Prevalence and risk factors of restless legs syndrome in maintenance peritoneal dialysis patients

Objectives To investigate the prevalence and its risk factors of restless legs syndrome (RLS) in maintenance peritoneal dialysis (PD) patients. Methods Patients who performed PD in the First Affiliated Hospital of Sun Yat-sen University were recruited by convenience sampling. International Restless Legs Syndrome Study Group diagnostic criteria and International Restless Leg Syndrome rating scale were used to diagnose and evaluate the RLS and its severity. Co-morbidities level, baseline demographic, clinical and biochemical data were collected to analyze the clinical characteristics of patients with RLS. Multivariate logistic regression analysis was used to assess the risk factors for RLS. Results A total of 421 PD patients were enrolled in this study. Their age was (46.3±12.8) years old, 44.2% were female and 17.3% with diabetes. The median vintage of PD was 46.8(28.0, 73.5) months. The prevalence of RLS was 14.0%, most of whom were affected with moderate or severe RLS. Logistic regression analysis showed that younger age, long-term dialysis duration, higher serum calcium and phosphorus were the risk factors associated with RLS in PD patients after adjustment for confounders (all P﹤0.05). Conclusions Prevalence of RLS in PD patients is 14.0%. Younger age, long-term dialysis duration, higher serum calcium and phosphorus were the risk factors associated with RLS.     

Prevalence and risk factors of restless legs syndrome in peritoneal dialysis patients

Objective To investigate the prevalence of restless legs syndrome (RLS) in peritoneal dialysis patients and analyze the related risk factors. Methods This study was a cross-sectional study. The patients receiving maintenance peritoneal dialysis from January 2017 to December 2017 in the Peritoneal Dialysis Center of the Second Hospital Affiliated to Soochow University were selected as the study subjects. RLS was screened for peritoneal dialysis patients by epidemiological field investigation based on the RLS diagnostic criteria of the International Restless Leg Syndrome Research Group in 2014. Clinical data and laboratory examinations of selected patients were collected and the differences of clinical indicators between RLS and non-RLS patients were compared. The risk factors related to RLS were analyzed by logistic regression. Results Seventy-six cases of RLS were screened out from 396 PD patients. The prevalence of RLS was 19.2%. Compared with non-RLS group, RLS group patients had longer dialysis age, less 24 hours urine volume, and elevated blood intact Parathormone (iPTH) and alkaline phosphatase (AKP) (all P﹤0.05). There was no significant difference in primary disease ratio, sex, age, body mass index, blood pressure, hemoglobin, creatinine, urea nitrogen, uric acid, ferritin, serum iron, transferrin saturation, blood calcium, blood phosphorus, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, eGFR, Kt/V, Ccr between RLS and non-RLS group patients (all P﹥0.05). Multivariate logistic regression analysis showed that long dialysis age (OR=1.010, 95%CI 1.001-1.018, P=0.022) and high blood AKP (OR=1.005, 95%CI 1.001-1.010, P=0.021) were independent risk factors for RLS in peritoneal dialysis patients (both P﹤0.05). Conclusions The prevalence of RLS is high in peritoneal dialysis patients. Long dialysis age and high blood AKP are independent risk factors for RLS.     

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.     

Prevalence and risk factors of exit-site infection in elderly peritoneal dialysis patients

Objective To explore the prevalence and risk factors of exit-site infection (ESI) in elderly peritoneal dialysis (PD) patients. Methods The status of exit-site was evaluated in elderly PD patients (≥60 years) who had catheter insertion in our center between January 1, 2009 and December 31, 2013, with follow-up for 1 year or withdrawing from peritoneal dialysis in this period. The patients were divided into ESI and non-ESI group. The data was collected including demographics, clinical features, and nursing care methods of the exit-site. Results A total of 247 patients were recruited in this study, aged (68.6±6.2) years, among whom there were 132 male (53.4%) and 119 diabetes (48.2%). Median follow-up time was 12.0 months. Thirty-two patients had 34 episodes of ESI with a rate of 82.5 patient-months per episode (0.15 episodes per year). Coagulase-negative Staphylococcus was the main pathogen, accounting for 35.3% of the ESI. No bacterial growth was found in 8.8%. The exit-site nursing care status included that poor compliance of exit-site care 23.5%, poor catheter immobilization 62.3%, history of catheter-pulling injury 9.7%, mechanical stress on exit-site 5.3%, improper frequency of nursing care 29.6%, mupirocin usage 13.8%, patients taking exit-site care 26.7%, exit-site caregiver instability 16.6%. There were no differences in demographic (such as age, gender, primary disease, etc) and laboratory data (hemoglobin, serum albumin, blood potassium, etc) between the ESI and non-ESI groups. Poor compliance with exit-site care (HR=2.352, 95%CI 1.008-5.488, P=0.048), poor catheter immobilization (HR=3.074, 95%CI 1.046-9.035, P=0.041) and exit-site caregiver instability (HR=2.423, 95%CI 1.004-5.845, P=0.049) were significantly correlated with increased risk of ESI. Conclusions The prevalence of ESI in elderly PD patients was 0.15 episodes per year. Educating PD patients to improve the compliance with exit-site care, maintain catheter immobilization and do exit-site care by a stable and trained caregiver may reduce ESI events in elderly PD patients.     

