自动腹膜透析充分性研究及其影响因素分析

目的探讨腹膜转运功能对自动腹膜透析(APD)充分性的影响。方法选择2009年1月至12月在北京大学人民医院肾内科住院的腹膜透析患者14例,先后行CAPD和APD治疗,并进行PET试验测定腹膜溶质转运功能。分别比较不同腹膜功能患者APD与CAPD充分性差异的异同。并比较不同腹膜功能患者延长存腹时间对APD充分性的影响。结果 APD小分子溶质清除充分性指标——尿素清除指数(KT/V)1.77±0.57,内生肌酐清除率(Ccr/w)(46.6±19.9)L——可达标,超滤量与CAPD无差异。虽APD总Ccr/w(46.6±19.9)KT/V较CAPD(63.8±29.4)KT/V下降,但亚组分析显示,此差异主要来自低转运、低平均转运者。这部分患者APD 14 h KT/V(1.67±0.50)较10 h(1.45±0.48)增加。结论 APD尤其适用于腹膜高转运、高平均转运患者;低转运、低平均转运者小分子溶质清除充分性差,需延长存腹时间或增加透析剂量。     

维持性透析患者体内的炎症状态

70年代起，随着对透析充分性认识的提高，人们将其定义为小分子溶质的清除(如尿素清除率Kt／V)，并相信它对提高终末期肾衰(ESRF)患者生存率起着非常重要的作用。因而在随后的20年中，透析剂量逐步上升。事实上，在那些处于较高溶质清除水平的患者，即使再增加透析剂量，     

腹膜透析充分性对心脏结构和功能的影响

目的:探讨腹膜透析(PD)充分性对患者心脏结构和功能的影响.方法:回顾性纳入2016年5月至2019年5月苏州大学附属第一医院行持续不卧床腹膜透析(CAPD)的ESRD患者99例,分为透析不充分组45例(Kt/V＜1.7且总Ccr＜50 L/1.73m2)及透析充分组54例(Kt/V≥1.7且总Ccr≥50 L/1.7...     

持续不卧床腹膜透析和日间不卧床腹膜透析临床效能的评判

腹膜透析(PD)因其便于保护残余肾功能(RRF)、血流动力学相对稳定、操作简便等优点,已日益成为终末期肾病(ESRD)患者的主要透析方法,但PD的方案在不同国家和地区有所不同.2006年,国际腹膜透析学会( ISPD)推荐ESRD患者最小PD剂量应使每周总尿素清除指数(Kt/V)(腹膜+ RRF)＞1.7,透析模式一般应予透析液24h留腹循环进行.     

定期尿激酶治疗对长期颈内静脉留置导管功能及透析充分性的影响

目的探讨定期尿激酶治疗对改善长期颈内静脉留置导管的功能和提高透析充分性的作用。方法颈内静脉导管留置时间小于3个月的维持性血液透析患者12例,导管留置时间大于3个月者13例。记录透析血流速,计算尿素清除指数(Kt/V)和溶质清除指数(SRI)。每2周重复尿激酶封管,3个月后复查上述指标。结果颈内静脉导管留置时间超过3个月者,透析血流速下降,Kt/V、SRI分别为1.12±0.22和57.2%±9.1%,较导管留置时间<3个月者降低(P<0.05、P<0.01);经过定期尿激酶治疗,透析血流速、Kt/V和SRI与近期插管透析者比较无差异。结论定期尿激酶治疗,可以有效保持长期颈内静脉留置导管功能,提高透析效率。     

腹膜清除效能与腹膜透析患者营养状况的关系

目的　回顾性分析腹膜清除效能与腹膜透析患者营养状况之间的关系。方法　选 取本院99例310例次行腹膜透析患者的随访资料,分别计算各例次的腹膜清除效能指标:腹膜尿 素Kt/v和腹膜Ccr。以蛋白呈现率(nPNA)、白蛋白、瘦体重百分比(%LBM)及主观综合评价法评 估营养状况;根据总尿素Kt/v分组,分析腹膜清除效能与营养状况间之的相关性。结果　A组 (Kt/v<1.7)的腹膜Kt/v、Ccr与白蛋白、%LBM、nPNA呈正相关;B组(1.7≤Kt/v≤2.0)腹膜Kt/ v、Ccr与白蛋白呈负相关;C组(Kt/v>2.0)腹膜Kt/v、Ccr与nPNA、%LMB呈正相关。结论　腹膜 清除效能与腹透患者营养状况之间在一定范围内呈负相关性,过高的腹膜清除对腹透患者的营养 状态并无益处。     

