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.     

血液透析和腹膜透析患者生存比较

目的 比较血液透析和腹膜透析患者的生存情况,探讨影响透析患者生存的主要危险因素。 方法 研究对象为2005年1月1日至2008年12月31日期间新进入透析且年龄≥18岁患者,随访至2009年3月31日。应用Kaplan-Meier法、log-rank检验及Cox回归模型分析患者的生存资料。 结果 共460例透析患者入选,其中247例起始采用血透治疗,213例起始采用腹透治疗。两组患者的基线资料,包括开始透析年龄、体质量指数（BMI）、估算肾小球滤过率（eGFR）、平均动脉压、进入透析治疗前心脑血管事件、Charlson并发症指数（CCI）等的差异均无统计学意义。中位随访时间为17.9（0.25,51）个月。意向治疗分析结果中,Kaplan-Meier生存曲线显示血透总体生存率优于腹透（P ＜ 0.05,log-rank检验）;透析1年内两组生存率差异无统计学意义（P = 0.14）,而透析1年后腹透患者的生存率显著低于血透患者（P ＜ 0.05）。亚组分析结果显示,≥65岁的非糖尿病肾病血透组生存率显著高于腹透组（P ＜ 0.05）。Cox回归分析显示,经混杂因素调整后,两种透析方式本身对透析生存无明显影响（HR,HD：PD = 0.778,95%CI 0.483~1.254,P = 0.303）;而年龄（HR = 1.051,95%CI 1.030~1.073,P ＜ 0.01）、透前有脑血管意外史（HR = 2.032,95%CI 1.125~3.670,P ＜ 0.05）、透前CCI≥5（HR=2.592,95%CI 1.230~5.465,P ＜ 0.05）、前白蛋白（HR = 0.022,95%CI 0.001~0.768,P ＜ 0.05）为透析患者生存率的主要影响因素。 结论 透析龄≤1年的血透和腹透生存率无显著差异;透析龄>1年的血透患者生存率可能逐渐高于腹透患者。老年非糖尿病患者血透生存率可能高于腹透。年龄、透前脑血管意外史、透前CCI≥5为影响透析生存率的主要危险因素。     

Impacts of baseline peritoneal transport characteristics and their changes during follow up on the survival of peritoneal dialysis patients

Objective To evaluate the effects of baseline and changes of peritoneal transport characteristics on the prognosis of maintaining peritoneal dialysis (PD) patients. Methods Five hundred and eight-six PD patients who started PD from September 11, 2006 to October 30, 2014 in a single center were included and followed up until March 30, 2016. According to their baseline D/Pcr value in peritoneal equilibrium test (PET), the patients were divided into high transport (H) group (D/Pcr 0.82-1.03), high average transport (HA) group (D/Pcr 0.65-0.81), low average transport (LA) group (D/Pcr 0.50-0.64) and low transport (L) group (D/Pcr 0.34-0.49). According to the changes of follow-up D/Pcr comparing with baseline D/Pcr, the patients were also divided into ascending group, descending group and no-change group. The patient and technical survival rates were estimated by Kaplan-Meier analysis. Cox proportional hazards analyses were used to analyze the risk factors for PD patient death and technical failure. Results There were 67 patients in L group, 229 patients in LA group, 252 patients in HA group, and 38 patients in H group. The patient survival rate in H group was significantly lower than those of L group (P=0.036), LA group (P=0.008) and HA group (P=0.041). There was no significant difference on technical survival rate among these 4 groups. According to the tendency of follow-up D/Pcr changes, there were 127 patients in ascending group, 101 patients in descending group and 179 patients in no-change group. There was no significant difference on patient survival among these 3 groups (P=0.064). However in patients with a high transport rate (D/Pcr≥0.65), the patient survival was lower in descending group than those in ascending group (P=0.033) and no-change group (P=0.049). Age over 65 years old (HR=2.499), malnutrition during follow-up (HR=3.144), ultrafiltration less than 400 ml/d during follow-up (HR=1.863) and high sensitive C reactive protein≥10 mg/L (HR=4.526) were the independent risk factors for patient death (all P＜0.05). Gender (HR= 1.609), age over 65 years old (HR=1.929), ultrafiltration less than 400 ml/d during follow-up (HR=1.708), high sensitive C reactive protein≥10 mg/L (HR=1.829), malnutrition (HR=1.876) and change of peritoneal transport function (HR=0.579) affect technical failure (all P＜0.05). Conclusions The survival rate of PD patients with basal high peritoneal transit is relatively low, especially for patients with descending transport rate during follow-up. The concern on the peritoneal transport status is constructive for the prognosis of PD patients.     

