Clinical features and treatment outcomes of early-onset peritoneal dialysis-associated peritonitis: a multi-center retrospective study

Objective To explore the clinical characteristics and treatment outcomes of early-onset peritoneal dialysis-associated peritonitis (EOP). Methods Clinical data of patients with peritoneal dialysis-associated peritonitis (PDAP) from 2013 to 2018 in four tertiary hospitals of Jilin province were collected retrospectively. According to whether the dialysis time of the first PDAP was ≤12 months or not, the subjects were divided into EOP group (≤12 months) and late-onset PDAP (LOP) group (＞12 months) , and clinical data, pathogenic bacteria, treatment outcomes of PDAP and prognosis of two groups were compared. Results A total of 575 patients were included, including 314 patients in the EOP group, with age of (56.53±15.57) years and 152 females (48.4%), and 261 patients in the LOP group, with age of (56.61±14.42) years old and 144 females (55.2%). Compared with LOP group, the proportion of pathogenic bacteria culture-negative in EOP group was higher and the proportion of streptococcal infection was lower (both P＜0.05). The initial treatment efficiency and cure rate of EOP group were higher than that of LOP group, while the extubation rate was lower than that of LOP group (all P＜0.05). Multivariate logistic analysis indicated that the cure rate of EOP was 79% higher than that of LOP (OR=1.79, 95%CI 1.13-2.82, P=0.012), and the extubation rate of EOP was 68% lower than that of LOP (OR=0.32, 95%CI 0.15-0.66, P=0.002). Kaplan-Meier survival curve showed that the cumulative rates of multiple PDAP, technical failure, all-cause death, and composite end points (technical failure or all-cause death) in EOP group were higher than those in LOP group (P≤0.001). After correcting for confounding factors by multivariate Cox proportional hazard regression, the risk of multiple PDAP, technical failure, all-cause death, and composite endpoint (technical failure or all-cause death) in EOP group was 2.02 times (HR=2.02, 95%CI 1.26-3.24, P=0.004), 2.53 times (HR=2.53, 95%CI 1.58-4.05, P＜0.001), 2.66 times (HR=2.66, 95%CI 1.70-4.16, P＜0.001) and 2.48 times (HR=2.48, 95%CI 1.78-3.43, P＜0.001) of LOP group respectively. Conclusion The treatment outcome of the first PDAP of EOP patients is good, but the long-term prognosis is poor.     

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.     

Early stage elevated platelet count is an independent risk factor for the poor prognosis of peritoneal dialysis-associated peritonitis

Objective To determine whether the early stage platelet count can predict the outcome of peritoneal dialysis-associated peritonitis (PDAP). Methods A retrospective cohort study was conducted by selecting PDAP patients who were hospitalized in the First People's Hospital of Foshan from January 2012 to January 2019. According to the final treatment outcome, the patients were divided into cured group and withdrawn group. The withdrawn group included patients who transferred to hemodialysis or died. Basic data on demography, blood routine examination, peritoneal fluid, biochemical indicators were compared between the two groups. Logistic regression analysis was used to analyze the withdrawn risk factors of PDAP. Results There were 180 patients included in the study, including 112 cases in the cured group and 68 cases in the withdrawn group. Compared with the cured group, there were older age [(53.38±14.17) years old vs (48.41±13.04) years old, t=2.407, P=0.017] , longer age of dialysis [(49.20±26.05) months vs (30.36±32.97) months, t=4.034, P＜0.001], longer hospital stay [(23.88±11.50) d vs (17.80±3.95) d, t=5.133, P＜0.001] and higher platelet count [(285.55±107.23)×109/L vs (234.90±74.03)×109/L, t=3.450, P=0.001], lower serum albumin [(31.72±7.47) g/L vs (35.40±4.93) g/L, t=-3.972, P＜0.001] in the withdrawn group. Multivariate logistic regression analysis showed that longer dialysis age (OR=1.012, 95%CI 1.007-1.024, P=0.015) and higher platelet count (OR=1.013, 95%CI 1.004-1.026, P=0.008) were independent risk factors, and higher serum albumin (OR=0.941, 95%CI 0.896-0.988, P=0.005) was an independent protective factor of withdrawal from peritoneal dialysis in PDAP patients. Conclusions The long dialysis age, early high platelet count are independent risk factors and high serum albumin level is an independent protective factor for withdrawal from peritoneal dialysis in PDAP patients.     

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.     

