管疾病是患者死亡的首位病因;年长、低Kt/V患者的死亡风险高。     

单中心腹膜透析患者的转归及其危险因素分析

目的分析山西医科大学第二医院腹膜透析中心腹透患者的临床资料,探讨腹透患者的转归及其危险因素。方法采用回顾性研究的方法,收集选取山西医科大学第二医院腹膜透析中心2009年1月至2019年6月期间维持性腹膜透析患者的临床资料,采用卡方检验和log rank检验进行单因素分析,采用多元逐步COX回归模型进行多因素分析,讨论腹膜透析患者的不良转归及其危险因素。结果 258例维持性腹透患者,原发病中慢性肾小球肾炎占42.2%,糖尿病肾病占32.9%;退出腹膜透析97例,退出率37.60%;退出腹膜透析患者中转血液透析者49例,占19.0%;死亡39例,占15.1%;肾移植4例,占退出的1.6%;失访5例。经单因素及多因素分析,合并心脑血管疾病(HR=2.599,95%CI:1.340～5.043,P=0.005)、24 h尿量小于400 mL(HR=0.207,95%CI:0.085～0.501,P0.001)、肌酐小于707μmol/L(HR=3.259,95%CI:1.682～6.316,P0.001)是腹膜透析患者死亡的独立危险因素。腹膜炎的发生(HR=3.548,95%CI:1.882～6.691,P0.001)、中性粒细胞百分比大于70%(HR=0.543,95%CI:0.302～0.977,P=0.042)、尿酸大于360μmol/L(HR=0.352,95%CI:0.168～0.735,P=0.005)、总胆固醇大于5.7 mmol/L(HR=0.368,95%CI:0.160～0.931,P=0.034)是腹膜透析患者转血液透析的独立危险因素。结论我中心退出腹膜透析患者的转归主要为死亡及转血液透析。合并心脑血管疾病、24 h尿量小于400 mL、肌酐小于707μmol/L是腹透患者死亡的独立危险因素;腹膜炎的发生、中性粒细胞百分比大于70%、尿酸大于360μmol/L、总胆固醇大于5.7 mmol/L是腹透患者转血液透析的独立危险因素。     

腹膜透析相关性腹膜炎患者病原菌耐药性及预后分析

目的了解腹膜透析(PD)患者腹膜炎的病原学特点、耐药情况及预后。方法回顾性分析2009年1月至2016年9月四川省人民医院PD中心发生的318例次PD相关性腹膜炎,对病原学种类、耐药性情况及腹膜炎结局进行分析。结果(1)腹膜炎细菌的分布情况:腹透液培养阳性185例次,培养阳性率58.1%。共培养得细菌194株,其中革兰阳性菌131株(67.5%),革兰阳性杆菌49株(25.2%),真菌14株(7.2%)。革兰阳性菌以表皮葡萄球菌和金黄色葡萄球菌为主,分别占25.9%和10.6%。革兰阴性菌以大肠杆菌为主(占40.8%)。(2)腹膜炎致病菌的耐药性分析:革兰阳性菌对青霉素的耐药率较高。革兰阴性菌对氨苄西林的耐药率较高,对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率较低。真菌呈现出较低耐药性。(3)腹膜炎结局分析:共治愈腹膜炎267例次(83.9%),退出51例次,退出率16.0%,其中拔管转血液透析31例次(9.7%),死亡13例(4.0%),失访7例。(4)腹膜炎复发、再发和重现致病菌分析:腹膜炎复发感染有3例次(0.94%),其中2例次为路邓葡萄球菌感染,1例次为表皮葡萄球菌感染。再发感染有1例次(0.31%)。重现感染有2例次(0.62%)。结论本PD中心导致PD相关性腹膜炎的主要致病菌为革兰阳性菌。革兰阳性和革兰阳性菌都对非加酶抗生素具有较高耐药性,合理选择抗菌药物是治愈PD相关性腹膜炎的关键。     