The risk factors of mortality in peritoneal dialysis patients in different periods

Objective To explore the risk factors and characteristics in patients with peritoneal dialysis who died in different periods. Methods The clinical data of new peritoneal dialysis patients in the Department of Nephrology and Peritoneal Dialysis Center of the First Affiliated Hospital of Nanchang University from November 1, 2005 to February 28, 2017 was retrospectively analyzed. The patients were divided into two groups according to the time of death: those who died within one year and died after one year. The risk factors of mortality between the two groups were analyzed by Cox regression model. Results A total of 997 patients were enrolled and 244 patients died. There were 69 patients (28.3%) died within one year and 175 patients (71.7%) died after one year. Cardiovascular and cerebrovascular disease was the dominating reason of death in both groups, accounting for 59.4% (died within one year group) and 51.4% (died after one year group) respectively. Cox regression analysis showed that for died within one year group, old age (HR=1.035, 95%CI: 1.016-1.055, P＜0.001), low blood total calcium (HR=0.167, 95%CI: 0.053-0.529, P=0.002), low albumin (HR=0.899, 95%CI: 0.856-0.943, P＜0.001) and low apolipoprotein A1 (HR=0.274, 95%CI: 0.095-0.789, P=0.016) were risk factors associated with mortality. However, for died after one year group, old age (HR=1.053, 95%CI: 1.038-1.069, P＜0.001), combined with diabetes (HR=2.181, 95%CI: 1.445-3.291, P＜0.001) and hypertriglyceride (HR=1.204, 95%CI: 1.065-1.362, P=0.003) were risk factors associated with mortality. Conclusions The risk factors of mortality for peritoneal dialysis patients of different periods were not exactly the same. For died within one year patients, old age, low blood total calcium, low albumin and low apolipoprotein A1 were independent risk factors for mortality.However, for died after one year patients, old age, combined with diabetes, and high triglycerides were independent risk factors for mortality.     

Prevalence and risk factors for hepatitis C virus infection in continuous ambulatory peritoneal dialysis patients

BACKGROUND.: Studies on hepatitis C virus antibodies (Anti-HCV) in CAPD patientsare scarce and include a small number of patients. Nevertheless,risk factors related to Anti-HCV in these patients are stillsubject to controversy. PURPOSE OF THE STUDY.: To analyse the incidence and risk factors associated with thepresence of Anti-HCV in CAPD patients. METHODS.: We studied 255 patients from five different treatment centresof our region. The analysis was repeated after excluding 161patients who had previously received haemodialysis treatmentat least once. Anti-HCV testing was made by the 2nd-generationELISA. As a supplementary test we used RIBA-4 in three centersand INNOLIA in the other two. Risk factors were analysed usinglogistic regression model for multivariate analysis. RESULTS.: In the whole group, 29 patients (11.4%) were anti-HCV positive.Logistic regression analysis determined the following variablesas independent risk factors: hepatitis previous to CAPD (P<0.0001,odds ratio (OR): 44.9), Anti HBc positivity (P=;0.019, OR: 9.24),blood transfusions previous to CAPD (P=;0.015, OR: 1.05) andCAPD duration (P=0.025, OR: 1.02). When patients who had previouslyundergone haemodialysis were excluded, the prevalence of HCVantibodies was 8.5% (8/94). In this group multivariate analysisshowed that Anti-HCV positivity correlated with hepatitis previousto CAPD (P<0.0003, OR: 126) and Anti HBc positivity (P=0.002,OR: 41.9). CONCLUSIONS.: Our prevalence of hepatitis C virus (HCV) infection in CAPDpatients was lower than other renal replacement therapy modalities,and correlated to events occurring mainly before starting CAPDtreatment. This technique could be considered as low risk forHCV infection.     

