Influence of autonomy and type of home assistance on the prevention of peritonitis in assisted automated peritoneal dialysis patients. An analysis of data from the French Language Peritoneal Dialysis Registry.

BACKGROUND: In France, 48% of home-based peritoneal dialysis (PD) patients require assistance to perform their exchange and manage their treatment. A total of 7% are aided by their family, and 41% by a private nurse. Of all the continuous ambulatory peritoneal dialysis (CAPD) patients, 61.7%, and among automated peritoneal dialysis (APD) patients 23%, are assisted at home for their bag exchanges and connections. Assisted APD patients (AAPD) are more comorbid and elderly so that a home helper is not always available: this explains why most helpers at home are private visiting nurses paid by the National Social Security. In addition to the home helper (nurse or family), 58% of centres make regular additional home visits to check the respect of procedures previously taught during the initial training of the nurse or the family helper. The aim of this study was to evaluate whether the type of home assistance received by dependent patients had an influence on peritonitis rates, and if home visits done by nurses of training centres may improve results. METHODS: Peritonitis rates and the probability of being peritonitis free were analysed for 1624 new APD patients recorded in the French PD Registry (RDPLF) between 2000 and 2004, and followed-up until early 2005. RESULTS: Nurse-assisted APD patients had a peritonitis rate of one episode every 36 months, and family-assisted patients one episode every 45 months; using Poisson analysis this trend was not significant (P=0.11). However, the probability of being peritonitis free was significantly higher for family-assisted (69.8% at 2 year) compared with home nurse-aided persons (54.4%) after adjustment for age, diabetes and the Charlson comorbidity index. This difference disappeared when nurses from the training centre regularly visited PD patients at their home in the presence of their helper, whichever type of assistance they received. In addition, when the nurses from the training centres visited private nurse-assisted patients, the probability of being peritonitis free was significantly improved in comparison with those persons who did not receive home visits, from 33.9% to 50.8% at 3 years (P=0.028). CONCLUSIONS: APD patients assisted at home by a private nurse have a higher risk of developing peritonitis than family-assisted patients, unless additional regular home visits are organized by the original training centre. Therefore, we recommend that home visits be regularly made for dependent PD patients to optimize the quality of care provided by the helper.     

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 role of APD in the management of pediatric patients: a report of the North American Pediatric Renal Transplant Cooperative Study

In an attempt to delineate the role of automated peritoneal dialysis (APD) in the management of the pediatric patient with end-stage renal disease (ESRD), the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) dialysis registry database was queried concerning the incidence and outcome of APD compared to those enrolled who were undergoing continuous ambulatory peritoneal dialysis (CAPD). During the 10-year period from January 1, 1992 to January 1, 2002, 65% of the 4150 index dialysis patients enrolled in NAPRTCS underwent peritoneal dialysis (PD). APD was the dialysis modality of 69% of those choosing PD, indicating that APD was the primary dialysis modality for children during this time interval. This initial comparison of APD and CAPD from the NAPRTCS dialysis registry database indicated that there was a higher percentage of younger patients choosing APD, the time to transplantation was shorter for the CAPD patient, and the incidence and time to first peritonitis episode was significantly ( p  = 0.006) better in the APD population. There was no difference in the other parameters evaluated between the APD and CAPD patients. These data indicate the significant role of APD in the management of pediatric patients with ESRD, especially in infants, who frequently require an extended period of dialysis prior to reaching the eligibility criteria for transplantation.     

Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials.