Survival analysis in automated peritoneal dialysis patients

Objectives To compare the clinical characteristics, long-term survival and associated risk factors of automated peritoneal dialysis (APD) patients and continuous ambulatory peritoneal dialysis (CAPD) patients. Methods As a retrospectively study, adult patients started peritoneal dialysis in Peking Union Medical College Hospital (PUMCH) from September 1st, 2002 to September 30th, 2016 were enrolled. Baseline information and dialysis associated parameters were collected. The primary outcome was death and the secondary outcome was technical failure. The risk factors of death were analyzed in APD patients by Cox's regression model. Homochromous gender and age matched CAPD patients were analyzed as control. Results The baseline condition of 69 APD patients were similar to those of 138 CAPD patients. The survival rates of APD patients at 1-year、3-year and 5-year were 95.4%, 88.0% and 73.0% respectively, which were superior to CAPD patients. No significant difference in technical survival was found between APD and CAPD patients. Single-factor Cox's regression analysis showed that all-cause mortality of CAPD patients was 2.2 times higher than that of APD patients (95% CI 1.221-3.837). In the multi-factor Cox regression analysis model, adjusted by age, complications (including cardiovascular disease and diabetes), nPCR and serum creatinine, dialysis modality was not an independent risk factor of dialysis patients. Age (HR=1.077, 95%CI 1.016-1.142, P=0.013), diabetes (HR=3.608, 95%CI 1.117-11.660, P=0.032) and serum albumin (HR=0.890, 95%CI 0.808-0.982, P=0.020) were independently associated with all-cause death of APD patients. Conclusions Dialysis modality was not an independent risk factor for the all-cause mortality of peritoneal dialysis patients. Age, diabetic nephropathy and hypoalbuminemia were independently associated with the death of APD patients.     

腹膜通透性与腹透患者长期生存的关系

目的：探讨腹膜通透性类型与腹透长期存活的关系。方法：测定71例腹透病例透析初期（3个月内）,以及其中18例持续腹透超过4年的病例透析初期和远期（4年以上）的腹膜平衡试验（PET）,计算并分析各种腹膜通透类型长期生存概率,及长期存活病人腹膜通透性的变化情况。结果：71例病人透析初期各种腹膜通透类型的比例辚高转运23．94％,高平均转运39．44％,低平均转运26．76％和低转运9．86％,18例持续腹透超过4年的病例中,高或高平均转运各2例,低或低平均转运分别为4例和10例,生存概率分别为11．76％,7．14％,57．14％和52．63％,其中7例透析初期和远期腹膜通透性未发生变化,9例通透性较前降低,另2例高血压肾病患腹膜通透性则较前增高,结论：各种腹膜通透类型均可能长期存活,但以低通透性腹膜长期生存概率较高,提示更适宜进行长期腹膜透析治疗,长期透析腹膜通透 可保持不变或不同程度降低,并观察到高血压肾病长期腹透后通透性较前增加的现象。     

老年腹膜透析患者的营养管理

营养不良是老年腹膜透析患者的常见并发症之一,且与患者预后不佳有关。老年腹膜透析患者营养不良的原因多样,除尿毒症毒素影响食欲及腹膜透析造成的营养物质流失外,老年患者由于心血管、糖尿病等合并症增多,且存在生理、心理以及社会学等方面的特殊因素,更易发生营养不良。定期合理评估老年腹膜透析患者的营养状态有助于及时发现诱因,预防营养不良发生。治疗需根据个体情况制定具体干预方案。     

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.     