腹膜透析患者β 2微球蛋白水平变化及其影响因素

目的:分析持续不卧床腹膜透析患者血清β 2微球蛋白水平与临床指标的关系,探讨β 2微球蛋白升高的相关危险因素。 方法:本研究为回顾性研究,选取2015年1月至2019年8月于东莞东华医院血液净化科接受腹膜透析的患者,根据β 2微球蛋白三分位数水平分为3组,比较其临床和实验室...     

Risk factors for catheter-related complications in pediatric peritoneal dialysis

Catheter-related complications, including infection, dialysate leak, and malfunction, are the principal causes of peritoneal dialysis (PD) failure. To determine risk factors predisposing to these complications, we conducted a retrospective study of 90 children on chronic PD who received 127 catheters from January 1990 to December 2000. There was a significant risk for dialysate leak when PD catheters were used early (14 days post placement) versus delayed use (>14 days). There was no significant difference in malfunction and infection rate between early and delayed use groups. Weight and height <5th percentile, low serum albumin, and history of abdominal surgery were not associated with an increased risk of complications. History of dialysis prior to catheter placement and presence of a gastrostomy tube (G-tube) were both associated with significant infection risk. Patients 3 years old were more likely to have a G-tube and had an increased risk of infection. We conclude that delayed use of the PD catheter led to a lower incidence of dialysate leak but had no effect on infection rate. Young age, G-tube, and history of prior dialysis are risk factors for infection. Multi-center, prospective controlled studies involving larger numbers of children are important to confirm these findings.     

Prevalence and determinants of masked hypertension defined by home blood pressure monitoring in peritoneal dialysis patients

Objective To evaluate the prevalence of masked hypertension defined by home blood pressure monitoring in patients on peritoneal dialysis (PD) and examine its determinants. Methods The patients who performed PD in the First Affiliated Hospital of Sun Yat-sen University from January 1, 2006 to December 31, 2013 were recruited. Baseline demographic, clinical and biochemical examination data were collected to analyze the prevalence and clinical characteristics in patients with masked hypertension defined by home blood pressure monitoring. Multivariate logistic regression model was used to analyze the related risk factors of masked hypertension in PD patients with clinic normotension. Results There were 1 425 patients (866 males) enrolled in this study, with age of (46.9±14.9) years and body mass index of (21.6±3.1) kg/m2. The prevalence of masked hypertension in PD patients was 31.9%, and the prevalence of masked hypertension in patients with clinic normotension was 57.5%. Multivariate logistic regression analysis showed that higher body mass index (OR=1.057, 95%CI 1.001-1.116, P=0.047), incorporating diabetes mellitus (OR=1.996, 95%CI 1.160-3.433, P=0.013), use of multiple antihypertensive drugs (OR=1.336, 95%CI 1.122-1.590, P=0.001) and elevated office blood pressure (OR=1.785, 95%CI 1.546-2.060, P＜0.001) were independent risk factors of masked hypertension in PD patients with clinic normotension. Conclusions The prevalence of masked hypertension is high in PD patients. Higher body mass index, incorporating diabetes mellitus, use of multiple antihypertensive drugs and elevated office blood pressure are independent risk factors for masked hypertension in PD patients with clinic normotension.     

Prevalence and influencing factors of peritoneal calcification in patients with long peritoneal dialysis duration