江宁地区维持性血液透析患者现况单中心调查研究

目的:调查江宁地区在南京医科大学附属江宁医院血液净化中心行维持性血液透析患者的现状。方法:选择2013年1月在本中心透析龄大于3个月的患者为研究对象,采用横断面调查的方法,对其临床资料进行统计分析。结果:共调查维持性血液透析患者138例,男86例,女52例,男女比例1.65∶1,平均年龄(50.71±14.44)岁。23.2%的患者原发病因不明。在明确原发病的患者中,原发性肾小球肾炎67例(占63.2%),糖尿病肾病14例(占13.2%),高血压肾损害8例(占7.5%)。透析龄≥5年占50.7%,透析龄≥10年占5.8%。单纯血液透析87例(63.0%),血液透析加血液透析滤过35例(25.4%),血液透析加血液灌流16例(11.6%)。94.9%的患者每周透析3次以上。自体动静脉内瘘132例(95.7%)。91.3%患者有高血压,52例(37.7%)患者血压未控制,有45例(32.6%)血红蛋白<110g/L;114例(82.6%)存在钙磷代谢紊乱,iPTH>300ng/dl者有67例(54.0%)。医保覆盖率100%。乙型肝炎感染者9例,丙型肝炎感染者17例,乙型和丙型肝炎同时感染者5例。结论:本中心血液透析患者男性多于女性,原发性肾小球肾炎是导致ESRD的主要原因,医保覆盖率较高,50.7%的患者透析龄在5年以上,但血压和血红蛋白的达标率低。相当比例的血液透析患者未能满意地控制钙磷代谢及继发性甲状旁腺功能亢进。     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

Clinical outcome of 371 episodes of peritoneal dialysis related peritonitis

Objective To analyze the clinical outcome of PD related peritonitis in our center. Methods All patients who developed PD related peritonitis between January 2004 and December 2010 in Renji Hospital of Shanghai Jiao Tong University School of Medicine were included. Outcomes of PD related peritonitis were analyzed. Results A total of 220 patients developed 371 episodes of PD related peritonitis during the study period in our center, and the average peritonitis rate was one episode per every 54.4 patient-months. Among the 371 episodes of peritonitis, 285 (76.8%) episodes had been cured, 17 (4.6%) episodes had needed temporary hemodialysis (HD), 46 (12.4%) episodes had led to switch to permanent HD and 21 (5.7%) episodes had caused death. After refractory peritonitis, there was a significant reduction of 4 h ultrafiltration (330 vs 270 ml, P＝0.036) and an increase tendency of 4h D/Pcr (0.55±0.08 vs 0.58±0.10, P＝0.086). Conclusions Peritoneal dialysis related peritonitis is an important contributor to technique failure and death in Chinese PD patients. Refractory peritonitis might injure peritoneal membrane function.     

Clinical characteristics of the first episode of peritonitis in elderly patients with peritoneal dialysis

Objective To analyze the clinical characteristics and prognosis for the first episode of peritonitis in elderly patients with peritoneal dialysis (PD). Methods PD patients who were aged more than 65 years old and had experienced PD-associated peritonitis (PDAP) for the first time at the PD center of the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2018, were retrospectively enrolled into this study. All patients were divided into two groups according to PD duration: short-term PD group (＜36 months) and long-term PD group (≥36 months). Demographic data, clinical indicators, treatment and prognosis of the first episode of PDAP were compared between the two groups. Results A total of 163 patients were enrolled. The age was (71.7±4.9) years and the median duration of PD was 21.8(5.5, 41.3) months. Among them, male accounted for 53.4%, and diabetic nephropathy accounted for 32.5%. The leading cause of the first episode of PDAP was both contamination by operation in short-term PD group and long-term PD group, accounting for 39.8% and 46.0%, respectively. The treatment failure rate of the first episode of PDAP in long-term PD group was significantly higher than that in short-term PD group (34.0% vs 13.3%, χ2=9.437, P=0.002). All PD patients with fungal peritonitis were extubated, and the treatment failure rate was 100.0%. Logistic regression analysis showed that long-term duration of PD (OR=12.544, 95%CI 2.168-72.576, P=0.005) and lower level of serum albumin (OR=0.858, 95%CI 0.744-0.988, P=0.034) were independently influencing factors for treatment failure of the first episode of PDAP in elderly patients. Conclusion Fungal infection, long-term duration of PD and lower level of serum albumin are influencing factors for treatment failure of the first episode of PDAP in elderly patients.     

长腹膜透析龄患者首次腹膜炎的临床特征分析

目的 探讨长腹膜透析龄患者首次腹膜炎的临床特征。 方法 回顾性分析2000年至2009年发生首次腹膜透析相关性腹膜炎患者315例,按发生首次腹膜炎时腹膜透析龄分为两组：A组（<36个月）261例,B组（≥36个月）54例。对两组相关临床资料进行比较。 结果 入组患者平均年龄（55.7±15.9）岁,男性占61.0%,基础肾脏病主要为慢性肾小球肾炎（54.6%）,其次为糖尿病肾病（20.6%）。发病时A组中位腹膜透析龄8.4个月;B组中位腹膜透析龄49.4个月。发生腹膜炎时,两组间血红蛋白、血清白蛋白和血钾水平差异无统计学意义,但两组血清白蛋白和血钾水平均低于正常值范围。两组腹膜炎最常见诱因均为换液操作接触污染（48.2%比45.2%）。剔除未做透出液细菌培养患者,两组革兰阳性菌分布情况差异无统计学意义,但B组革兰阳性菌对甲氧西林的耐药率显著高于A组（46.2%比19.1%,P = 0.035）。两组革兰阴性菌分布情况及超广谱耐药菌比例差异无统计学意义。B组真菌感染比例显著高于A组（17.8%比6.4%,P = 0.011）。B组初始治疗有效率及临床结局显著差于A组（均P < 0.05）。两组间革兰阴性菌及真菌腹膜炎治疗失败率差异无统计学意义,但B组革兰阳性菌、无菌生长及未作培养腹膜炎治疗失败率显著高于A组（23.1%比1.5%、46.2%比6.7%、22.2%比0%,均P < 0.05）。Logistic回归分析整体资料显示,真菌感染、发病时较长腹膜透析龄、较低血清白蛋白水平为首次腹膜透析相关性腹膜炎治疗失败的独立影响因素（P = 0.000、0.002、0.025）。 结论 长腹膜透析龄患者首次腹膜炎的临床结局较短腹膜透析龄患者差。较高真菌和其他耐药菌感染率以及营养不良是影响其疗效的主要因素。     