Patient survival and causes of death on hemodialysis and peritoneal dialysis – single-center study

Survival and causes of death in children dialyzed in a single center were analyzed. During the last 12 years a chronic dialysis program was introduced in 146 children in our center and 125 of them, eligible for observation, were included in this analysis; 58 patients were on hemodialysis (HD) and 67 on peritoneal dialysis [continuous ambulatory peritoneal dialysis/automated peritoneal dialysis (CAPD/APD)]. Mean age at the start of dialysis was 13.1 years in HD and 9.8 years in CAPD/APD patients. Overall, 16 patients died (12.5%); 6 (10.3%) on HD and 10 (14.9%) on CAPD/APD; 4 HD patients died of hemorrhagic stroke and 2 were killed in road traffic accidents. Of 10 CAPD/APD patients, 7 died of heart failure, ischemic stroke, and/or disseminated thromboembolic disease. Another was killed in a road traffic accident and 2 died during the course of severe infections. The 1-year patient survival rate was 96.6% in HD patients and 95% in CAPD/APD patients, 2-year survival 94% and 93% and 5-year survival 91% and 78%, respectively (P=0.2, NS). In conclusion, the survival rate for HD and CAPD patients is similar, although after 2 years of therapy, it is lower in CAPD patients. The main causes of death are cardiovascular. However, in CAPD/APD patients, heart failure with low cardiac output and thromboembolic complications are major causes of death, and in HD patients the main cause is hemorrhagic stroke. Received: 21 February 2001 / Revised: 31 July 2001 / Accepted: 2 August 2001     

Fatigue in chronic peritoneal dialysis patients

Fatigue is a common complaint in long termdialysis patients that may influence theirquality of life. The present study was carriedout in order to evaluate the prevalence andcourse of fatigue in a group of chronic PDpatients and to find the possible factor(s)related to its development. We retrospectivelyreviewed 100 charts of the patients previouslyon PD. The presence or absence of fatigue inthe 1st and last clinic visits and the 1st and2nd changes in fatigue state were studiedaccording to the monthly clinical records ofthe primary nurses. Data regarding dialysatevolume, urine volume, weekly erythropoietin(EPO) dose, hemoglobin, hematocrit, blood urea,serum creatinine, residual renal creatinine andurea clearances, dialysate to peritonealcreatinine ratio (D/P Cr), total weekly Kt/Vand total creatinine clearance/l.73 m² bodysurface area (TCrCl) were collected. Fifty-fivepatients were male and 45 female. The mean ageat the 1st clinic visit was 61.3 ± 16 years.At the 1st visit 55 patients had fatigue and 45did not. In 32 of the 55 patients fatiguedisappeared after a mean duration of 7.9 ± 8.4months and in 31 of the 45 patients fatigueappeared after a mean duration of 8 ± 6.8months. So at the last visit the frequency offatigue increased significantly from 55% to67% (p < 0.001). In patients with fatigue themean age and female percentage were higher(64.2 ± 14.1 vs 57.8 ± 17.6, p = 0.05 and 1.2vs 0.5, p < 0.05 respectively), mean hemoglobinconcentration was lower (104.4 ± 14.7 vs110.6 ± 14.2 g/L, p < 0.04) and mean EPO dosewas higher (6379.6 ± 7142 vs 3395.4 ± 4337.8units/week, p < 0.02) at the 1st clinic visit.EPO dose was also higher in patients withfatigue at the last visit (8253.7 ± 10317.3units/wk vs 4736.4 ± 5432.5, p < 0.03). Nocorrelation was found between dialysis adequacyaccording to either weekly Kt/V or TCrCl andnutritional state according to nPCR andfrequency of fatigue. We conclude that fatigueis a common symptom in PD patients and it'sprevalence increases over time. Anemia seemsto be the most important factor associated withfatigue. Dialysis adequacy and nutritionalstate did not show any correlation with thefrequency of fatigue in our study.     

黄芪改善腹透患者腹腔巨噬细胞功能的临床研究

目的：研究黄芪对尿毒症患腹腔巨噬细胞功能的影响。方法：对43例尿毒症初始行腹膜透析的患在腹透液中不加（对照组）和加入黄芪注射液（用药组）治疗1周,用ELISA法检测观察前后腹腔巨噬细胞分泌TNF－a能力和吞噬功能的变化。结果：黄芪用药组腹腔巨噬细胞吞菌率、吞噬指数、杀菌率和巨噬细胞分泌TNF－a水平和对照组相比均明显上升（P＜0．01）,巨噬细胞分泌TNF－a水平与用药前自身对比也显提高（P＜0．05）。结论：腹透液中加入黄芪注射液可提高腹透患腹腔巨噬细胞功能。     