Relationship between abdominal aortic calcification and outcomes in maintenance hemodialysis patients

Objective To investigate the relationship between abdominal aortic calcification (AAC) and outcomes in maintenance hemodialysis (MHD) patients. Methods One hundred and seventy MHD patients in the dialysis center of the Second Hospital of Tianjin Medical University from June 2014 and October 2014 were enrolled prospectively. Abdominal aortic calcification (AAC) was measured using AAC score (AACS) by abdominal lateral plain radiography. According to the AACS, the patients were divided into mild AAC (AACS＜5) group and severe AAC (AACS≥5) group for comparison, and Kaplan-Meier analysis was used to compare their survival rates. Multivariable COX regression models were used to determine the risk factors of all - cause mortality and cardiovascular disease mortality in MHD patients. Results Severe AAC (AACS≥5) was present in 28.2% (48/170) patients. The median follow-up duration was 25.6 (22.0, 26.0) months. During the follow-up, 6 patients (4.9%) in AACS＜5 group and 14 patients (29.2%) in AACS≥5 group died. Kaplan-Meier analysis showed that patients in AACS≥5 group had higher all-cause mortality rate and cardiovascular disease mortality rate as compared with patients in AACS＜5 group (χ2=9.746,P=0.002; χ2=9.697,P=0.002). Multivariate COX regression analysis demonstrated that high AACS (HR=4.373, 95%CI 1.562-7.246, P=0.005) and hypoproteinemia (HR=0.886, 95% CI 0.797 - 0.985, P=0.025) were independent risk factors for all-cause mortality, while hypoproteinemia (HR=0.829, 95%CI 0.718-0.956, P=0.010) and low 1,25(OH)D3 (HR=0.769, 95% CI 0.627 - 0.944, P=0.012) were independent risk factors for cardiovascular disease mortality. Conclusions AAC is significantly associated with overall survival in MHD patients. To further evaluate the relationship between AAC and outcomes in MHD patients, multi-center and long term follow up studies of large sample size are necessary.     

Risk factors and outcomes of multiple episodes of peritoneal dialysis related bacterial peritonitis

Objective To investigate the risk factors and prognosis of peritoneal dialysis (PD) related bacterial peritonitis. Methods The clinical data of patients with PD related bacterial peritonitis from January 2006 to September 2016 in our hospital were retrospectively analyzed and followed up until December 2016. Patients were divided into two groups according to the frequency of peritonitis, single episode group and multiple episodes group (no less than two episodes of peritonitis). According to efficacy of therapy, the episodes of peritonitis were divided into two groups, cured group (no relapse, recurrence or repeat episodes) and failure group (relapse, recurrent or repeat infection after the therapy of initial episode). Logistic regression and Cox regression were used to analyze the risk factors for outcomes. Results Five hundred and fifty-nine patients had PD related bacterial peritonitis, including 339 patients in the single episode group and 220 patients in the multiple episodes group. Logistic analysis showed low serum albumin level (OR=787, P＜0.001) and malnutrition (OR=0.422, P＜0.001) at baseline were independent risk factors for multiple episodes (P＜0.001). The technical survival was better in the single episode group than that in the multiple episodes group (75.2% vs 36.2%, P=0.001) while the difference of survival rate was not significant between the two groups (48.2% vs 24.1%, P=0.592). Five hundred and thirteen episodes of peritonitis were analyzed, including 147 episodes in failure group (88 relapse episodes, 16 recurrent episodes and 43 repeat episodes) and 366 episodes in cured group. There were 78 patients in failure group and 253 patients in cured group. Logistic analysis showed prolonged response time (OR=1.200, P＜0.001), Gram-positive bacteria infection (OR=1.736, P=0.022), higher hs-CRP level (OR=1.004, P=0.013), lower serum albumin level (OR=0.936, P=0.008) were independent risk factors for failure of therapy. Multivariate Cox regression showed prolonged response time (HR=1.120, P=0.032), Gram-positive bacteria infection (HR=2.462, P=0.002), higher hs-CRP level (HR=1.007, P=0.009) were independent risk factors for failure of therapy and higher serum albumin level (HR=0.942, P=0.048) was an independent protection factor. Conclusions Low serum albumin level and malnutrition at baseline are independent risk factors for patients with multiple peritonitis episodes. Prolonged response time, Gram-positive bacteria infection, the high hs-CRP level are independent risk factors for relapse or recurrent or repeat episodes while high serum albumin level was an independent protection factor.     

Clinicopathological and prognostic analysis of IgA nephropathy patients with anemia