Objective To investigate the prevalence and related factors of peritoneal calcification in peritoneal dialysis (PD) patients with long dialysis duration, and to explore the relationship between peritoneal calcification and vascular calcification. Methods This cross-section study enrolled PD patients who had received PD for more than 4 years in Peking University People's Hospital. Peritoneal calcification and abdominal aortic calcification were reviewed by CT scan. Demographic data, clinical characteristics, laboratory data including calcium phosphorus metabolism indexes (Ca, P, ALP and iPTH) and PD adequacy were collected. The influencing factors of peritoneal calcification were analyzed by Logistic regression analysis. The correlation between peritoneal calcification and abdominal aortic calcification were tested by Spearman correlation analysis. SPSS 19.0 was used for statistical analysis. Results (1) Seventy-nine PD patients were enrolled: 32 males (40.5%); mean age was (58.7±13.1) years and average PD duration was 77.25(58.00, 88.00) months. The major primary diseases were glomerulonephritis (46.8%) and diabetic nephropathy (30.4%). (2) 6 patients (7.6%) had CT-detectable peritoneal calcification. 77(97.5%) patients were found with various degrees of peritoneal thickening. The prevalence of peritoneal calcification was 7.6% in patients with PD duration more than 4 years, 10.3% in patients with PD duration more than 6 years, 18.8% in patients with PD duration more than 8 years and 40.0% in patients with PD duration more than 10 years, showing an increasing trend. Compared with non-peritoneal calcification group, the patients in peritoneal calcification group received higher doses of Vitamin D (P＜0.001) and lower triglyceride levels (P=0.041). The patients were divided into two groups according to whether dialysis duration was longer than 9 years, and the proportion of patients with long PD duration in peritoneal calcification group was higher (P=0.013). Logistic regression analysis showed that PD duration, calcium and phosphorus metabolism indexes were not independent risk factors of peritoneal calcification. High vitamin D dose was an independent risk factor for peritoneal calcification (B=2.667, OR=14.394, 95%CI 1.655 - 125.165, P=0.016). (3) 74 patients were found with abdominal aortic calcification in different degrees, and the prevalence rate of abdominal aortic calcification was 93.7%. Spearman correlation analysis showed that there was no correlation between peritoneal calcification and vascular calcification (r=0.70, P=0.542). Conclusions The prevalence of peritoneal calcification in long PD duration patients is low. Peritoneal calcification may be associated with high Vitamin D dose and long PD duration.     

频发腹膜透析相关性腹膜炎的临床特征及危险因素的探讨

目的探讨频发腹膜透析相关性腹膜炎的临床特征及危险因素。方法回顾性分析2007年1月至2014年12月安徽医科大学附属省立医院腹膜透析置管后行持续性非卧床腹膜透析的尿毒症患者,选择1年内发生腹膜炎≥2次者定义为频发组,1年内仅发生1次腹膜炎者定义为单发组,比较2组临床及实验数据差异,并分析频发腹膜透析相关性腹膜炎的危险因素。结果频发组13例,发生感染性腹膜炎30例次,单发组57例,发生感染性腹膜炎57例次。频发组与单发组相比,患者血压和体质量指数明显升高(P0.05),未及时治疗者[7例(53.85%)比13例(22.81%)]及抗感染疗程不足者[5例(38.46%)比8例(14.04%)]增多(P0.05),无效拔管率[5例(38.46%)比7例(12.28%)]增加(P0.05),血红蛋白、血白蛋白显著降低(P0.05),全段甲状旁腺素水平升高(P0.05)。病原学检查分析频发组革兰阴性菌感染率(33.33%)及真菌感染率(10.00%)均较高,但以革兰阴性菌增加的趋势最明显(P=0.035)。2组间置管时年龄、性别、透析时间、文化程度、腹膜炎诱因、病死率、残余肾功能、外周血白细胞、血钙、血磷、C反应蛋白、血总胆固醇、三酰甘油、首次腹透液白细胞数比较差异均无统计学意义。Logistic回归分析显示高体质量指数、严重高血压、低血红蛋白、低血白蛋白为频发腹膜透析相关性腹膜炎的危险因素。结论营养不良、体质量指数过高、严重高血压为腹膜透析者频发腹膜炎的危险因素,积极纠正低蛋白血症、控制血压、保持标准体质量指数,积极按时规范治疗腹腔内源性感染有助于该病的预防和控制。     