Risk factors for mortality in diabetic peritoneal dialysis patients

Objective To investigate the risk factors of all-cause mortality in diabetic patients on peritoneal dialysis (PD). Methods As a single-center retrospective cohort study, all incident PD patients who were catheterized at the First Affiliated Hospital of Nanchang University between November 1, 2005 and February 28, 2017 were included. Patients were divided into diabetes mellitus group (DM group) and non-diabetes mellitus group (NDM group). Outcomes were analyzed by Kaplan-Meier method. Multivariate Cox proportional hazards models were utilized to assess the risk factors of all-cause mortality. Results A total of 977 patients were enrolled. Compared with NDM group, patients in DM group were older (47.5±14.4 vs 59.3±11.3, P＜0.01), had more cardiovascular disease (CVD) (7.5% vs 20.3%, P＜0.01), higher levels of serum hemoglobin (78.2±17.2 vs 82.3±14.6 g/L, P＜0.01) , and lower levels of serum albumin (36.1±5.0 vs 32.7±5.6 g/L, P＜0.01). The one-, three- and five-year patient survival rates of DM and NDM group were 89.7%, 56.0%, 31.9% and 94.7%, 81.3%, 67.4%, respectively.Survival rate was significantly lower in DM group than in NDM group ( χ2=63.51, P＜0.01). Stratified analysis showed that DM group had significant lower survival rate than NDM group in patients younger than 70 years old ( χ2= 73.35, P＜0.01), while survival rate was similar between the two groups patients older than 70 years old ( χ2= 0.003, P=0.96). Multivariate Cox proportional hazards model analysis showed that DM (HR: 1.74, 95%CI: 1.27-2.38, P＜0.01), age (HR: 1.05, 95%CI: 1.04-1.06, P＜0.01), leukocyte (HR: 1.06, 95%CI: 1.00-1.12, P=0.04) and triglyceride (HR: 1.19, 95%CI: 1.07-1.32, P＜0.01) were all independent risk factors for all-cause mortality of PD patients. However, age (HR: 1.05, 95%CI: 1.04-1.07, P＜0.01) and alkaline phosphatase (HR: 1.01, 95%CI: 1.00-1.01, P=0.02) were independent risk factors for all-cause mortality of diabetic patients. Conclusions Long-term survival rate was lower in diabetic PD patients than in non-diabetic PD patients. DM, age, leukocyte and triglyceride were independent risk factors of mortality in PD patients. Age and alkaline phosphatase were independent risk factors of mortality in diabetic patients.     

重新评价腹膜平衡试验以确定腹膜透析患者的溶质转运类型

目的 确定由Twardowski提出的腹膜平衡试验（PET）的转运类型评判值是否适合本中心患者。方法 选取我院自1995年来首次进行PET测试的患者158例。首先依据Twardowski的评判标准（值）判断患者的转运类型,再根据本组患者实际4hD/Pcr的χ±s来确定患者的溶质转运类型,然后将患者重新分组:按两种数值均符合高转运为H1组,均符合平均转运为A组,均符合低转运为L1组,部分高转运患者经重新评价后符合平均转运为H2组,部分平均转运患者经重新评价后符合低转运为L2组。通过与临床情况（溶质和水的清除）进行对照,以进一步评价更适合本中心患者的评判标准。结果 按照Twardowski的标准,高转运、高平均转运、低平均转运及低转运患者的比例分别为21.5％、44.9％。27.8％及5.7％。本研究患者群中4hD/Pcr的均值和标准差为0.70和0.14,据此重新评判后,各组的比例分别为14.6％、33.5％、33.5％及18.4％。经与临床结果相对比,L2组对水份的清除能力明显高于A组（P<0.005）,与L1组差别无显著性意义。结论4hD/Pcr在不同的地区和人群中表现出不同的均数和标准差值,因而产生了不同的腹膜转运类型。根据本中心患者人群确定的值更适合本中心患者的临床情况。     