Objective To analyze the clinicopathological features of IgA nephropathy (IgAN) patients with anemia and the influencing factors of prognosis. Methods The clinical and pathological data of patients diagnosed with primary IgAN at the First Affiliated Hospital of Fujian Medical University from January 1, 2006 to December 31, 2016 were retrospectively analyzed. The patients were divided into anemia group and non-anemia group according to whether the patient was anemia or not. The clinical and pathological data of the two groups were collected. All of them were followed up from the date of renal biopsy to January 1, 2018. Survival curves of the two groups were drawn by Kaplan-Meier method, and compared by Log-rank test. Multivariate Cox proportional hazards regression model was adopted to explore the influencing factors of prognosis in IgAN patients. Results A total of 231 subjects were enrolled, including 122 males (52.8%), and the male-female ratio was 1.12∶1. Their age was (34.8±10.1) years (15-68 years). There were 70 patients (30.3%) in anemia group, 161 cases (69.7%) in non-anemic group. Compared with non-anemia group, anemia group had higher proportion of females, lower serum albumin, higher proportion of tubular atrophy/interstitial fibrosis (T1/2), endothelial cell proliferation (E1) and crescent formation (C1/2), which were statistically significant (all P＜0.05). The patients had a median follow-up time as 6.3 years (0.3-12.9 years). Survival analysis showed that patients in anemia group had lower cumulative renal survival rate than that in non-anemia group ( χ2=15.234, P＜0.001). Multivariate Cox hazards regression analysis revealed that anemia (HR=3.820, 95%CI 1.674-8.719, P=0.001), tubular atrophy/interstitial fibrosis (T1/2) (HR=3.770, 95%CI 1.026-13.852, P=0.046), glomerular segmental sclerosis/adhesion (S1) (HR=4.211, 95%CI 1.139-15.576, P=0.031), hypertension (HR=2.988, 95%CI 1.276-6.999, P=0.012), increased 24 h urinary protein (HR=1.103, 95%CI 1.046-1.163, P＜0.001) and estimated glomerular filtration (eGFR)＜60 ml?min-1?(1.73 m2)-1 (HR=3.725, 95%CI 1.639-8.462, P=0.002) were the independent risk factors for poor renal prognosis in patients with IgAN. Conclusions The clinicopathological features of IgAN patients with anemia are relatively serious, and the renal cumulative survival rate is lower. Anemia, tubular atrophy/interstitial fibrosis (T1/2), glomerular segmental sclerosis/adhesion (S1), hypertension, increased urinary protein and eGFR＜60 ml?min-1?(1.73 m2)-1 are the independent risk factors for poor renal prognosis in patients with IgAN.     

507例2型糖尿病合并慢性肾脏病患者肾活检的临床病理特点

目的 总结和分析糖尿病肾病(diabetic kidney disease,DKD)与非糖尿病肾病(non-diabetic kidney disease,NDKD)患者临床病理特点,为临床2型糖尿病合并慢性肾脏病患者肾活检指征提供循证医学证据.方法 通过南方医科大学南方医院大数据库收集2002年2月至2018年6月在该院接受肾活检的2型糖尿病合并慢性肾脏病患者,并根据肾活检结果将其分为DKD组和NDKD组(包括DKD合并NDKD),比较两组间临床表现及病理类型特点,并采用Logistic回归模型分析DKD和NDKD患者的相关因素.结果 共纳入507例患者,DKD患者114例(22.5%),NDKD患者393例(77.5%).病理表现:NDKD的最常见病理类型为膜性肾病(30.0%)和IgA肾病(19.1%),其中有5.6%患者为DKD合并NDKD.临床表现:与NDKD组患者相比,DKD组患者有更长的糖尿病史(>1年,76.3%比36.1%,P<0.001),更易发生糖尿病视网膜病变(42.1%比4.8%,P< 0.001),24h尿蛋白量更高[3.69(1.70,6.74)g比2.21 (0.91,4.97)g,P<0.001],血肌酐更高[117.5 (85.8,194.5) μmol/L比89.0 (68.0,143.8) μmol/L,P<0.001],血红蛋白更低[(105.07±20.85) g/L比(124.41±25.02) g/L,P=0.002],胆固醇更低[(5.69±1.87) mmol/L比(6.43±2.75) mmol/L,P=0.001].Logistic回归分析显示,糖尿病史(OR=4.162,95%CI 1.717~10.098,P=0.002)、较高收缩压(每增加1 mmHg,OR=1.028,95%CI 1.011~1.045,p=0.001)、降压药服用史(OR=3.141,95%CI 1.496~6.591,P=0.002)、糖尿病视网膜病变(OR=5.561,95%CI2.361~13.100,P<0.001)、较高糖化血红蛋白(每增加1%,OR=1.680,95%CI1.333~2.118,P<0.001)是DKD的相关因素,而血尿(OR=2.781,95%CI 1.334~5.798,P=0.006)和较高血红蛋白(每增加1g/L,OR=1.022,95%CI1.008~1.037,P=0.002)则为NDKD的相关因素.结论 DKD与NDKD之间的临床表现及病理类型存在差异,糖尿病病史、眼底检查、大量蛋白尿、降压药服用史、较高的糖化血红蛋白水平对DKD的诊断有较好的预测作用,而血尿和较高的血红蛋白水平对NDKD的诊断有一定指导意义.糖尿病合并慢性肾脏病患者行肾活检的指征需根据各临床表现综合分析.     