高甲状旁腺激素腹膜透析者颈动脉斑块发生率及其影响因素

目的 探讨高甲状旁腺激素腹膜透析者颈动脉斑块的发生率及影响因素.方法 根据甲状旁腺激素水平将受试者分为甲状旁腺激素正常组及甲状旁腺激素升高组.应用二维超声检测受试者颈动脉斑块,选用Logistic分析评估颈动脉斑块的危险因素.结果 共145例腹膜透析者纳入研究,其中甲状旁腺激素正常组69例（47.7％）,甲状旁腺激素升高组76例（39.1％）.与甲状旁腺激素正常组相比,甲状旁腺激素升高组颈动脉斑块发生率明显升高（50.3％ vs 30.5％,P＜0.001）.在甲状旁腺激素升高组,校正各种混杂因素后,高龄[比值比（OR）=1.04,95％可信区间（CI）1.02～ 1.06]、糖尿病（OR=3.31,95％ CI 1.92～6.43）、高血磷（OR=1.02,95％ CI 1.01 ～ 1.03）、高钙磷乘积（OR=1.27,95％ CI 1.10～4.54）为颈动脉斑块形成的独立危险因素.结论 高甲状旁腺激素的腹膜透析者颈动脉斑块发生率高,高龄、糖尿病、高血磷及高钙磷乘积是其动脉斑块形成的独立危险因素.     

慢性肾衰竭腹膜透析患者的预后分析

目的分析慢性肾衰竭腹膜透析患者的生存率及预后影响因素。方法回顾性调查2003年1月至2011年6月在我院规律随访的353例腹膜透析患者,总结患者的预后和退出原因,比较死亡患者与继续腹膜透析患者临床指标差异,分析患者死亡的危险因素和独立危险因素。结果353例患者中退出159例,其中死亡74例,死亡原因主要是心血管疾病。腹膜透析患者1年、2年、3年、4年的生存率分别为92％、80％、68％、58％。Logistic回归分析显示,年龄、糖尿病肾病、血红蛋白、血白蛋白和血肌酐是患者死亡的危险因素。COX回归分析显示,年龄、血红蛋白和血肌酐是死亡的独立危险因素（均P〈0．05）。结论根据年龄、血红蛋白和血肌酐水平可以对腹膜透析患者预后做初步判断,重视患者的营养状况,有利于改善预后、降低死亡率。     

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.     

腹膜透析患者动脉硬化评价及其影响因素分析

目的评估中青年(19~60岁)非糖尿病腹膜透析患者动脉硬化情况,并分析其危险因素。方法研究对象为中青年(19~60岁)非糖尿病腹膜透析患者86例,收集患者基础资料(患者身高、体质量指数、血压、透析时间、用药史、尿量等)、臂-踝脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)及各项实验室指标(肝肾功能、血脂、电解质、甲状旁腺素、超敏C反应蛋白、缺血修饰白蛋白),并对相关指标进行分析。结果依据患者baPWV是否升高(baPWV1 400 ctn/s为升高)分为高baPWV组(39例)和正常baPWV组(47例)。高baPWV组患者较正常baPWV组baPWV明显升高[(1 961±412)cm/s比(1 349±234)cm/s],且透析时间、缺血修饰白蛋白水平[(95.8±6.0)kU/L]、超敏C反应蛋白[(5.1±1.0)mg/L]较正常baPWV组高,总尿素清除指数(1.8±0.9)、总肌酐清除率[(56.5±11.4)L·周~(-1)·(1.73 m~2)~(-1)]、残余肾小球滤过率[(3.8±1.0)L·周~(-1)·(1.73 m~2)~(-1)]、血白蛋白[(31.6±5.3)g/L]较正常baPWV组低,差异均有统计学意义(P0.05)。Pearson相关分析显示腹膜透析患者baPWV与透析时间、血钙、缺血修饰白蛋白、超敏C反应蛋白呈正相关(r值分别为0.54、0.48、0.49、0.51,P值均0.05),与总尿素清除指数、残余肾小球滤过率、血白蛋白呈负相关(r值分别为-0.36、-0.55、-0.59,P值均0.05)。Logistic回归分析显示透析时间、残余肾小球滤过率、超敏C反应蛋白是腹膜透析患者baPWV最主要影响因素。结论腹膜透析时间、残余肾功能、微炎症是青中年非糖尿病腹膜透析患者动脉硬化最主要的影响因素。保护残余肾功能、改善炎症状态、改善腹膜透析的充分性可以降低腹膜透析患者动脉硬化风险,减少心血管疾病的发生。     

Risk factors for encapsulating peritoneal sclerosis in patients who have experienced peritoneal dialysis treatment