抑郁障碍对腹膜透析患者的影响

目的：研究腹膜透析（腹透）患者产生抑郁障碍的可能因素及其对腹透的影响,尝试药物治疗,以期改善生活质量,方法：选择无精神病史的规律性腹透患者43例,进行汉密顿抑郁量表（HAMD）和抑郁自评量表（SDS）评分,并分为抑郁组和非抑郁组,在组间进行性别,年龄,文化程度和医疗付费情况的比较,观察患者透析充分性,营养,感染率,主不业率及顺应性在组织间的差异,并选择重度抑郁状态者预以抗抑郁治疗（Prozac20mg/d),观察疗效,结果：（1）37．2％的患者存在抑郁障碍,（2）通过比较,两组的年龄,性别,文化,程度,婚烟障碍和医疗付费情况均无显著差异,（3）两组间的顺应性差异有显著性意义（不顺应者在抑郁组中占53．3％,非抑郁组仅7．7％,P＜0．01）,感染率差异也有显著性意义（抑郁组：0．04）,SAG评分示抑郁组营养不良占62％,非抑郁组占4．3％,（P＜0．05）,（4）在16例中选6例预Prozac治疗1月后重测HAMD和SDS评分,相关因子分下降（例少未统计）,结论：抑郁状态在腹透患者中常见,它可造成腹透患者的营养不良,顺应性下降,透析不充分,感染率上升,抗抑郁的药物治疗可望改善患者的抑郁状态。     

Effects of seasonal changes on peritoneal dialysis associated peritonitis in peritoneal dialysis patients

Objectives To investigate the effects of seasonal changes on peritoneal dialysis associated peritonitis (PDAP) in patients on peritoneal dialysis (PD), and to provide evidence for clinical prevention and treatment of PDAP. Methods All episodes of PD-related peritonitis during clinic follow-up in maintenance PD patients from Jan 1st, 2007 to Dec 31st, 2015 in Peking University People's Hospital were reviewed. The incidence of peritonitis, laboratory indexes, pathogens and clinical outcomes in different seasons were recorded and analyzed. One-way ANOVA and chi square test were employed to compare the incidence of PDAP and related data in different seasons, and Pearson correlation was used to analyze correlations between PDAP rate and monthly mean temperature and mean humidity. Results During nine years, a total of 119 PD patients occurred 190 times of peritonitis during home PD. The PDAP rate in summer was the highest, 0.21 episodes/year, followed by spring (0.16 episodes/year) and autumn (0.16 episodes/risk year), but there was no significant difference among peritonitis rates in four seasons. There were significant positive correlation between monthly mean temperature, monthly mean humidity and the peritonitis rate (mean temperature: r=0.828, P＜0.01; mean humidity r=0.657, P＜0.05). (2) As for bacteria, in Summer the PDAP rate caused by Staphylococcus aureus and Coagulase negative staphylococcus (CoNS), and Gram-negative bacteria was higher than that in other seasons, but there was no statistical difference. There were significant positive correlation between monthly mean temperature, mean humidity and the rate of CoNS peritonitis (mean temperature: r=0.704, P＜0.05; mean humidity: r=0.607, P＜0.05). (3) There were no statistical difference among results of PD related peritonitis in different seasons about general situation, clinical manifestation, causes of peritonitis and laboratory index before peritonitis episodes. PD procedure-related problems were the main cause of peritonitis in summer and autumn. (4) The cure rate of all peritonitis was 90%. The highest cure rate was in autumn and winter, while the lowest cure rate was in summer, but no statistical difference. Among the peritonitis episodes with treatment failure, 52.6% occurred in summer. Conclusions There is some correlation between the rate of PDAP and seasons. Higher temperature and higher humidity were significantly correlated with higher peritonitis rate, especially the rate of CoNS peritonitis. The prognosis of PDAP in summer was relatively poor, with higher proportion of hospitalization and lower cure rate.     

改良腹膜平衡试验在腹膜透析患者中的应用

目的 观察改良腹膜平衡试验(改良PET)在腹膜透析(腹透)患者中的应用,初 步建立改良PET转运参数的参考值,探讨其评估腹膜溶质转运特性的准确性及临床意义。方法 97例腹透患者用高渗腹透液(4．25％葡萄糖)进行改良PET,分别测定4 h透析液肌酐与血肌酐 比值(4h D／Pcr)、计算物质转运面积系数(MTAC)、1 h透析液钠与血钠比值(1h D／PNa+)及记录 净超率量(nUF)。其中有14例患者在1个月内曾行标准腹膜平衡试验(标准PET),其结果与改 良PET进行自身比较。所有患者在研究时及研究前1个月内均无腹膜炎。结果 97例腹透患 者中有90例nUF大于400 ml,这些患者的转运参数经正态分布校正后建立了改良PET的参考 值。改良PET的4 hD／Pcr为0．70±0．15,标准PET4 hD／Pcr为0．68±0．13,两者非常接近,差异 无统计学意义。两种PET对患者腹膜转运特性分型结果相似。7例nUF小于400 ml的患者中有 5例有效腹膜表面积增大;2例存在水通道介导的水转运障碍,其中1例同时存在有效腹膜表面 积增大,还有1例患者改良PET转运参数在正常范围内。结论 与标准PET相比,用高渗腹透 液进行改良PET能够准确地评估腹膜小分子溶质转运特性,此外还能提供更多更敏感的液体转 运信息,为临床诊断超滤衰竭,以及进一步鉴别其原因提供了有力的手段。     