Relationship between coronary artery calcification and outcomes in maintenance hemodialysis patients

Objective To evaluate the relationship between coronary artery calcification (CAC) and outcomes in maintenance hemodialysis (MHD) patients. Methods Eighty-six patients who were on MHD between October 2014 and May 2015 in the blood purification center of our hospital were enrolled prospectively. CAC was measured and scored by multiple slice computed tomography (MSCT). According to the CAC score (CACs), the patients were divided into mild CAC (CACs＜100) group and severe CAC (CACs≥100) group. Kaplan-Meier analysis was performed to analyze the survival rates of the two groups, and a COX proportional hazards regression model was used to estimate the risk factors of all-cause mortality and cardiovascular disease mortality in MHD patients. Results Severe CAC (CACs≥100) was present in 62.8% (54/86) patients. The median of follow-up duration was 28.9(23.8, 29.4) months. During the follow up, 2(6.3%) patients in CACs＜100 group and 18 (33.3%) patients in CACs≥100 group died. Kaplan-Meier survival analysis demonstrated that patients in CACs≥100 group had higher all-cause mortality and cardiovascular mortality as compared with patients in CACs＜100 group (P=0.007, P=0.030). Multivariate COX regression analysis demonstrated that CACs≥100 (HR=7.687, 95%CI 1.697-34.819, P=0.008) and low single-pool Kt/V (HR=0.092, 95%CI 0.020-0.421, P=0.002) were independent risk factors for all-cause mortality. Old age (HR=1.192, 95%CI 1.100-1.291, P＜0.001), short duration of dialysis (HR=0.598, 95%CI 0.445-0.804, P=0.001), low 25-hydroxy vitamin D3 (HR=0.461, 95%CI 0.326-0.630, P＜0.001), and low total cholesterol (HR=0.405, 95%CI 0.213-0.772, P=0.006) were independent risk factors for cardiovascular disease mortality. Conclusions The CACs is significantly related with overall survival in MHD patients. Large multicenter prospective studies are to be evaluated the association between CACs and long-term survival in MHD patients.     

Correlation of body weight and its change with albuminuria in physical examination population

Objective To study the effect of baseline weight and its change on new-onset albuminuria or increased urine albumin/creatinine ratio (ACR) in the physical examination population. Methods The subjects of this study were those who completed two or more physical examinations at the Physical Examination Center of Sichuan Provincial People's Hospital from September 1, 2013 to September 1, 2018. The general information and laboratory examination results at the first and last physical examinations were collected. According to body mass index (BMI), they were divided into normal BMI group and overweight/obese group. The differences in general clinical data and laboratory test results between the two groups were compared. The primary endpoint events were new-onset albuminuria or urine ACR increase≥30%. Stepwise multiple linear regression method was used to analyze the influencing factors for ACR increase, and Cox proportional hazard model method was used to analyze the impact of baseline weight and its change on new-onset albuminuria or ACR increase≥30%. Results A total of 1 761 physical examination subjects were included in this study. The follow-up time was (16.54±7.87) months. There were 59 patients with new-onset albuminuria, 30 patients with ACR increase≥30%, and 35 patients with albuminuria reversal. Multiple linear regression analysis showed that BMI was an independent influencing factor for ACR ( β=0.127, P＜0.001). Cox regression analysis showed that the older age (HR=1.041, 95%CI 1.018-1.064, P＜0.001), hypertension (HR=2.035, 95%CI 1.278-3.242, P=0.003), diabetes (HR=2.081, 95%CI 1.310-3.305, P=0.002) and hyperuricemia (HR=1.700, 95%CI 1.084-2.668, P=0.021) were independent influencing factors for new-onset albuminuria or ACR increase≥30%, while BMI (HR=1.053, 95%CI 0.975-1.137, P=0.191) and weight change rate (HR=1.030, 95%CI 0.972-1.092, P=0.322) were not independent influencing factors for endpoint events. Subgroup analysis indicated that overweight/obesity had interactions with age, hypertension, diabetes, and hyperuricemia, respectively (P for interaction＜0.05), and the effects of overweight/obesity on the pre-set primary endpoint events in each subgroup were basically consistent. There were interactions between weight gain and hypertension and diabetes (P for interaction＜0.05). Weight gain increased the risk of the primary endpoint events of women (HR=3.355, 95%CI 1.164-9.670, P=0.025), and the effects of overweight/obesity on the pre-set primary endpoint events of each subcomponent were basically the same (all P﹥0.05). The incidence of albuminuria reversal in the group with obvious weight loss was slightly higher than that in the group with obvious weight gain, but the difference was not statistically significant (P﹥0.05), which might be related to the small weight loss range (-6.08%±3.51%). Conclusions Overweight or obesity may increase the risk of albuminuria, and people with diabetes, hypertension, and hyperuricemia may be more likely to occur. Mild weight loss is not enough to reverse albuminuria.     

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.     

