Prognostic analysis of end-stage renal disease patients without diabetes mellitus receiving hemodialysis and peritoneal dialysis

Objective To compare the prognosis of hemodialysis (HD) and peritoneal dialysis (PD) in end-stage renal disease (ESRD) patients without diabetes mellitus and identify related influencing factors. Methods Patients who started hemodialysis with an arteriovenous graft or fistula or PD in the First Affiliated Hospital of Zhengzhou University from January 1, 2013 to February 1, 2019 were included. They were followed up until May 1, 2019. The patients were divided into HD group and PD group according to the initial dialysis modality. Kaplan-Meier method was used to obtain survival curves, the Cox regression model was used to evaluate influence factors for survival rates, and the inverse probability of treatment weighting (IPTW) was used to eliminate influence of the confounders in the groups. Results There were 371 patients with maintenance dialysis enrolled in this study, including 113 cases (30.5%) in HD group and 258 cases (69.5%) in PD group. At baseline, the scores of standard mean difference (SMD) in age, body mass index (BMI), combined with cerebrovascular disease, Charlson comorbidity index (CCI), blood potassium, plasma albumin and hemoglobin between the two groups were greater than 0.1. The score of SMD decreased after IPTW, and the most data were less than 0.1, which meant that the balance had been reached between the two groups. The Kaplan-Meier survival curve showed that the cumulative survival rates had no significant difference for all-cause death before using IPTW between the two groups (Log-rank χ2=0.094, P=0.759). After adjusting for confounders with IPTW, the Kaplan-Meier survival curve showed that the cumulative survival rates still had no significant difference for all-cause death between the two groups (Log-rank χ2=2.090, P=0.150). Univariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus for all-cause death (PD/HD, HR=1.171, 95%CI 0.426-3.223, P=0.760). Multivariate Cox regression analysis showed that there was no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus (PD/HD, HR=1.460, 95%CI 0.515-4.144, P=0.477), and high plasma albumin (HR=0.893, 95%CI 0.813-0.981, P=0.019) was an independent protective factor for survival in ESRD patients without diabetes mellitus. There was still no significant difference between HD and PD on survival rates in ESRD patients without diabetes mellitus after using IPTW (PD/HD, HR=1.842, 95%CI 0.514-6.604, P=0.348). Conclusion The difference of cumulative survival rates between HD and PD is not significant in ESRD patients without diabetes mellitus.     

腹膜透析患者血清铁蛋白水平与微炎症及透析效果相关性分析

目的分析腹膜透析患者血清铁蛋白与C反应蛋白(CRP)之间的相关性,探讨血清铁蛋白对腹膜透析效果的影响。 方法回顾性分析2009年6月至2015年7月在广西医科大学第一附属医院腹膜透析中心规律随诊的腹膜透析患者120例,根据血清铁蛋白浓度将其分成三组,Ⅰ组：男性患者血清铁蛋白≤200 μg/L或女性患者血清铁蛋白≤150 μg/L;Ⅱ组：男性患者血清铁蛋白浓度为200～500 μg/L或女性患者150～500 μg/L;Ⅲ组：血清铁蛋白≥500 μg/L,将三组的临床资料进行分析。根据CRP值,将120例患者分为A组(CRP ≤8 mg/L)和B组(CRP > 8 mg/L),比较两组间血清铁、转铁蛋白饱和度、总铁结合力和血红蛋白水平差异。血清铁蛋白与各相应临床指标进行相关性分析。采用SPSS 16.0统计学软件进行数据分析。 结果(1)与Ⅰ组及Ⅱ组比较,Ⅲ组C反应蛋白水平显著升高,血红蛋白及Kt/V值均低于Ⅰ组及Ⅱ组(P<0.05),Ⅰ组与Ⅱ组比较无显著性差异(P>0.05)。(2)Ⅰ组总铁结合力明显高于Ⅱ组和Ⅲ组(P<0.05),Ⅱ组与Ⅲ组比较无显著性差异(P>0.05)。(3)相关性分析提示血清铁蛋白与血红蛋白及总铁蛋白结合力呈负相关(r＝－0.194,r＝－0.298;P<0.05),与血尿素氮、年龄及C反应蛋白呈正相关(r＝0.234,r＝0.238,r＝0.203;P<0.05)。(4)与A组比较,B组患者血清铁蛋白水平显著升高(t＝2.271, P<0.05),两组间总铁结合力、转铁蛋白饱和度及血红蛋白无显著性差异(t＝0.391,t＝0.371, t＝0.835; P>0.05)。 结论腹膜透析患者血清铁蛋白水平受微炎症状态的影响,高浓度的血清铁蛋白可影响腹膜透析患者的透析充分性,应该联合年龄、转铁蛋白饱和度、血红蛋白及CRP等指标,正确的判断患者缺铁情况。     