Background The present study was conducted to clarify the clinical risk factors related to the development of encapsulating peritoneal sclerosis (EPS), which is one of the most serious complications in patients undergoing peritoneal dialysis (PD).Methods The records of 78 patients with a history of PD treatment, including 18 with EPS, were retrospectively analyzed (male/female, 51:27; age, 51.8 ± 11.0 years; PD treatment, 94.1 ± 42.7 months). The inclusion criteria were: duration of PD more than 24 months; 36-month follow up after discontinuation of PD; available data for dialysate-to-plasma creatinine ratio (D/P Cr), by fast peritoneal equilibration test within 3 months before PD discontinuation; and absence of EPS at PD discontinuation. Analytical parameters included age, sex, underlying renal disease, duration of PD, membrane transport state (higher transporter or lower transporter: D/P cr ratio more than or less than 0.75), number of episodes of peritonitis during PD treatment, performance of peritoneal lavage after PD discontinuation, and reasons for PD withdrawal (ultrafiltration failure, acute peritonitis, social matters).Results Significant differences were noted regarding the PD duration, D/P cr, higher membrane transport state, and number of peritonitis episodes during PD. On receiver operating characteristic curves, the cutoff points for EPS were: D/P cr ratio, 0.74; number of peritonitis episodes, 2; and PD duration (months), 115.2. Multivariate analysis, employing the factors age, PD duration, higher membrane transport state, and number of peritonitis episodes, which were selected by stepwise analysis, identified the latter two factors as significant for the development of EPS (odds ratio [OR], 4.0; P = 0.046 and OR, 12.0; P = 0.049, respectively).Conclusions A higher transporter membrane state and the number of peritonitis episodes are factors contributing to the occurrence of EPS in patients who have experienced PD treatment.     

Sclerosing encapsulating peritonitis in pediatric peritoneal dialysis patients

The aim of this study was to define the incidence and characteristics of sclerosing encapsulating peritonitis (SEP) in pediatric peritoneal dialysis (PD) patients in Japan. A questionnaire was sent to all dialysis units with at least two pediatric PD patients. Among 687 patients registered, 11 cases (1.6%) of SEP were diagnosed. The mean age of patients with SEP at the start of PD was 9.7±3.6 years and at SEP diagnosis, 19.1±3.8 years. All patients had undergone PD for more than 5 years, and the mean PD duration was 9.6±3.3 years. SEP was diagnosed in 6.6% and 12% of patients dialyzed for >5 years and >8 years, respectively. The incidence of peritonitis among patients with SEP was not different from that among the Japanese pediatric registry. All patients had virtually no residual urine volume and 9 had impaired peritoneal ultrafiltration. Peritoneal calcification was the most-frequent radiological finding. Peritoneal biopsy was performed in 7 patients and confirmed sclerotic peritonitis in all. Ten patients transferred to hemodialysis, and only 1 patient underwent surgery. Three patients died. We recommend that patients on PD for more than 5 years who have impaired peritoneal ultrafiltration or peritoneal calcification should be carefully managed as presumptive cases of SEP. Received: 25 February 1999 / Revised: 9 July 1999 / Accepted: 13 July 1999     

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。     

Incidence and risk factors of new foot ulcer among diabetic patients on peritoneal dialysis

Objective To study the incidence and risk factors of new foot ulcer among diabetic patients on peritoneal dialysis. Methods This is a single-center prospective cohort study. Clinically-stable diabetic patients on peritoneal dialysis in our renal division were recruited from January 2014 to June 2014. Baseline data including general information, biochemistry data, dialysis adequacy, the dorsalis pedis artery pulse, clinical symptoms of diabetic foot and ankle brachial index were recorded. All patients were followed till to Dec 31, 2015. The outcomes consisted of new foot ulcer, amputation due to foot ulcer or gangrene, and lower limb vascular blood supply revascularization. Results Totally 108 patients were recruited and followed up the average time (17.7±5.6) months. Among 108 patients, 16 cases had a history of diabetic foot ulcer, and 1 case had amputation. During the follow-up, 11 cases (10.2%) had new foot ulcer, 3 cases (2.8%) had amputation due to foot ulcers or gangrene, and 8 cases (7.4%) had lower limb vascular blood supply revascularization. A total of 13 cases (12%) had composite end points with 81.3 times/1000 patients of incidence. Univariate and multivariate Cox regression models showed that the history of foot ulcer was the only independent risk factors for new foot ulcers-related composite end points. Conclusion The incidence of new foot ulcer-related composite end points was 12%, which could be independently predicted by the history of diabetic foot ulcer.