Effects of serum uric acid level on all-cause death and cardiovascular death in patients of maintaining peritoneal dialysis

Objective To investigate the effects of serum uric acid (SUA) on all-cause death and cardiovascular death in patients of maintaining peritoneal dialysis (PD). Methods One thousand and sixty-three PD patients in the First Affiliated Hospital of Zhejiang University Medical College were included. The SUA levels at 6 months after PD start were measured. Patients with SUA≥420 μmol/L were grouped in hyperuricemia group (492 cases) and patients with SUA＜420 μmol/L were grouped in normal uric acid group (571 cases). The effects on all-cause mortality and cardiovascular mortality were retrospectively analyzed. Results The median age of the patients was 51(41, 62) years; 557 cases were male (52.40%); the median follow-up time was 33(20, 54) months (6-96 months); 167 cases (15.71%) died during the follow-up period, including 64 cases (6.02%) with cardiovascular causes. The mortality in hyperuricemia group was 19.11%(94/492) and the cardiovascular mortality was 7.93%(39/492), both rates were higher than those in normal uric acid group, and the differences were statistically significant (P=0.005, P=0.015, respectively). Hyperuricemia (SUA≥420 μmol/L) at 6 months after PD start (HR=1.572, 95%CI 1.155-2.141, P=0.004), high uric acid level (continuous variable) at 6 months after PD start (HR=1.002, 95%CI 1.001-1.004, P=0.008), and age≥65 years (HR=3.571, 95%CI 2.556-4.990, P＜0.001), serum albumin≤30 g/L (HR=1.907, 95%CI 1.278-2.845, P=0.002), high Charlson comorbidity index (HR=1.209, 95%CI 1.032-1.417, P=0.019) at the beginning of PD start were independent risk factors for all-causes death in PD patients. Hyperuricemia (SUA≥420 μmol/L) at 6 months after PD start (HR=1.734, 95%CI 1.033-2.912, P=0.037) and age≥65 years (HR=1.761, 95%CI 1.024-3.209, P=0.041), with diabetes (HR=2.775, 95%CI 1.358-5.671, P=0.005) at the beginning of PD start were independent risk factors for cardiovascular death in PD patients. Conclusions SUA at 6 months after PD is an independent risk factor for all-cause death and cardiovascular death in PD patients.     

Serum phosphorus variation is associated with mortality in maintenance hemodialysis patients

Objective To investigate the relationship between serum phosphorus variability and mortality in maintenance hemodialysis (MHD) patients. Methods A total of 502 MHD cases from Renji hospital hemodialysis center were registered in Shanghai Registry Network from January 2007 to April 2015. They were recruited with general information, laboratory results and outcomes. According to their median of coefficient of variation (CV) of blood phosphorus, the patients were divided into high variation group (CV≥0.226 mmol/L) and low variation group (CV＜0.226 mmol/L). The relationship of serum phosphorus CV with all-cause mortality and cardiovascular disease mortality was assessed respectively. Results The average age was (63.9±14.6) years, the median dialysis age was 82.0 (43.0, 139.0) months, 118 patients (23.5%) died for all cause and 64 patients (12.7%) died for cardiovascular disease. Compared with patients in low phosphorus variation group, patients had a higher all-cause mortality in high phosphorus variation group (27.7% vs 19.3%, P=0.028). Higher cardiovascular disease mortality was observed in high variation group as well, but this difference was no statistical significant (15.4% vs 10.0%, P=0.082). COX regression analysis showed that ＞60 years of age (HR=2.762, 95%CI 1.707-4.468, P＜0.001), low hemoglobin (HR=0.466, 95%CI 0.317-0.686, P＜0.001), low albumin (HR=0.555, 95%CI 0.366-0.840, P=0.005), high CV of phosphorus (HR=1.479, 95%CI 1.023-2.139, P=0.037) were independent risk factors for all-cause mortality. Moreover, ＞60 years of age (HR=2.666, 95%CI 1.469-4.837, P=0.001), low hemoglobin (HR=0.480, 95%CI 0.238-0.801, P=0.005), and high CV of phosphorus (HR=1.655, 95%CI 1.003-2.729, P=0.049) were independent risk factors for cardiovascular disease mortality. There was no significant statistical difference between patients phosphorus on target and patients phosphorus below target in all-cause disease mortality (P=0.065) and cardiovascular disease mortality (P=0.425). High variation group whose phosphorus on target had higher all-cause mortality and cardiovascular disease mortality than those in low variation group (29.2% vs 16.9%, P=0.047; 15.0% vs 6.0%, P=0.033). Kaplan-Meier method showed that patients with high phosphorus variation had higher all-cause (P=0.023) and cardiovascular disease mortality (P=0.047) than patients with low phosphorus variation. Conclusions The high CV of phosphorus is independently correlated with all-cause and cardiovascular disease mortality. Patients with standard-reaching phosphorus in the low variation group have a lower mortality. A serum phosphorus level sustainably reaching the standard may improve the survival in MHD patients.     