BACKGROUND: A systematic review of randomized controlled trials (RCTs) comparing continuous ambulatory peritoneal dialysis (CAPD) with all forms of automated peritoneal dialysis (APD) was performed to assess their comparative clinical effectiveness. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL, were searched for relevant RCTs. Analysis was by a random effects model and results expressed as relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI). RESULTS: Three trials (139 patients) were identified. APD when compared to CAPD was found to have significantly lower peritonitis rates (two trials, 107 patients, rate ratio 0.54, 95% CI 0.35-0.83) and hospitalization rates (one trial, 82 patients, rate ratio 0.60, 95% CI 0.39-0.93) but not exit-site infection rates (two trials, 107 patients, rate ratio 1.00, 95% CI 0.56-1.76). However no differences were detected between APD and CAPD in respect to risk of mortality (RR 1.49, 95% CI 0.51-4.37), peritonitis (RR 0.75, 95% CI 0.50-1.11), switching from the original peritoneal dialysis (PD) modality to a different dialysis modality including an alternative form of PD (RR 0.50, 95% CI 0.25-1.02), PD catheter removal (RR 0.64, 95% CI 0.27-1.48) and hospital admissions (RR 0.96, 95% CI 0.43-2.17). Patients on APD were found to have significantly more time for work, family and social activities. CONCLUSIONS: APD appears to be more beneficial than CAPD, in terms of reducing peritonitis rates and with respect to certain social issues that impact on patients' quality of life. Further, adequately powered trials are required to confirm the benefits for APD found in this review and detect differences with respect to other clinically important outcomes that may have been missed by the trials included in this review due to their small size and short follow-up periods.     

Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience

Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p?<?0.05). Percentage of peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p?<?0.05). Time to develop peritonitis was 10.25?±?3.1 months in CAPD compared to 16.1?±?4 months in APD (p?<?0.001). Relapse and recurrence rates were similar in both groups. Median patient survival in CAPD and APD groups with peritonitis was 13.1?±?1 and 14?±?1.4 months respectively (p?=?0.3) whereas in peritonitis free patients it was 15?±?1.4 months in CAPD and 23?±?3.1 months in APD (p?=?0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.     

An African community-based chronic ambulatory peritoneal dialysis programme.

BACKGROUND: The reasons for failure of continuous ambulatory peritoneal dialysis (CAPD) are varied. Against a background of mass poverty, poor resources, and the cheaper cost of CAPD it is the primary choice of dialysis. The aims of this study were to determine infection rates and document factors responsible for CAPD failure. METHODS: We report a prospective study in a large African tertiary hospital and its community based satellite clinics. Infection rates as well as factors that may influence them were studied. Sites of infections were documented and causes of CAPD failure recorded. All patients qualifying for dialysis from January 1998 to July 1999 were included. RESULTS: Eighty-four patients were enrolled. There were 55 males and 29 females. The mean age was 39+/-10 (range 16-71) years and mean duration on dialysis at the end of the trial period was 17 months. The peritonitis rate was one episode every 27.9 patient months. Attrition to haemodialysis occurred in 16.6% of patients (n=14) and loss to follow-up in 29.8% (n=25). Fourteen patients regained renal function or were transplanted. Peritonitis appeared to be related to a poor BAD-C score (Bara Adapted Dialysis Compliance), i.e. combination of clinical status and clinic visits (P=0.07). The odds ratio for failure of CAPD with peritonitis was 5.3 times higher (confidence interval (CI) 1.7-17.1; P=0.0085). A low BAD-C score was a significant indicator of CAPD 'failure' (P=0.0001). The natural turnover rate of patients was 46%. Home conditions, employment, and education levels did not correlate with CAPD 'failure'. CONCLUSION: The peritonitis rate and aetiology are similar to the developed world. Socioeconomic factors did not appear to play a role in peritonitis rates or CAPD failure.     

Continuous cycling peritoneal dialysis is associated with lower rates of catheter infections than continuous ambulatory peritoneal dialysis

Continuous cycling peritoneal dialysis (CCPD), unlike continuous ambulatory peritoneal dialysis (CAPD), provides freedom from daytime exchanges and is associated with lower rates of peritonitis. However, catheter infection (CI) rates have not been reported for CCPD. Previous data suggested that a CAPD disconnect system (Y-set) was associated with lower rates of CI. These results suggested that patients on CCPD, which is also a disconnect system, might also have low CI rates. We evaluated our CCPD patients for infection rates and compared them with two groups of matched control CAPD patients, one using a spike system and one a Y-set disconnect system to evaluate this hypothesis. The CCPD patients had the lowest rates of CIs (0.5 episodes per year or one episode every 25 months), followed by the CAPD patients using the Y-set (0.8 episodes per year or one episode every 14 months). CAPD patients using the spike system had the highest rates of CIs (1.2 episodes per year or one episode every 10 months). Peritonitis rates followed the same pattern among the patient groups: CCPD, 0.3 episodes per year; CAPD, Y-set 0.5 episodes per year; CAPD, spike system 1.3 episodes per year. Our data suggest that disconnect systems, such as the CAPD Y-set and CCPD, reduce CIs, as well as peritonitis.     