老年腹膜透析患者高血压多因素Logistic回归分析

目的分析老年腹膜透析(PD)患者高血压的影响因素及防治措施。方法选取稳定持续不卧床腹膜透析(CAPD)超过6个月的老年患者76例。对可能影响其高血压的因素进行单因素比较、Pearson分析及多因素Logistic回归分析。统计资料包括:年龄、性别、体重、原发疾病、药物使用、血清白蛋白、血清尿酸水平、血红蛋白、电解质水平、C反应蛋白(CRP)、主观营养评分、蛋白质总氮呈现率(nPNA)、Kt/V、D/Pcr、rGRF等。结果以有无高血压为因变量,经多因素Logistic回归分析五个变量引入方程:尿酸(OR=3.403)、容量负荷(OR=4.222)、rGFR(OR=0.265)、总Kt/V(OR=0.162)、血清白蛋白(OR=0.180)。结论高尿酸血症、容量超负荷、营养不佳、残肾功能差、透析不充分性为老年PD患者高血压独立危险因素。     

腹膜透析联合血液透析治疗终末期肾病

目的:探讨腹膜透析联合血液透析(PHD)治疗因腹膜透析(PD)欠充分的终末期肾病(ESRD)患者的临床经验。方法:回顾性分析南京军区南京总医院全军肾脏病研究所PD中心11例PD治疗不充分的ESRD患者,改用PHD治疗后的临床疗效。随访观察患者的一般临床表现、透析充分性、营养指标及降压药的使用情况。结果:本组患者男性8例、女性3例。透析时年龄50.6±16.5岁(23~74岁)。原发病分别为慢性肾小球肾炎9例(81.8%),糖尿病肾病2例(18.2%)。PHD前的平均行PD治疗3.1±1.2(1.2~4.4)年。经过PHD治疗后患者食欲改善,饮食限制减少;所有患者的不安腿症状得以改善;皮肤瘙痒不同程度减轻。小分子物质清除率增加,每周尿素Kt/V由1.54±0.2增至1.96±0.4(P<0.05)。血浆白蛋白由39.4±4.1 g/L升至40.7±3.8 g/L(P>0.05);血红蛋白由86±10 g/L升至96±13 g/L(P<0.05)。结论:PHD能提高透析的充分性,改善患者临床症状和营养状态,可作为一种新的肾脏替代治疗模式在临床推广。     

老年与中青年腹膜透析患者透析前评估与预后分析

目的:对不同年龄腹膜透析(PD)患者进行透析前评估和预后分析,以期延长PD患者生存率。方法:选择上海交通大学医学院附属瑞金医院肾脏科2006年～2007年开始接受PD治疗的患者181例[老年组(≥65岁)96例,中青年组(18～64岁)85例]。记录基线各项临床指标,定期随访(每2～4周)、评估透析充分性(包括水分、溶质清除情况,营养评估,心血管评估等),及时记录各项并发症。比较两组患者的基线状况、透析充分性、腹膜炎发生率、生存率等,分析各项临床指标对预后影响,寻找潜在的危险因素。结果:老年组高血压(88.54%vs68.24%,P0.01),心脑血管疾病(69.79%vs30.59%,P0.01)及外周血管疾病(38.54%vs18.82%,P0.01)发生率较中青年组高。在透析充分性、腹膜炎发生率亦无差异的情况下(P0.05),截止2009年5月,老年组死亡51例,中青年组仅17例。老年组近、远期生存率均显著低于中青年组(12个月:66.69%vs82.31%、36个月:39.37%vs75.90%,P0.01)。COX回归提示透前合并心脑血管及外周血管疾病为死亡的独立危险因素(RR=4.076,95%CI:1.111～14.950,P0.05)。结论:老年PD患者生存率低于中青年患者,可能与透析前合并心脑血管疾病较高有关。     

如何调整腹膜透析患者的容量平衡

容量平衡是指维持患者液体摄人和清除的平衡，避免出现水钠潴留或脱水的状态。腹膜透析（PD）患者容量平衡的控制是影响PD成败的关键。良好的容量平衡是PD充分性的重要指标之一，反之不仅影响PD的溶质清除，也是退出PD的主要原因。因此，国内外学者一直重视PD容量超负荷与炎症、营养不良、心血管并发症的关系，并进行了广泛的研究。目前研究表明，     