Risk factor analysis of pneumonia in maintenance hemodialysis patients

Objective To investigate the risk factors of pneumonia in maintenance hemodialysis (MHD) patients. Methods The clinical data of patients undergoing dialysis longer than three months at the Hemodialysis Center of West China Hospital of Sichuan University from July 2013 to July 2018 were retrospectively analyzed. The patients were divided into pneumonia group and non- pneumonia group. Follow-up time started from admission to the beginning of hemodialysis. All patients were followed until the patient died, or withdrawn from hemodialysis, or transferred to another center, or until the study deadline (April 2019). Baseline clinical data were compared between the two groups, and the differences in clinical data between the pneumonia group and the baseline were also analyzed. Risk factors for pneumonia in hemodialysis patients was analyzed by binary logistic regression. Kaplan-Meier curve was used to compare the survival prognosis of the two groups, and the Log-rank method was used for significant test. A multivariate Cox proportional hazard model was used to analyze risk factors for MHD patients' death. Results (1) A total of 311 patients were enrolled in the study, in which 178 (57.2%) of the patients were male, and 75(24.1%) of the patients had pneumonia. Compared with non-pneumonia group, the pneumonia group patients were older (P=0.002), had higher level of white blood cells (P=0.001) and lower level of serum creatinine (P=0.003), albumin (P=0.001), and serum magnesium (P=0.039). There were also statistically significant differences between the two groups in the proportion of females and underlying diseases (all P＜0.05). (2) The time of pneumonia occurred from the initial time of dialysis was (10.69±9.82) months. Compared with baseline values, decreased hemoglobin and albumin level were found (both P＜0.01). (3) Logistic regression analysis showed male patients had lower risk of pneumonia than female patients (OR=0.438, 95%CI 0.242-0.795, P=0.007). For every 1 g/L increase in albumin, the risk of pneumonia was reduced by 6.4% (OR=0.936, 95%CI 0.885-0.991, P=0.022). Kaplan-Meier survival curve analysis showed that the difference in 5-year cumulative survival rate between pneumonia group and non-pneumonia group was statistically significant ( 60.6% vs 84.4%, χ2=16.647, P＜0.001). (4) Multivariate Cox regression analysis showed that long dialysis time (HR=0.870, 95%CI 0.832-0.909, P＜0.001) and high serum albumin level (HR=0.898, 95%CI 0.845-0.955, P=0.001) were protective factors in patients with MHD. Pneumonia (HR=3.008, 95%CI 1.423-6.359, P=0.004) was an independent risk factor for death in MHD patients. Conclusions Hemoglobin and albumin level are reduced in MHD patients with pneumonia. Low albumin level is a risk factor for pneumonia in patients. MHD patients with pneumonia have a lower survival time than those without pneumonia.     

Pathological classification and prognosis of renal damage caused by antineutrophil cytoplasmic antibody associated vasculitis

Objective To analyze the pathological characteristics and prognostic factors of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods A retrospective analysis of AAV patients with renal biopsy results admitted to Kidney Disease Center of the First Affiliated Hospital from January 2004 to February 2017 was performed. The patients were divided into 4 types according to Berden classification, and their clinical, pathological characteristics and prognosis were compared. The survival curves of each type of patients were plotted by Kaplan-Meier method, and the difference of survival curves was compared using Log-rank test. With entering the maintenance dialysis as the endpoint, Cox regression was used to analyze the prognostic factors. Results A total of 175 patients with AAV, including 59 cases (33.7%) of focal type, 39 cases (22.3%) of crescent type, 32 cases (18.3%) of sclerosis type, 45 cases (25.7%) of mixed type. The basal serum creatinine levels in crescent type group and sclerosis type group were significantly higher than those in the focal type group or mixed type group (all P＜0.05), and loop necrosis rate in sclerosis type group was significantly lower than chat in the focal type group or crescent type group (both P＜0.05). The median follow-up period was 11.8 (0.5-86.7) months. The event-free survival rates were 83.1%, 77.8%, 64.1% and 50.0% in the focal type, mixed type, crescent type and sclerotic type groups (Log-rank χ2=11.537, P=0.009). Cox regression analysis showed higher parathyroid hormone (HR=1.013, 95%CI 1.007-1.019, P＜0.001), glomerular sclerosis ≥50% (HR=10.532, 95%CI 2.903-38.203, P＜0.001) were independent risk factors for AAV patients entering maintenance dialysis, and higher estimated glomerular filtration rate (HR=0.943, 95%CI 0.896-0.993, P=0.025) was protective factor. Conclusion The prognosis of AAV renal damage is worsened according to focal, mixed, crescent and sclerosis types. Lower estimated glomerular filtration rate, higher parathyroid hormone and glomerular sclerosis ≥50% are independent risk factors for AAV patients entering maintenance dialysis.     