Single UK centre experience on the treatment of PD peritonitis--antibiotic levels and outcomes.

BACKGROUND: There are few studies of the pharmacokinetics of vancomycin and gentamicin in peritoneal dialysis (PD) patients and the influence of antibiotic concentrations on treatment outcome. Concerns about resistance to ceftazidime and potential of aminoglycoside toxicity make the choice of empiric antibiotic difficult. METHODS: We retrospectively collected data from 613 patients on PD between 1 June 2002 and 31 December 2005. During this time, we adopted a protocol that minimized aminoglycoside exposure to patients with residual renal function and carefully monitored serum antibiotic concentrations. RESULTS: There were no statistical differences in mean day-5 vancomycin concentrations for continuous ambulatory peritoneal dialysis (CAPD) vs automated peritoneal dialysis (APD) and for anuric vs not-anuric patients. However, low levels (<12 mg/l) were recorded for 12.8% CAPD and 15% APD patients. These remained low at day 10 in 16% patients (25% if not anuric) despite incremental dosing. Vancomycin concentration did not predict cure or relapse of Gram-positive or culture-negative peritonitis. Gentamicin concentration (>2 mg/l in >50% patients) did not predict outcome of Gram-negative and culture-negative peritonitis. Moreover, cure rates were the same irrespective of whether gentamicin was continued for 14 days or was switched to ceftazidime after 5 days. CONCLUSION: We have confirmed that the International Society for Peritoneal Dialysis (ISPD) dosing guideline for vancomycin in CAPD and APD patients produces adequate serum concentrations of the antibiotics in the vast majority. However, large incremental dosing of vancomycin is needed if day-5 levels are low; especially for not-anuric patients. Whilst evidence of gentamicin toxicity in PD remains controversial, ISPD dosing regimen resulted in high levels for >50% patients. High gentamicin concentrations did not correlate with treatment success, but switching gentamicin to ceftazidime at day 5 appeared safe and limited aminoglycoside exposure. Increasing vancomycin and gentamicin concentrations do not appear to improve cure rates and alternative strategies (such as combination treatment) should be considered for future research.     

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.     

Automated peritoneal dialysis as the modality of choice: a single-center, 3-year experience with 458 children in Mexico

Automated peritoneal dialysis (APD) has been considered as the ideal dialysis modality for pediatric patients. This study reports the 3-year APD experience with 458 end-stage renal disease (ESRD) children who started APD in a single pediatric center in Mexico City between June 2003 and June 2006. By June 2003, there were 310 patients being treated with continuous ambulatory peritoneal dialysis (CAPD). At that time, these patients were gradually switched to APD, with priority being given to those prescribed more than four exchanges per day, younger than 6 years of age, or presenting complications [hernias or decreased ultrafiltration (UF)]. An improvement of daily UF was observed when the patients were switched from CAPD (590 ± 340 ml/day) to APD (846 ± 335 ml/day). The presence of edema decreased (from 67% to 8%) as well as the percentage of patients requiring antihypertensive drugs (from 83% to 38%), the peritonitis rate improved from one episode every 35 patient/month to one episode every 47 patient/month, the total number of hospitalizations decreased (from 384 to 51), and 85% of children attended school. While waiting for renal transplant, APD is the dialysis modality of choice for ESRD children at the La Raza Medical Center in Mexico City. Dr. Divino Filho is an employee of Baxter Health Care and holds stock in the company.     