快速腹膜平衡试验215例结果分析

目的分析215例快速腹膜平衡试验的结果,并与其他腹膜透析中心结果比较。方法对215例腹膜透析患者行快速腹膜平衡试验,据Twardowski分组标准将患者分为低转运组、低平均转运组、高平均转运组、高转运组,将每组所占比例与其他腹膜透析中心的分组结果进行比较。结果本研究快速腹膜平衡试验结果构成比与其他腹膜透析中心的结果构成比有显著性差异,低平均转运组和高平均转运组比例较高,高转运组和低转运组比例较低。结论本院腹膜透析中心快速腹膜平衡试验结果构成比显示出与其他腹膜透析中心不同的特点,这种差异可能与本院腹膜透析中心的治疗方式有关,提示腹膜透析治疗方式可能影响腹膜转运功能。     

Reasons for the dropout of peritoneal dialysis patients

Objective To explore the reasons for withdrawal from peritoneal dialysis (PD) in our hospital. Methods This was a single-center, retrospective cohort study. Patients who started PD in the Department of Nephrology, the First Affiliated Hospital of Nanchang University from November 1st, 2005 to February 28th, 2017, were enrolled, and followed up to May 31, 2017. Patients who continued PD after May 31, 2017 were as the control group. Patients who withdrew from PD were divided into 4 subgroups: death group, hemodialysis group, kidney transplantation group and loss of follow-up group. The clinical characters of 4 subgroups were compared with the control group. Results A total of 998 patients were enrolled with age of (49.36±14.94) when PD started and median dialysis duration of 27.13(12.84, 42.29) months, in whom 570 patients (57.11%) were male. Five hundred and seventeen dropout events were recorded, and the dropout rate was 51.80%. The main reason for withdrawal from PD was death (258 patients, 49.90%), followed by hemodialysis (166 patients, 32.11%), kidney transplantation (66 patients, 12.77%) and loss to follow-up (27 patients, 5.22%). The leading cause of death was cardio-cerebro-vascular diseases (136 cases, 52.71%), followed by infection (42 cases, 16.28%), dyscrasia (20 cases, 7.75%) and tumor (5 cases, 1.94%). The main reason for transfering to hemodialysis was insufficient dialysis (76 cases, 45.78%), followed by peritonitis (55 cases, 33.13%) and catheter dysfunction (24 cases, 14.46%). Compared with those in the control group, in the death group patients were older at PD commencement, and had higher proportions of hypertension, diabetes and cardio-cerebro-vascular diseases (all P＜0.05). The proportions of male and diabetes mellitus were higher in the hemodialysis group than those in the control group (both P＜0.05). Biochemical indicators showed that serum albumin and blood phosphorus were lower in the death group than those in the control group (both P＜0.05); blood albumin was significantly lower in the hemodialysis group than that in the control group (P＜0.05). Conclusions The main reasons for withdrawal from PD in our center are death and transfering to hemodialysis. The cardio-cerebro-vascular disease is the leading cause of death, and inadequate dialysis is the main reason for transfering to hemodialysis.     