Association between body-mass index and survival in peritoneal dialysis patients

Objective To evaluate the association between body-mass index and prognosis in peritoneal dialysis (PD) patients. Methods In this observational study of a single nephrology unit in Shanghai East Hospital, 81 incident continuous ambulatory peritoneal dialysis(CAPD) patients were included from Jan 2008 to Dec 2013, whom were followed-up by 36 months or until death. The patients were classified as underweight (BMI＜18.5kg/m2); normal weight (18.5～23.9kg/m2); overweight (24～27.9kg/m2) and obese (BMI≥28kg/m2). The patients and technique survival rates were estimated by Kaplan-Meier analysis. Cox proportional hazards analyses were used to elucidate relationship between BMI and all-cause mortality and technique failure in PD patients. Results The overall survival rate was similar between normal and overweight groups (P=0.96), but significantly lower in underweight group and obese group (P＜0.01 respectively). The overall technical survival rate of obese group was lower compare with normal group (P＜0.01). The main cause of technical failure was peritonitis (81.3%). BMI was positively correlated with albumin (r=0.24, P＜0.05), hemoglobin (r=0.56, P＜0.01), glucose(r=0.23, P＜0.05) and cholesterol (r=0.41, P＜0.01), but negatively correlated with Kt/V (r=-0.36, P＜0.01) and Ccr(r=-0.34, P＜0.01). In adjusted Cox proportional hazard mode 3, obese was independently associated with all-cause mortality (HR: 5.93, 95%CI: 1.10～31.79). Obese and peritonitis were independently associated with technical failure (HR: 10.33, 95%CI: 1.04～78.02 and HR: 2.74, 95%CI: 1.17～6.40 respectively). Conclusions Underweight and obese CAPD patients have poorer outcome. Obese CAPD patients also have lower technical survival rate. Obesity was an independent risk factor for all-cause mortality in CAPD patients.     

Effects of different vascular access types on new atrial fibrillation in maintenance hemodialysis patients： a prospective cohort study

Objective To investigate the effects and related risk factors of different vascular access types on new atrial fibrillation in maintenance hemodialysis (MHD) patients. Methods This was a single-center prospective cohort study. Patients who established long-term dialysis access and were voluntarily followed up in the Second Hospital of Tianjin Medical University from January 1, 2013 to June 30, 2013 were enrolled to follow-up for 5 years. Patients were divided into fistula group (patients with autogenous arteriovenous fistula) and catheter group (patients with tunneled cuffed internal jugular vein catheter). The incidences of new atrial fibrillation in the two groups were compared by Kaplan-Meier survival analysis. Cox regression analysis and receiver operator characteristic curve (ROC) were used to assess the risk factors of new atrial fibrillation. Results A total of 315 eligible patients were enrolled, including 150 males (47.62%). There were 189 patients (60.00%) in the fistula group, and 126 patients (40.00%) in the catheter group. Multivariate Cox regression analysis showed that older age (HR=1.021, 95%CI 1.003-1.040), arteriovenous fistula (HR=1.899, 95%CI 1.019-3.539), increased dialysis blood flow (HR=1.030, 95%CI 1.010-1.051) and left atrial diameter (HR=1.097, 95%CI 1.022-1.177) were independent risk factors for new atrial fibrillation in MHD patients (all P＜0.05). Kaplan-Meier survival analysis showed that the incidence of new atrial fibrillation in fistula group was higher than that in catheter group (Log-rank χ2=9.53,P=0.002). ROC curve analysis showed that age [the area under the curve (AUC)=0.608, P=0.008], arteriovenous fistula (AUC=0.594, P=0.021), dialysis blood flow (AUC=0.659, P＜0.001) and left atrial diameter (AUC=0.604, P=0.011) could predict the occurrence of new atrial fibrillation. Conclusions Older age, arteriovenous fistula, increased blood flow during dialysis and left atrial diameter are independent risk factors for new atrial fibrillation in MHD patients, which can predict the occurrence of atrial fibrillation. The incidence of new atrial fibrillation in patients with arteriovenous fistula is higher than that in patients with catheter.     

腹主动脉钙化评分预测腹膜透析患者心脑血管预后的价值

【目的】 探讨腹主动脉钙化评分(abdominal aortic calcification score,AACS)与腹膜透析患者心脑血管预后的关系。方法 研究对象来自2011年7月至2014年7月期间在上海交通大学医学院附属仁济医院接受规律腹透治疗的患者。采用腹部侧位X线摄片评估所有入选者腹主动脉钙化程度,并根据Kauppila评分系统行AACS评分。根据AACS三分位数将患者分为无钙化组(AACS=0)、轻中度钙化组(0相似文献   

Clinical and pathological features of hyperuricemia in children with IgA nephropathy at a single center