腹膜透析治疗急性重症胰腺炎临床观察

目的探讨腹膜透析在急性重症胰腺炎（SAP）中的治疗效果。方法将40例急性重症胰腺炎患者随机分为两组．即腹膜透析组20例和非透析组20例。透析组于起病后48h内进行透析治疗,非透析组进行常规治疗。观察比较两组血尿淀粉酶的变化,白细胞恢复正常的时间,平均住院时间,治愈率,病死率及并发症发生率。结果在上述各项指标的改善。腹膜透析组明显优于对照组,P〈0．05。结论腹膜透析可改善早期急性重症胰腺炎的预后,提高治愈率,降低死亡率和减少并发症发生。     

Association between metabolic syndrome and prognosis in patients with peritoneal dialysis

Objective To investigate the incidence situation of metabolic syndrome (MS) in patients with continuous ambulatory peritoneal dialysis (CAPD), and analyze the correlation between MS and prognosis of patients. Methods The patients who received peritoneal dialysis from June 1, 2002 to April 30, 2018 and followed up regularly were divided into MS group and non-MS group according to the diagnostic criteria of MS. Follow-up was until July 31, 2018. The differences of clinical data, metabolic indexes and clinical outcomes between the two groups were compared. The survival rates of the two groups were compared by Kaplan-Meier survival curve, and the risk factors of all-cause death and cardiovascular disease (CVD) death were analyzed by Cox regression analysis. Results A total of 516 patients with CAPD were enrolled in this study, including 340 males (65.9%) and 176 females (34.1%). Their age was (47.29±12.20) years. The median follow-up time was 20 (9, 39) months. According to the diagnostic criteria of MS, the patients were divided into MS group (210 cases, 40.7%) and non-MS group (306 cases, 59.3%). At baseline, there was no significant difference in age, educational background, duration of peritoneal dialysis, smoking history and drinking history between the two groups (P＞0.05), but the patients in MS group were more exposed to high glucose peritoneal dialysate (P＜0.05). The body mass index (BMI), blood phosphorus, blood glucose, blood potassium, triglyceride, cholesterol and systolic blood pressure in MS group were significantly higher than those in non-MS group (all P＜0.05), and HDL-C level was significantly lower in MS group than in non-MS group (P＜0.05). There were no significant differences in other indicators between the two groups (P＞0.05). Kaplan-Meier survival curve showed that the cumulative survival rate in MS group was significantly lower than that in non-MS group, and the difference was statistically significant (Log-rank χ2=14.87, P＜0.001). If CVD death was taken as the end event, the cumulative survival rate in the non-MS group was significantly higher than that in the MS group (Log-rank χ2=14.49, P＜0.001). Multivariate Cox regression analysis showed that MS and high 4 h dialysate creatinine/serum creatinine ratio (4hD/Pcr) were independent risk factor for all-cause death (HR=1.982, 95%CI 1.240-3.168, P=0.004; HR=3.855, 95%CI 1.306-11.381, P=0.015) and CVD death (HR=2.499, 95%CI 1.444-4.324, P=0.001; HR=5.799, 95%CI 1.658-20.278, P=0.006) in patients with CAPD. Conclusion The prevalence of MS in patients with CAPD is high, and MS and high 4hD/Pcr are independent risk factor for all-cause and CVD death in CAPD patients. They can be used as valuable indicators to predict the treatment outcomes and long-term prognosis of patients with CAPD.     