Hyperkalemia in chronic peritoneal dialysis patients

Background. Chronic peritoneal dialysis (PD) patients often develop hypokalemia but less commonly hyperkalemia.Methods. We explored incidence and mechanisms of hyperkalemia in 779 serum samples from 33 patients on PD for 1 − 59 months. Normal serum potassium concentration was defined as 3.5 − 5.1 meq/l.Results. Mean monthly serum potassium concentrations were normal (except for 1 month), but we observed hypokalemia (<3.5 meq/l) in 5% and hyperkalemia (>5.1 meq/l) in 14% of 779 serum samples. Incidence of hyperkalemia did not change over time on PD: Year 1 (15%), Year 2 (11%), Year 3 (19%), Years 4–5 (22%). Hyperkalemia was mostly modest but occasionally extreme [5.2–5.4 meq/l (55%), 5.5–5.7 meq/l (21%), 5.8–6.0 meq/l (10%), >6.0 meq/l (14%)]. Of 31 patients (2 excluded due to brief PD time), 39% displayed hyperkalemia only, 23% displayed hypokalemia only, and the remainder (38%) displayed both or neither. Comparing hypokalemia-only with hyperkalemia-only patients, we found no difference in potassium chloride therapy, medications interrupting the renin-angiotensin system, small-molecule transport status, and renal urea clearance. We compared biochemical parameters from the hypokalemic and hyperkalemic serum samples and observed lower bicarbonate concentrations, higher creatinine concentrations, and higher urea nitrogen concentrations in the hyperkalemic samples (p < 0.001 for each), without difference in glucose concentrations.Conclusion. We observed hyperkalemia 3 times as frequently as hypokalemia in our PD population. High-potassium diet, PD noncompliance, increased muscle mass, potassium shifts, and/or the daytime period without PD might contribute to hyperkalemia.     

尿毒症腹膜透析患者骨质疏松及危险因素

目的 通过分析患者的临床随访数据,探讨已规律行腹膜透析的尿毒症患者骨质疏松的患病率及相关危险因素。方法 本研究纳入了260例规律行腹膜透析6月以上的尿毒症患者,记录患者一般资料和生化指标,测定骨密度判断是否为骨质疏松,并对可能影响骨质疏松的危险因素进行单因素分析和Logistic多因素回归分析。结果 骨质疏松者128例（49.2%）,骨质疏松的发生与性别(OR=5.086,P=0.001)、年龄(OR=2.783,P=0.017) 、透析龄(OR=2.145,P=0.021)、糖尿病(OR=1.684,P=0.029)显著相关,与体重指数、抗酒石酸酸性磷酸酶-5b、全段甲状旁腺素、血钙、磷、钙磷乘积、碱性磷酸酶、尿素清除指数、白蛋白、血脂等无显著相关性( P＞0.05)。结论 腹膜透析患者骨质疏松的患病率较一般人群高,性别、年龄、透析龄、糖尿病是其危险因素。     

长期腹膜透析患者转归临床分析

目的研究长期腹透患者临床转归,分析其临床特点。方法对本院1994年1月至2003年8月腹透龄超过3年以上的58例腹透患者进行分析。根据其临床转归分为继续腹透组、转向移植组、转向血透组及死亡组。比较各组间近期营养指标（半年以内血清白蛋白水平）、近期透析充分性指标（Kt／V、Ccr）、水清除指标及残肾功能等临床特点。对死亡组同时做回顾性前后自身对照研究（死亡前半年以内与死亡前1年资料比较）。对继续腹透组回顾性分析比较1年前资料,并前瞻性追踪随访1年。结果死亡组总Kt／V显著低于其余3组（P〈0．05）;总Ccr显著低于继续腹透组（P〈0．01）。继续腹透组、移植组及血透组3组间总Kt／V、总Cer及血清白蛋白水平差异无统计学意义。血透组水清除指标显著低于继续腹透组及移植组;继续腹透组水清除指标稍高于死亡组但无显著性差异。死亡组近期总Kt／V显著低于死亡前1年总Kt／V（P〈0．05）;近期总Ccr显著低于死亡前1年总Ccr（P〈0．01）。继续腹透组近期总Kt／V及总Ccr与1年前及1年后指标比较差异均无统计学意义,但残肾Kt／V或残肾Ccr随时间推移而显著下降（P〈0．05）。继续腹透组残肾Kt／V或残肾Ccr显著高于死亡组及血透组（P〈0．05）。死亡组血清白蛋白水平较其余3组降低但差异无统计学意义。死亡组13例中有7例死于心脑血管疾病。结论腹透3年以上患者大部分仍可继续腹透。透析不充分是长期腹透患者死亡的重要原因。死亡的病因主要为心脑血管疾病。残肾功能可影响长期腹透患者的转归。