Single-center experience of encapsulating peritoneal sclerosis in patients on peritoneal dialysis for end-stage renal failure

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD). It is characterized by a progressive, intra-abdominal, inflammatory process resulting in sheets of fibrous tissue that cover, bind, and constrict the viscera, thereby compromising the motility and function of the bowel. Although recent therapeutic approaches have been reported with variable success, the ability to detect reliably at an early stage patients at risk for EPS would be beneficial and allow treatment standardization. The aim of this study was to evaluate the clinical features of EPS and identify possible risk factors for its development in CAPD and APD patients. METHODS: This was a review of all cases of EPS in a single center over the last 5 years. RESULTS: There were 810 CAPD and APD patients, managed in our program over this period. We identified 27 cases of EPS, giving an overall of 3.3% in this population. The mean duration of CAPD before diagnosis of EPS was 72.6 +/- 39.7 months (range 16-172). Sixteen cases required surgical treatment and were classified as severe; others were treated conservatively (mild to moderate group). Ten patients received tamoxifen treatment with apparent benefit. The overall mortality rate was 29.6%. Eight patients from the severe group and the entire moderate group survived on hemodialysis or transplantation at 48.71 and 27.63 months follow-up, respectively. Peritonitis rates were not different between the 2 groups and peritoneal history was unremarkable compared to overall peritonitis rates in the unit. Data on small solute transport were not available in all patients in this retrospective analysis. CONCLUSION: EPS is a serious, life-threatening complication of CAPD. Most cases had PD duration of more than 4 years. Careful monitoring by CT scans of the peritoneal membrane in patients beyond 5 years, and early catheter removal in patients with peritoneal thickening should be considered for long-term CAPD patients. Treatment with tamoxifen may be of benefit in these patients.     

Peritoneal fluid and solute transport: influence of treatment time, peritoneal dialysis modality, and peritonitis incidence

The integrity of the peritoneal membrane in peritoneal dialysis (PD) is of major importance for adequate dialysis and fluid balance. However, alterations in peritoneal fluid transport, such as ultrafiltration failure, often develop during long-term PD. To investigate peritoneal solute and fluid transport and to analyze the influence of treatment time, peritonitis incidence, and PD modality (continuous ambulatory PD [CAPD] or automated PD [APD]), a cross-sectional study with an extended peritoneal transport test that used dextran 70 in 2 L of glucose was performed in 23 nonselected chronic PD patients. Compared were long-term (>40 mo) with short-term PD patients (<40 mo), CAPD with APD patients, and those with a peritonitis incidence of >0.25/yr to those with an incidence of <0.25/yr. Dialysate/plasma (D/P) ratio and mass transfer area coefficient of creatinine, lymphatic absorption rate (LAR), transcapillary ultrafiltration, and effective ultrafiltration were measured. Long-term PD patients had higher D/P ratio of creatinine (73.5 +/- 2.3% versus 65.9 +/- 2.2%; P < 0.01) and higher LAR (243 +/- 69 ml/4 h versus 96 +/- 31 ml/4 h; P < 0.03), both resulting in lower effective ultrafiltration (242 +/- 35 ml/4 h versus 324 +/- 30 ml/4 h; P < 0.05). D/P ratio (r = 0.66) and LAR (r = 0.67) were positively correlated to PD duration. Patients on APD compared with those on CAPD and patients with a history of peritonitis compared with those without did not differ in terms of D/P ratio, mass transfer area coefficient, LAR, transcapillary ultrafiltration, and effective ultrafiltration. Lower ultrafiltration after long-term PD is both the result of increased small solute transport and increased lymphatic absorption. APD or CAPD modality and peritonitis incidence do not have a significant influence on small solute transport or fluid kinetics.     