腹膜透析剂量与残余肾功能及透析质量的关系研究

目的观察慢性肾脏病5期患者应用非透析治疗、不同腹膜透析剂量治疗对肾功能的影响。方法选取慢性肾脏病5期的非糖尿病肾病患者,采用非透析保守治疗者20例,腹膜透析剂量4升／天者26例、6升／天者35例及8升／天者43例。随访观察1年,检查各项指标及肾功能的变化。结果随访1年后,非透析患者血压的控制较4升／天腹膜透析组差（P〈0．05）,血清白蛋白水平、血钙水平低于4升／天透析组,血磷及甲状旁腺素水平高于不同剂量透析组。各组尿量及残余肾功能均有不同程度的下降,其中腹膜透析各组尿量、肾功能及非透析组肾功能均较观察前具有统计学差异（P〈0．05）,而各组之间肾功能下降的幅度未见显著性差异（P〉0．05）。结论慢性肾脏病5期患者早期的腹膜透析治疗对患者钙磷代谢、蛋白质营养改善及血压的控制优于非透析治疗。腹膜透析治疗对残余肾功能的保护与非透析治疗相比未见明显优势,不同的透析剂量在1年的观察期内未显示对肾功能的影响。     

腹腔镜在腹膜透析管复位中的临床应用

目的：评价应用腹腔镜手术方法行腹膜透析管复位的治疗效果,并总结相关治疗经验。方法收集2010年3月至2014年5月我院腹透中心收治的33例经常规保守治疗后,腹透液进出仍然不通畅,并确诊为导管持续性移位,须行手术复位腹膜透析导管患者的临床资料,进行回顾性分析,评价腹腔镜下腹透导管复位术的效果。结果33例导管持续性移位的患者均采用全麻下腹腔镜手术复位。术中所见多为单纯导管移位（21/33,63.6%）,腹腔镜直视下将腹膜透析管直接放至膀胱直肠陷窝或子宫直肠陷窝,并加用不可吸收线将导管固定于邻近腹壁,以减少再次移位的可能性;其次为大网膜包裹（12/33,36.4%）,腹腔镜直视下钝性分离包裹于导管上的大网膜,后续操作步骤同单纯导管移位者。全部33例患者均用上述技术成功复位,手术时间维持在30~45 min,平均出血量约5~10 ml;术中患者生命体征平稳,未见明显并发症;术后行腹膜透析,伤口处无渗液、漏液,伤口愈合良好;术后随访3~50个月,33例患者均可正常进行腹膜透析,未再出现导管移位。结论腹腔镜下腹膜透析管复位定位准确,切口小,易于愈合,合理运用可显著提高腹膜透析技术成功率。     

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.     

生血宁片治疗维持性腹膜透析患者肾性贫血的临床观察

目的观察中成药生血宁片治疗维持性腹膜透析患者肾性贫血的临床疗效及对铁代谢指标、营养不良和微炎症状态的影响。方法选取武汉大学中南医院维持性腹膜透析肾性贫血患者56例,随机分为治疗组和对照组,治疗组口服生血宁片,对照组口服多糖铁复合物胶囊,两组均同时联合皮下注射重组人促红细胞生成素针。治疗12周后观察和比较2组患者治疗前后血红蛋白、红细胞比容、血清铁蛋白、转铁蛋白饱和度、血清肌酐、白蛋白、超敏C反应蛋白等指标变化,同时观察治疗中的不良反应。结果 2组患者在治疗前的贫血指标之间差异无统计学意义(P0.05),治疗后治疗组及对照组患者贫血治疗的总有效率分别为92.9%及82.1%,治疗组总有效率明显高于对照组(P0.01);治疗后两组患者的贫血指标较治疗前有显著变化(P0.05),治疗组用药后血红蛋白、红细胞比容、血清铁蛋白、转铁蛋白饱和度、血清白蛋白均较治疗前明显升高(P0.05),与对照组相比贫血指标差异有统计学意义(P0.05);治疗组超敏C反应蛋白水平较治疗前有所下降,但差异无统计学意义(P0.05)。对照组患者有7例不良反应,而治疗组患者无一例不良反应发生,其不良反应发生明显低于对照组。结论生血宁片可有效纠正腹膜透析患者贫血状态,改善铁代谢和营养不良,同时并未增加腹透患者体内微炎症状态。采用生血宁片联合促红细胞生成素治疗维持性腹膜透析患者肾性贫血的临床疗效明显,且未见明显不良反应。     