Objective To investigate the clinical, pathological features and risk factors of hyperuricemia in children with IgA nephropathy (IgAN). Methods A retrospective study of 269 primary IgAN children diagnosed between January 1, 2006 to December 31, 2017 at the Children Kidney Disease Center, the First Affiliated Hospital of Sun Yat-sen University, was performed in the hyperuricemia group (uric acid＞350 μmol/L) and the normal uric acid group. The clinical and pathological characteristics were analyzed, and the risk factors of hyperuricemia were analyzed by using multivariate logistic regression analysis. Results There were 185 males and 84 females in the 269 IgAN children with age of (9.2±3.1) years old, among whom there were 70 patients (26.0%) accompanied by hyperuricemia. Clinical indicators such as hypertension, urea nitrogen, serum creatinine, blood lipids, urinary protein in hyperuricemia group were higher than those in normal uric acid group (all P＜0.05), while estimated glomerular filtration rate, serum total protein and albumin were less (all P＜0.05). There were 58 patients (23.0%) and 12 patients (70.5%) associated with hyperuricemia among IgAN children with CKD 1-2 and CKD 3-5. The proportion of hyperuricemia in CKD stage 3-5 IgAN children was statistically higher than that in normal uric acid group (P＜0.01). The hyperuricemia group had a higher proportion of Lee IV and V grade, and a lower proportion of the Lee III grade than the normal uric acid group (all P＜0.05). According to the Oxford pathological classification score, there was no significant difference in total scores of renal lesions, glomerular score, and tubulointerstitial score between the two groups (all P＞0.05). According to the Katafuchi semi-quantitative score, there was no significant difference in the total scores of renal lesions, glomeruli, and tubulointerstitial scores (all P＞0.05), while the hyperuricemia group had higher renal vascular scores than the normal uric acid group (P＜0.01). Multivariate logistic regression analysis showed that hypertension (OR=12.596, 95%CI 1.778-89.243, P=0.011), higher total cholesterol (OR=1.192, 95%CI 1.064-1.336, P=0.002), higher urea nitrogen (OR=1.273, 95%CI 1.104-1.468, P=0.001), proteinuria 3+(OR=1.875, 95%CI 1.309-2.684, P=0.001), proteinuria 4+(OR=1.627, 95%CI 1.241-2.134, P＜0.001) and CKD stage 3 (OR=3.355, 95%CI 1.376-8.181, P=0.008) were the risk factors of hyperuricemia in children with IgAN. Conclusions Twenty-six percent IgAN children patients are accompanied by hyperuricemia, and their clinical parameters and pathological changes are more severe than those in normal uric acid group. Hypertension, higher total cholesterol, higher urea nitrogen, proteinuria 3+/4+ and CKD stage 3 are the risk factors of hyperuricemia in children with IgAN.     

Association of serum magnesium with cardiovascular mortality and all-cause mortality in peritoneal dialysis patients

Objective To investigate the association of serum magnesium with cardiovascular disease (CVD) and all-cause mortality in peritoneal dialysis patients. Methods A retrospective study was performed in patients who initiated peritoneal dialysis from January 1, 2013 to July 31, 2019 in the Shaoxing People's Hospital. According to the standard of serum magnesium, the patients were divided into control group (Mg≥0.7 mmol/L) and low-magnesium group (Mg﹤0.7 mmol/L). The differences in baseline biochemical variables, comorbidities, medications, and clinical outcomes between the two groups were compared. Logistic regression was used to analyze the related factors of hypomagnesemia. Kaplan-Meier survival analysis and Fine-Gray model were used to compare the difference in cumulative survival rate between the two groups. Cox regression model and competitive risk model were used to analyze the risk factors of all-cause mortality and CVD mortality. Results A total of 381 peritoneal dialysis patients were enrolled in this study. Among them, 321 patients were in control group and 60 patients in low-magnesium group. The total median follow-up time was 27(15, 43) months. There were significant differences in serum albumin, magnesium, phosphorus, intact parathyroid hormone, low-density lipoprotein chloesterol, high sensitivity C-reactive protein and 4-hour dialysate-to-plasma creatinine (4 h D/Pcr) between the two groups. CVD was the main cause of death in patients on peritoneal dialysis. Multivariate logistic regression analysis showed that hypoalbuminemia (OR=0.901, 95%CI 0.831-0.976, P=0.011), hypophosphatemia (OR=0.217, 95%CI 0.080-0.591, P=0.003), higher hsCRP (OR=1.276, 95%CI 1.066-1.528, P=0.008), and higher 4 h D/Pcr (OR=1.395, 95%CI 1.014-1.919, P=0.041) were independent risk factors for patients with hypomagnesemia. Kaplan-Meier survival curve analysis showed the cumulative survival rate of patients in low-magnesium group was significantly lower than that of control group (Log-rank χ2=5.388, P=0.020). Fine-Gray model analysis showed the cumulative CVD survival rate of low-magnesium group was significantly lower than that of control group (Gray=6.915, P=0.009). Multivariate-corrected Cox regression model and competitive risk model analysis showed that higher serum magnesium level was a protective factor for all-cause mortality and CVD mortality when serum magnesium was used as a continuous variable (HR=0.137, 95%CI 0.020-0.946, P=0.044; SHR=0.037, 95%CI 0.002-0.636, P=0.023, respectively). Hypomagnesemia was an independent risk factor for all-cause mortality and CVD mortality when serum magnesium was used as categorical variable (HR=1.864, 95%CI 1.044-3.328, P=0.035; SHR=2.117, 95%CI 1.147-3.679, P=0.029, respectively). Conclusions Hypomagnesemia is susceptible to peritoneal dialysis patients with hypoalbuminemia, hypophosphatemia, higher hsCRP and higher peritoneal transport characteristics. Hypomagnesemia is an independent risk factor for CVD mortality and all-cause mortality in peritoneal dialysis patients.