The characteristic of causative organisms and outcomes of peritonitis in younger and elderly peritoneal dialysis patients

Objective To provide guide for prevention and cure of peritonitis in peritoneal dialysis(PD) by comparing the causative organisms and clinical outcome of PD related peritonitis in younger and elderly patients in our center. Methods All patients who developed PD related peritonitis between January 2006 and December 2013 in Wuhan NO.1 hospital were included. According to their age, episodes were divided into younger patients group (＜65 years) and elderly patients group (≥65 years). The microbiology and clinical outcome of PD related peritonitis were compared, and the related risk factors of the treatment failure were analyzed. Results Three hundred and sixty - six episodes of peritonitis occurred in 258 patients during the study period. The overall rate of peritonitis was 1 episode in 76.8 patient-months. Elderly patients had higher incidence of peritonitis (1 episode every 56.4 months vs 1 episode every 88.7 months, P=0.001), higher incidence of fungus infection (9.6% vs 3.9%, P=0.026) and higher mortality ( 46.2% vs 14.0%, P=0.001) than that in younger patients. Cox regression analysis showed that longer duration of PD treatment and fungal peritonitis were both risk factors of the treatment failure. Conclusion Elderly patients had higher incidence of peritonitis, higher incidence of fungus infection and higher PD - related mortality than younger patients.     

Prognostic analysis of aged end-stage renal disease patients receiving hemodialysis and peritoneal dialysis

Objective To compare the survival rates of elderly hemodialysis (HD) and peritoneal dialysis (PD) patients and identify their independent prognostic predictors. Methods Patients aging ＞60 years old who initiated dialysis between January 1, 2008 and December 31, 2014 were included. Propensity score method (PSM) was applied to adjust for selection bias. Kaplan-Meier method was used to obtain survival curves and a Cox regression model was used to evaluate risk factors for mortality. Results 447 eligible patients with maintenance dialysis were identified, 236 with hemodialysis and 211 with peritoneal dialysis. 174 pairs of patients were matched, with the baseline data [age, gender, Charlson comorbidity index (CCI) and the primary disease] between two groups showing no significant difference (P＞0.05). Cardiovascular events, cerebrovascular events and infection were major causes of death in both groups and there was no significant difference in the causes of death between two groups (P＞0.05). The overall survival rates at 1 and 5 year were 93.6% and 63.4% respectively in HD group, 91.9% and 61.5% in PD group. The differences of total survival rates between HD and PD patients were not significant (P＞0.05). Cox regression analysis showed age(≥80 year) (P＜0.001, HR=1.058, 95%CI 1.028-1.088), diabetic nephropathy (P=0.001, HR=2.161, 95%CI 1.384-3.373), CCI≥5 (P=0.007, HR=1.935, 95%CI 1.201-3.117) were independent prognostic risk predictors in HD patients; age(≥80 year) (P=0.022, HR=1.043, 95%CI 1.006-1.081), serum albumin level ＜ 35 g/L (P=0.025, HR=1.776, 95%CI 1.075-2.934), and prealbumin (P=0.012, HR=0.968, 95%CI 0.944-0.993) were independent prognostic predictors in PD patients. Conclusions The differences of total survival rates between aged HD and PD patients are not significant. Age, diabetic nephropathy, CCI≥5 and age, serum albumin＜35 g/L, prealbumin＞30 g/L respectively influence the survival of elderly HD and PD patients.     