Metabolic syndrome in peritoneal dialysis patients: choice of diagnostic criteria and prognosis

Objectives To investigate whether the presence of metabolic syndrome (MS) modifies overall survival and cardiovascular (CV) outcomes among patients undergoing long-term peritoneal dialysis (PD) and to explore suitable diagnostic criterion for PD patients. Methods A total of 258 patients on PD in Peking University Third Hospital between October 2008 and March 2009 were enrolled and followed until June 2017. According to the diagnostic criteria of WHO, IDF and ATP Ⅲ, the patients were divided into MS group and non-MS group. The median following time was 51.9 (26.8, 97.9) months. Overall survival and cardiovascular death were analyzed by the Kaplan-Meier method. The analyses were also done among non-diabetic PD patients. The influence of MS and its components on outcomes was analyzed by Cox regression models. Results Among 258 PD patients, 106(41.1%) fulfilled the WHO criteria, 121(46.9%) the IDF criteria, and 167(64.7%) the ATP criteria. 139 cases were dead, among which 50(36.0%) cases were caused by CV diseases. The patients with MS had worse outcomes than those without MS by WHO and IDF criteria (cumulative survival rates of WHO criteria: 21.3% vs 44.8%, P﹤0.01; cumulative surviva rats of IDF criteria: 23.3% vs 45.7%, P﹤0.01). It was the same even in non-diabetic PD patients. The patients with MS had more CV death than those without MS by WHO and IDF criteria (both P﹤0.05). Among non-diabetic PD patients, the results remained the same only by IDF criteria (P﹤0.05). By ATP criteria, above analyses showed no difference. By multivariate Cox regression analysis, MS and serum albumin (all P﹤0.01) were independently associated with increased risk for overall and cardiovascular survival. Among MS components, waist girth, low-density lipoprotein cholesterol (LDL-C) levels and blood sugar (all P﹤0.01) were significant risk factors for adverse survival outcomes. Conclusions In patients undergoing PD, both overall survival and cardiovascular survival were worse in patients with MS than those without MS. Waist girth, blood sugar and serum LDL-C were the main risk factors. For PD patients the IDF criterion for MS was recommended.     

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。     

Pauci-immune rapidly progressive glomerulonephritis after nephrectomy in a renal donor

Idiopathic rapidly progressive glomerulonephritis (RPGN) is a clinicopathologic syndrome in which glomerular damage is accompanied by a rapid and progressive decline in renal function, usually resulting in irreversible renal failure in weeks or months. We report the occurrence of pauci-immune RPGN, more specifically microscopic polyarteritis nodosa (PAN), in a 60-year-old woman 15 months after donor nephrectomy, and 3 months after documentation of intact, residual renal function. The transplanted kidney continues to function well in the recipient, 6 years posttransplantation, and 4.5 years beyond destruction of the donor's contralateral kidney by RPGN. The donor underwent cadaveric renal transplantation after 2 years on dialysis, and at the 3-year mark has intact renal function. These intriguing observations strongly argue that host environmental factors, rather than intrarenal factors, play a major causative role in the pathogenesis of RPGN.     

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.     