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腹膜透析(PD)相关性感染是PD主要的并发症,也是患者退出PD的主要原因。各中心需结合自身情况,遵循指南建议对PD相关感染进行个体化治疗。腹膜炎的治疗目的应该是迅速控制感染以及保护腹膜功能,而不是挽救PD导管。     

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??Abstract??Peritoneal dialysis (PD) is one of renal replacement therapeutics for patients with end-stage renal disease (ESRD).PD patients mainly died of cardiovascular disease.Patients with chronic kidney disease (CKD) have risks of cardiovascular disorders??which are non-traditional and related to the disease itself??including anemia??mineral metabolic disturbance??inflammation??oxidative stress??and protein energy wasting.These factors are correlated with the increased mortality of all causes as well as cardiovascular causes.Strategies to improve the long-term survivals of these patients include??managing of traditional and non-traditional cardiovascular factors such as blood pressure??blood glucose??blood lipid??smoking??anemia and calcium-phosphorus metabolic disturbance??and decreasing inflammation??oxidation stress and protein energy wasting.Meanwhile??high attention should be paid to the survival influencing factors that can be corrected such as residual renal function??peritoneal integrity and size of PD centers.     

Incremental peritoneal dialysis - conclusions

Peritoneal dialysis (PD) adequacy, defined as the sum of renal clearance and peritoneal clearance with a minimum Kt/V target of 1.70, can be achieved with incremental dialysis (Incr-PD), which should therefore not be confused with early dialysis. The Peritoneal Dialysis Study Group census data show that the use of Incr-PD is widespread in Italy and has increased over the years. In 2010 Incr-PD was used in 50% of the centers performing peritoneal dialysis (PD), against 38.5% in 2008 and 29.2% in 2005. The use of PD is also significantly higher in these centers than in those not using Incr-PD (27.5% vs 21.4%; p<0.001). Despite the widespread use of Incr-PD, there is no evidence in the literature showing significantly different clinical results between starting PD incrementally or on full-dose. However, some data suggest a benefit of Incr-PD in that it favors the choice of PD and is associated with a better quality of life. This method allows for the dialysis adequacy and ultrafiltration targets indicated by the current guidelines to be achieved easily without the risk of underdialysis. In view of the frequent errors in the collection of diuresis and of the progressive reduction over time of residual renal function (RRF), frequent RRF monitoring is necessary so that the dialysis dose can be adjusted. Furthermore, dialysis adequacy should always be measured by collection of the dialysate.     

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??Abstract??The elderly CKD patients constitute the fast-growing population reaching end-stage renal disease (ESRD) and commencing dialysis therapy.Peritoneal dialysis (PD) has many advantages on elderly patients such as home-based therapy??relatively stable hemodynamics??etc.However??elderly patients have multiple complicated disorders and are more susceptible to malnutrition??which are very important prognostic factors for survival of patients.A high burden of physical and cognitive impairment in elderly patients may increase the risk of peritonitis and technique failure.Intensive care should be taken to cope with the comorbidities and malnutrition in the elderly.Offering assisted peritoneal dialysis to unstable or frail elderly ESRD patients will help to perform the procedure at home and improve the technique survival.All these strategies for the care of elderly PD patients will result in better survival and quality of life.     

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??Abstract??Protein-energy malnutrition (PEM) is a common complication in peritoneal dialysis patients.The morbidity increases with the extension of the duration of dialysis.PEM seriously affect patients?? quality of life??hospitalization rate and mortality.The main factors leading to PEM are inflammation??diabetes??high peritoneal transporter and elder age of patients.The main countermeasures to prevent PEM in PD patients include nutritional support??use of amino acid peritoneal dialysis solution??improvement of micro-inflammatory state??adequate dialysis??better fluid volume control??correction of metabolic acidosis??and the protection of residual renal function.In addition??automated peritoneal dialysis (APD) has the advantage of delivering higher doses of dialysis??more exchanges??shorter dwelling time??and thus might be more effective in management of PEM in PD patients.     

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??Abstract??Peritoneal dialysis (PD) is one main method of renal replacement therapeutics for patients with end-stage renal disease (ESRD).As a main complication of PD??infectious peritonitis plays a key role in the technique failure and mortality of PD patients.In this paper??combining with the latest researches and experiences from our center??we discuss the factors influencing the occurrences of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis and their management??so as to reduce the incidence rate of PD-associated peritonitis and improve the life quality of these patients.     