APD in the elderly

Few elderly patients with end-stage renal disease (ESRD) are treated with peritoneal dialysis (PD). Among dialysis patients ≥65 years of age reported by the U.S. Renal Data System (USRDS), the percentage treated with chronic peritoneal dialysis (CPD) is lower than in any other age group. To evaluate the effectiveness of automated peritoneal dialysis (APD) in the elderly, we compared several outcome measures in cohorts of different ages maintained on APD. The outcome measures we examined included mortality and technique failure rates, peritonitis rates, outcomes of peritonitis, and quality of life measures. We found that while patients ≥65 years of age have a higher mortality rate than younger patients, technique failure rates, overall peritonitis rates, and most quality of life measures are not different than for younger patients. However, patients ≥65 years of age have higher gram-negative peritonitis rates and lower scores on the physical component score of the SF-36 than younger patients. The present study suggests that APD is a reasonable treatment modality for elderly patients with ESRD and that elderly patients with progressive renal failure should be considered as candidates for APD.     

Treatment of fungal peritonitis complicating continuous ambulatory peritoneal dialysis with oral fluconazole: a series of 21 patients

Twenty-one episodes of fungal peritonitis occurred over 35 monthsamong 290 patients on CAPD, accounting for 6.3% of all peritonitisepisodes. Patients with more frequent bacterial peritonitiswere at higher risk of developing fungal peritonitis, and 28.6%of cases followed antimicrobial therapy. Candida species accountedfor 85.7% of cases. Oral fiuconazole was used as initial therapyin all patients, which was followed by catheter removal if peritonitisfailed to improve. The cure rate with fluconazole therapy alonewithout catheter removal was 9.5%. Fluconazole plus catheterremoval, the latter necessitated in 85.7% of cases, resultedin a cure rate of 66.7%. The remaining 3 (14.3%) patients respondedto intravenous amphotericin given as salvage therapy. Disease-relatedmortality was 14.3%. Reinsertion of dialysis catheter was attemptedin 15 patients and CAPD was successfully resumed in 13 (86.7%).We conclude that oral fluconazole can be safely used as initialtherapy in patients with fungal peritonitis complicating CAPD.Although catheter removal was necessary in the majority of patients,this sequential approach resulted in a relatively low prevalenceof peritoneal adhesions and subsequent CAPD failure.     

Peritoneal transport status and first episode of peritonitis: a large cohort study

BackgroundPeritonitis is one of the most serious complications of peritoneal dialysis (PD). This study aimed to explore the relationship between peritoneal transport status and the first episode of peritonitis, as well as the prognosis of patients undergoing continuous ambulatory peritoneal dialysis (CAPD).MethodA retrospective cohort study was conducted, analyzing data of CAPD patients from 1st January 2009, to 31st December 2017. Baseline data within 3 months after PD catheter placement was recorded. Cox multivariate regression analysis was performed to determine the risk factors for the first episode of peritonitis, technique failure and overall mortality.ResultsA total of 591 patients were included in our analysis, with a mean follow-up visit of 49 months (range: 27–75months). There were 174 (29.4%) patients who had experienced at least one episode of peritonitis. Multivariate Cox regression analysis revealed that a higher peritoneal transport status (high and high-average) (HR 1.872, 95%CI 1.349–2.599, p = 0.006) and hypoalbuminemia (HR 0.932,95% CI 0.896, 0.969, p = 0.004) were independent risk factors for the occurrence of the first episode of peritonitis. In addition, factors including gender (male) (HR 1.409, 95%CI 1.103, 1.800, p = 0.010), low serum albumin (HR 0.965, 95%CI 0.938, 0.993, p = 0.015) and the place of residence (rural) (HR 1.324, 95%CI 1.037, 1.691, p = 0.024) were independent predictors of technique failure. Furthermore, low serum albumin levels (HR 0.938, 95%CI 0.895, 0.984, p = 0.008) and age (>65years) (HR 1.059, 95%CI 1.042, 1.076, p < 0.001) were significantly associated with the risk of overall mortality of PD patients.ConclusionsBaseline hypoalbuminemia and a higher peritoneal transport status are risk factors for the first episode of peritonitis. Factors including male gender, hypoalbuminemia, and residing in rural areas are associated with technique failure, while hypoalbuminemia and age (>65years) are predictors of the overall mortality in PD patients. Nevertheless, the peritoneal transport status does not predict technique failure or overall mortality of PD patients.     