Clinical outcome of 371 episodes of peritoneal dialysis related peritonitis

Objective To analyze the clinical outcome of PD related peritonitis in our center. Methods All patients who developed PD related peritonitis between January 2004 and December 2010 in Renji Hospital of Shanghai Jiao Tong University School of Medicine were included. Outcomes of PD related peritonitis were analyzed. Results A total of 220 patients developed 371 episodes of PD related peritonitis during the study period in our center, and the average peritonitis rate was one episode per every 54.4 patient-months. Among the 371 episodes of peritonitis, 285 (76.8%) episodes had been cured, 17 (4.6%) episodes had needed temporary hemodialysis (HD), 46 (12.4%) episodes had led to switch to permanent HD and 21 (5.7%) episodes had caused death. After refractory peritonitis, there was a significant reduction of 4 h ultrafiltration (330 vs 270 ml, P＝0.036) and an increase tendency of 4h D/Pcr (0.55±0.08 vs 0.58±0.10, P＝0.086). Conclusions Peritoneal dialysis related peritonitis is an important contributor to technique failure and death in Chinese PD patients. Refractory peritonitis might injure peritoneal membrane function.     

Long-term survival analysis of the elderly peritoneal dialysis patients

Objective To analyze the clinical data of the elderly peritoneal dialysis (PD) patients in Peking Union Medical College Hospital (PUMCH), and to find the risk factors for the long-term survival. Methods Baseline data and the outcome of maintenance PD patients from 1996-03 to 2015-09-30 were collected for a retrospective cohort study. Patients were divided into the non-elderly group (＜65 years old), the 65-79 years old group and the ≥80 years old group, and were follow to 2016-09-30. The survival rate was calculated by Kaplan-Meier method and the risk factors of outcome were analyzed by the Cox's regression model. Results Among 577 PD patients, about 243(42.1%) were elderly patients, including 207 patients aged between 65 and 79 years (35.9%) and 36 patients aged 80 or more (6.2%). The most common primary disease causing PD was diabetic nephropathy (DN) for both elderly and non-elderly patients. The 1-year, 3-year, 5-year survival rate of patients aged between 65 and 79 years were 87.0%, 61.9%, 32.4% respectively, and 72.5%, 48.5%, 27.3% for the ≥80 years old group. The dominating reasons of death were cardiovascular events and infection. There was no difference of technical survival rates among three groups, and the most common reason for technical failure was peritonitis. For elderly patients, diabetes (HR=2.193, 95%CI 1.445-3.328, P＜0.001) and lower baseline serum albumin (HR=0.968, 95%CI 0.940-0.996, P=0.026) were independent risk factors for death. However, for non-elderly patients, diabetes (HR=3.746, 95%CI 2.149-6.529, P＜0.001) was the only independent risk factor for death. Conclusions Cardiovascular diseases and infection are the main reasons for death among the elderly PD patients in PUMCH. Diabetes and lower baseline serum albumin may predict the mortality of elderly PD patients independently. Better management of nutrition might improve survival in elderly PD patients.     