Correlation between gastrointestinal diseases and peritoneal dialysis-associated peritonitis

Objective To investigate the incidence of gastrointestinal symptoms and diseases in peritoneal dialysis (PD) patients, and explore their associations with PD-associated peritonitis. Methods PD patients who were followed up in PD center of the First Affiliated Hospital of Sun Yat-sen University from March 1, 2016 to December 31, 2017 were prospectively enrolled and followed up until withdrew from PD or until December 31, 2019. Gastrointestinal symptoms, gastrointestinal diseases and peritonitis episodes were collected during the study period. The severity of gastrointestinal symptoms was assessed by the Gastrointestinal Symptoms Rating Scale. The demographic and clinical data were compared between patients with and without gastrointestinal diseases. The influencing factors of peritonitis were analyzed by Poisson regression model. Results A total of 471 PD patients were included. Among them, 387(82.2%) patients had at least one gastrointestinal symptom, and 142(30.2%) patients had gastrointestinal diseases. The incidence of peritonitis was 0.094 episodes per patient year, 0.034 episodes per patient year for gram-positive bacteria peritonitis and 0.027 episodes per patient year for gram-negative bacteria peritonitis. The multi-factor Poisson regression model showed that gastrointestinal disease was an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis (OR=1.852, 95%CI 1.252-6.369, P=0.002; OR=3.324, 95%CI 1.616-6.836, P=0.001, respectively), and higher score of diarrheal symptoms was an independent influencing factor for the occurrence of gram-negative bacterial peritonitis (OR=2.832, 95%CI 1.616-4.963, P＜0.001). Conclusions The incidence of gastrointestinal diseases in PD patients is 30.2%. Gastrointestinal disease is an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis, and diarrhea symptom is an independent influencing factor for the occurrence of gram-negative bacteria peritonitis.     

Improved patient/technique survival and peritonitis rates in patients treated with automated peritoneal dialysis when compared to continuous ambulatory peritoneal dialysis in a Mexican PD center

Since its introduction in Mexico in 1998, the use of automated peritoneal dialysis (APD) has grown steadily and now 35% of Mexican patients are being treated with it. Peritonitis continues to be the most important infectious cause of drop out in peritoneal dialysis (PD) programs and naturally has an impact on technique survival. The objective of this study was to compare patient and technical survival as well as peritonitis rates in APD vs continuous ambulatory peritoneal dialysis (CAPD) in our hospital PD program. We included all patients who initiated therapy between January 2003 and December 2005. Data at the beginning of therapy, causes of end-stage renal disease, gender, age, dialysis modality, drop out reasons, as well as peritonitis rate and date of presentation of first peritonitis event were collected and analyzed. For Kaplan-Meier survival analysis, patient status (alive, dead, or lost to follow up) at December 2005 was used as the observational end point. Modality differences were analyzed using a Cox regression model. A total of 237 patients were evaluated: 139 on CAPD and 98 on APD. The median age was 62 years on CAPD and 59 years on APD (P<0.031), and the percentage of diabetics was, respectively, 77 and 70% (P=NS). The CAPD drop out causes were death (57%), transfer to HD (29%), and other causes (16%), whereas in APD, 62% were due to death, 24% to transfer to HD, and 14% to other causes. APD/CAPD patient survival for year 1, 2, and 3 was 82/62, 62/49, and 56/42%, respectively. In conclusion, both therapies are considered good renal replacement therapy options in our hospital, but APD is the most attractive one as demonstrated by the positive results presented here.     

The changing trends of peritoneal dialysis related peritonitis and novel risk factors

Abstract

Aim: Continuous ambulatory peritoneal dialysis (PD) has become a treatment modality for end stage renal disease with a peak of its use in 1990s. The aim of this study was to examine the peritonitis rates, causative organisms and the risk factors of peritonitis in a large group of patients in our center. Methods: The study was conducted in the Nephrology Department of a University Hospital in Turkey. Patients in the PD programme between January 2000 and January 2006 were included. Cohort-specific and subject specific peritonitis incidence, and peritonitis-free survival were calculated. Causative organisms and risk factors were evaluated. Results: Totally 620 episodes of peritonitis occurred in 440 patients over the six years period. Peritonitis rates showed a decreasing trend through the years (0.79 episodes/patient-year 2000–2003 and 0.46 episodes/patient-year 2003–2006). Cohort-specific peritonitis incidence was 0.62 episodes/patient-years and median subject-specific peritonitis incidence was 0.44 episodes/patient-years. The median peritonitis-free survival was 15.25 months (%95 CI, 9.45–21.06 months). The proportion of gram-negative organisms has increased from 9.8% to 17.3%. There was a significant difference in the percentage of culture negative peritonitis between the first three and the last three years (53.1% vs. 43.2%, respectively). Peritonitis incidence was higher in patients who had been transferred from HD, who had catheter related infection and who had HCV infection without cirrhosis. Conclusions: Our study showed significant trends in the peritonitis rates, causative organisms and antibiotic resistance. Prior HD therapy, catheter related infections and HCV infection were found to be risk factors for peritonitis.