Treatment of peritonitis in APD: pharmacokinetic principles

Clinicians treating peritoneal dialysis (PD)-associated peritonitis should be aware that continuous ambulatory PD (CAPD) and automated PD (APD) have different effects on the pharmacokinetics of antibiotics. Results from various APD and comparative CAPD pharmacokinetic studies are reviewed. In APD patients, antibiotic half-lives were shorter during the cycler exchanges. Antibiotic peritoneal clearance was greater in patients treated with APD than those treated with CAPD regimens. Antibiotic clearance depends upon residual renal function and dialysate flow rate. To ensure that maximal antibiotic bioavailability occurs with intermittent intraperitoneal (IP) dosing, it is recommended that the antibiotic-containing dialysate must dwell at least 4 hours to ensure an adequate antibiotic depot in the body. Knowledge of antibiotic disposition in PD patients will assist clinicians in appropriate IP antibiotic dose selection and prevention of dose-related adverse effects.     

辅助腹膜透析的预后分析

目的比较辅助腹膜透析和自主腹膜透析对腹膜透析(peritoneal dialysis,PD)患者的预后影响。方法回顾性收集1996年3月13日至2016年12月31日在北京协和医院行PD且资料完整的637例成人患者的临床资料,按照患者是否独立完成PD操作将将患者分为自主PD组和辅助PD组,按照PD的模式不同进一步将辅助PD组分为自动化腹膜透析组(automated peritoneal dialysis,APD)和持续非卧床腹膜透析组(continuous ambulatory peritoneal dialysis,CAPD),分别比较辅助PD和自主PD两组间以及辅助APD和辅助CAPD两组间患者生存、技术生存及无腹膜炎生存方面的差异。结果本研究纳入辅助PD组373例(APD 35例,CAPD 338例),自主PD组264例。与自主PD相比,辅助PD患者年龄更大,合并糖尿病、高血压及心血管疾病比例更高,透析开始时血白蛋白、钾、磷、血肌酐、尿素、甲状旁腺素和标准蛋白分解率更低,而血二氧化碳总量和估算肾小球滤过率更高。辅助APD组与辅助CAPD组比较则前者合并心血管疾病比例,护工辅助比例以及透析3个月后残余肾功能水平更高。辅助PD组患者生存不及自主PD组,但经多因素校正后辅助PD不是患者死亡的独立危险因素(HR1.479,95%CI 0.978~2.236,P=0.064),两组在技术生存及无腹膜炎生存方面相当。辅助APD与辅助CAPD比较,两组的患者生存、技术生存及无腹膜炎生存均无差异。结论辅助PD的患者生存劣于自主PD,而技术生存及无腹膜炎生存两组无差异。辅助APD的患者生存、技术生存和无腹膜炎生存与辅助CAPD无差异,可以作为有需求患者的治疗选择。     

维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及危险因素分析

目的 探讨维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及相关危险因素.方法 以中山大学附属东华医院腹膜透析中心192例患者为研究对象.根据腹膜透析液培养结果分成腹膜炎组与正常组.采用多因素logistic回归分析腹膜透析相关性葡萄球菌腹膜炎的危险因素.结果 共16例（8.3％）患者发生腹膜透析相关性葡萄球菌腹膜炎.致病菌以表皮葡萄球菌为主,占50.0％（8/16）.治愈12例（75.0％）,死亡1例.高龄（OR=1.35,95％ CI 1.16～7.68,P=0.026）、糖尿病（OR =3.34,95％ CI 1.90～6.54,P＜0.001）、低血红蛋白（OR=1.68,95％ CI 1.21～6.48,P=0.022）及低白蛋白血症（OR=1.04,95％ CI1.02～1.07,P=0.036）是腹膜透析相关性葡萄球菌腹膜炎的相关危险因素.结论 腹膜透析相关性葡萄球菌腹膜炎发生率较高;高龄、低血红蛋白、糖尿病及低白蛋白血症是其相关危险因素.