快速腹膜平衡试验215例结果分析

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

长腹膜透析龄患者首次腹膜炎的临床特征分析

目的 探讨长腹膜透析龄患者首次腹膜炎的临床特征。 方法 回顾性分析2000年至2009年发生首次腹膜透析相关性腹膜炎患者315例,按发生首次腹膜炎时腹膜透析龄分为两组：A组（<36个月）261例,B组（≥36个月）54例。对两组相关临床资料进行比较。 结果 入组患者平均年龄（55.7±15.9）岁,男性占61.0%,基础肾脏病主要为慢性肾小球肾炎（54.6%）,其次为糖尿病肾病（20.6%）。发病时A组中位腹膜透析龄8.4个月;B组中位腹膜透析龄49.4个月。发生腹膜炎时,两组间血红蛋白、血清白蛋白和血钾水平差异无统计学意义,但两组血清白蛋白和血钾水平均低于正常值范围。两组腹膜炎最常见诱因均为换液操作接触污染（48.2%比45.2%）。剔除未做透出液细菌培养患者,两组革兰阳性菌分布情况差异无统计学意义,但B组革兰阳性菌对甲氧西林的耐药率显著高于A组（46.2%比19.1%,P = 0.035）。两组革兰阴性菌分布情况及超广谱耐药菌比例差异无统计学意义。B组真菌感染比例显著高于A组（17.8%比6.4%,P = 0.011）。B组初始治疗有效率及临床结局显著差于A组（均P < 0.05）。两组间革兰阴性菌及真菌腹膜炎治疗失败率差异无统计学意义,但B组革兰阳性菌、无菌生长及未作培养腹膜炎治疗失败率显著高于A组（23.1%比1.5%、46.2%比6.7%、22.2%比0%,均P < 0.05）。Logistic回归分析整体资料显示,真菌感染、发病时较长腹膜透析龄、较低血清白蛋白水平为首次腹膜透析相关性腹膜炎治疗失败的独立影响因素（P = 0.000、0.002、0.025）。 结论 长腹膜透析龄患者首次腹膜炎的临床结局较短腹膜透析龄患者差。较高真菌和其他耐药菌感染率以及营养不良是影响其疗效的主要因素。     

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

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

重新评价腹膜平衡试验以确定腹膜透析患者的溶质转运类型

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

改良腹膜平衡试验在腹膜透析患者中的应用

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

Effects of timing of dialysis initiation on the prognosis of peritoneal dialysis patients: a retrospective cohort study

Objective To analyze the effects of dialysis therapy initiation on the prognosis of peritoneal dialysis (PD) patients. Methods PD patients who were newly catheterization and long-term followed-up in Peking University Shenzhen Hospital from January 1, 2012 to March 25, 2019 were retrospectively analyzed. According to the estimate glomerular filtration rate (eGFR) at the time of patients catheterization, the patients were divided into early-dialysis group [eGFR＞5.5 ml?min-1?(1.73 m2)-1] and late-dialysis group [eGFR≤5.5 ml?min-1?(1.73 m2)-1]. The endpoint events were transferred to other renal replacement therapy (such as hemodialysis, kidney transplantation) or death. Kaplan-Meier method was used to draw survival curve, and log-rank test was used to compare the difference of survival rate between the two groups. Cox proportional hazard model was used to analyze the influencing factors of all-cause death and technical death in PD patients. Results A total of 342 PD patients were enrolled in this study, and there were 165 cases and 177 cases in the early-dialysis and the late-dialysis group respectively. Compared with the early-dialysis group, the proportion of patients with diabetes and men, and the level of hemoglobin, serum calcium and CO2 binding capacity in the late-dialysis group were lower, while the incidence of hypertension, serum phosphorus, blood uric acid and blood urea nitrogen level were higher in the late-dialysis group (all P＜0.05). The median follow-up time was 33(16, 57) months. Kaplan-Meier survival analysis showed that the cumulative survival rate of late-dialysis group was significantly higher than that of early-dialysis group (Log-rank χ2=12.004, P＜0.001). After adjusting for gender, age of catheterization, body mass index (BMI), diabetes mellitus and hypertension, the risk ratio of all-cause death in the early-dialysis group was 1.950 times higher than that in the late-dialysis group (HR=1.950, 95%CI 1.019-3.730, P=0.044). Subgroup analysis showed that the timing of dialysis and the risk of end-point events were not affected by BMI, diabetes stratification and other factors (interactive P＞0.05), but there was interaction between dialysis time and catheter age (interactive P＜0.05). According to the age of catheterization, the risk of all-cause death were higher in the early dialysis group at a young age (≤48 years old) (HR=21.287, 95%CI 2.609-173.665, P=0.004). Conclusions The mortality rate of PD patients is higher in early-dialysis group, which is independent of gender, age, BMI, diabetes and hypertension. The difference is more distinct in low age group.