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??Abstract??Peritoneal dialysis (PD) is the primary method of renal replacement therapy for patients with end-stage renal disease (ESRD)??which has been widely promoted and applied in our country nowadays.Effective execution of PD depends on the successful insertion of peritoneal dialysis catheter and management of catheter related complications.This review was designed to delineate the different ways of catheter insertion during PD (including an open surgical procedure??laparoscopic insertion and the percutaneous Seldinger technique)??and the diagnosis and countermeasures of PD catheter-related complications??and to enhance the capacity of nephrologist??s catheter implantation??thus improving patients?? survival rate and quality of life.     

Adequacy testing in peritoneal dialysis: a five years experience in a single dialysis center

BACKGROUND: An increasing number of patients is treated with peritoneal dialysis (PD). Adequacy testing in PD has gained wide interest because of its shown relation with morbidity and mortality. METHODS: We describe retrospectively the 5 years follow-up (1993-1998) of adequacy testing of our PD patient population on 1 January 1998. We were used to change the PD regime if Kt/Vurea was < 1.7. RESULTS: On 1 January 1998 there were 57 patients on PD treatment (41 patients on CAPD, 16 on CCPD). The total PD group adequacy values are given on 1 January 1998. During the 5 years follow-up residual renal Kt/Vurea declined, from a mean value of 0.51 to zero. Mean values of total Kt/Vurea remained unchanged (2.01 at the start, 1.83 at 3 years, 1.91 at 5 years) as a consequence of an increase in peritoneal Kt/Vurea. CONCLUSIONS: We were able to maintain a reasonable dialysis adequacy in time by adjusting the total daily PD fluid amount, despite the total loss of residual renal function in 5 years. However, it will be difficult to reach the newest DOQI guidelines, especially in patients with total loss of their residual renal function and in patients with a larger body surface area.     

Lymph node retrieval in pancreaticoduodenectomy specimens: does educating the pathologist matter?

Background:Many previous studies have suggested that the number of lymph nodes retrieved should serve as a benchmark for assessing the adequacy of the resection. The aim was to retrospectively observe the impact of nodal retrieval after educating the pathologist.Methods:Patients undergoing a pancreaticoduodenectomy (PD) between September 2005 and March 2009 were included in the study. The PDs performed between September 2005 and March 2008 were designated as Group A. The pathologistswere educated regarding the importance of nodal counts in PD by the surgeon on the 1st April 2008. PDs performed betweenApril 2008 and March 2009 were designated as Group B.Results:Ninety-eight PDs performed by a single surgeon (D.R.J.) for peri-ampullary malignancy were evaluated. The median number of lymph nodes retrieved in Group A was 11(3–32) nodes. The median number of lymph nodes retrieved in Group B was 22 (10–29) nodes (P < 0.001).The lymph node ratio (positive/total nodes), median number of positive nodes retrieved, and the node positivity (node positive compared to node negative) rate did not change.Discussion:A single intervention with the pathologists did impact the number of lymph nodes retrieved from PD specimens. However, the lymph node ratio and lymph node positivity rate remained unchanged. The pathologist is critical to nodal retrieval in PD, but the use of this lymph node number for benchmark of surgical adequacy may be simplistic.     

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??Abstract??Objective To investigate the applicability of Hristea diagnostic scoring in differentiated diagnosis between viral meningitis (VM) and tuberculous meningitis (TBM).Methods The study was performed retrospectively in resident patients with TBM (n=87) or VM (n=76) in our hospital.The prediction of TBM was determined by Hristea diagnostic scoring using parameters such as duration of symptoms before admission??neurological stages??cerebrospinal fluid (CSF)/blood glucose ratio and CSF protein concentrations.The diagnostic value of the scoring was assessed by calculating the area under the receiver operating characteristic (ROC) curves.Results The Hristea scores of all parameters were significantly different between TBM and VM patients.The sensitivity??specificity??positive predictive value and negative predictive value of Hristea scoring for TBM were 89.7%??86.8%??88.6% and 88.0%??respectively.The area under the ROC curve value for the diagnostic scoring was 0.92.Conclusion Hristea diagnostic scoring is helpful in early diagnosis and differential diagnosis of TBM and VM??and the usefulness of the scoring should be validated in larger series.