糖尿病或新发高血糖对腹膜透析患者预后的影响

目的 探讨糖尿病(diabetes mellitus, DM)或腹膜透析(peritoneal dialysis, PD)后新发空腹血糖(fasting plasma glucose, FPG)升高对PD患者预后的影响,分析PD后新发FPG升高的比例及其预测因子。方法 回顾性分析2009年3月至2021年10月于哈尔滨医科大学附属第二医院肾内科开始PD治疗的成年患者的基线特征和实验室数据。根据PD开始时是否合并DM将患者分为两组,A组：DM组;B组：非DM组。再根据PD开始后是否发生新发FPG升高(至少2次复查结果FPG≥7.0 mmol/L),将B组分为两个亚组：B_c组,高FPG组;B_d组,非高FPG组。通过Kaplan-Meier生存曲线比较各组及各亚组间的差异,Cox回归模型分析PD患者死亡及新发FPG升高的潜在预测因子。结果 本研究共纳入474例患者,DM组129例(27.2%),非DM组345例(72.8%)。与非DM组相比,DM组患者的累积生存率显著更低(log-rank=25.756,P<0.001),但两组间的技术生存率...     

维持性腹膜透析共识

腹膜透析（腹透）是终末期肾衰竭患者的一种成功的肾脏替代治疗方法，它为终末期肾衰竭患者的生存提供了可能。为使腹膜透析治疗更合理、更规范，更经济，以提高患者的生存率和生活质量，有必要建立以循证医学为基础的临床实践指南或共识。国外的K／DQQI腹透指南，即是根据循证医学的要求，在收集大量文献的基础上，由专家们筛选、整理、讨论而形成的，对腹透临床具有很好的指导意义。     

腹膜透析患者心血管预后影响因素研究进展

近年来越来越多的证据表明心血管疾病是腹膜透析(peritoneal dialysis,PD)患者的重要死亡原因,心血管并发症是影响PD患者远期预后的重要因素.探讨影响PD患者心血管疾病的危险因素,重视对PD患者心血管系统的保护,是提高PD患者远期生存率的重要保证.本文将对近年来腹膜透析患者心血管预后影响因素作一综述.     

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。     

腹膜蛋白清除率对腹膜透析患者心血管预后的预测价值

目的:探讨腹膜蛋白清除率（peritoneal protein clearance,Pcl）对腹膜透析（腹透）患者心血管预后的预测价值。方法:本研究为前瞻性队列研究。入选2014年1月至2015年4月在上海交通大学医学院附属仁济医院腹透中心规律随访且透析龄>3个月的患者。所有患者随访至死亡、退出腹透、转其他中心或研究终...     

糖尿病腹膜透析患者住院原因及临床特点分析

目的：分析糖尿病腹膜透析患者住院原因及其临床特点。方法：回顾性分析近2年在我院规律腹膜透析的76例患者住院时的临床资料,按患者原发病分为糖尿病肾病组及非糖尿病肾病组,分析两组患者住院原因,比较两组患者的血红蛋白,血清白蛋白,血脂,钙、磷,钠、钾等临床生化指标,根据超声心动图结果,比较两组患者心功能情况。结果：共有76例患者纳入观察,其中男29例,女47例,平均年龄（61.5.4±16.8）岁,平均透析龄（35.2±30.1）月,糖尿病患者31例,非糖尿病患者45例,观察期间76例患者共住院136例次,糖尿病腹透患者住院原因主要为腹膜炎,心功能不全、胃肠道疾病及肺部感染,非糖尿病腹膜透析患者住院原因主要为腹膜炎、脑血管疾病及胃肠道疾病,糖尿病腹透患者心功能更差,左心室肥厚更为突出,血清白蛋白,血钾及血磷水平低于对照组,差异有统计学意义。结论：糖尿病腹膜透析患者反复住院的原因主要为腹膜炎、心血管疾病及胃肠道疾病。与非糖尿病腹透患者相比,糖尿病腹透患者营养状况差,心血管并发症更严重。对糖尿病腹透患者更应早期关注透析相关并发症,以减少住院率的发生。     

关注腹膜透析患者预后

腹膜透析（简称腹透）是终末期肾衰患者延续生命的有效治疗手段之一,多项大型研究显示腹膜透析具有与血液透析（简称血透）相同的临床效果,且具有很多优势,譬如：可以居家操作,免除了医院往返的劳顿;操作易学简便又安全;血液动力学影响小,能较好地保护残肾功能;同时腹透费用比血透低、患者数增加不受医院透析机资源限制、血行感染机会少,等等。因此,腹膜透析目前已经成为终末期肾衰竭替代治疗的重要方式。     

血液透析患者转腹膜透析原因及预后分析

目的 分析血液透析转腹膜透析的原因并探讨影响其预后的因素.方法 调查2005年2月至2009年10月在本中心由血液透析转腹膜透析的连续性不卧床腹膜透析患者.以COX回归法分析影响患者死亡预后的因素.结果 21例转腹膜透析患者中血管通路条件不佳者16例.糖尿病患者平均存活时间短,低蛋白血症影响患者预后(P=0.001).结论 血液透析转腹膜透析的主要原因是血管通路条件不佳.糖尿病肾病患者预后较非糖尿病患者差.低蛋白血症的患者提示预后不良.     

维持性腹膜透析患者导管相关性感染的防治

导管相关性感染是维持性腹膜透析的一种严重并发症，可导致住院率、技术失败率和死亡率的增加，对其防治主要从改良导管及连接系统的设计和放置的技术、严格腹透操作和出口处护理、对患者和护理人员进行培训、以及预防性应用抗生素等方面着手。     

Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus

Purpose

The optimal target for glycated hemoglobin (HbA1c) has not been well defined in peritoneal dialysis (PD) patients with diabetes mellitus.

Methods

The objective of our study was to examine the predictive value of predialysis and time-averaged follow-up HbA1c values on technique and patient survival in diabetic PD patients treated in the Toronto General Hospital Home Peritoneal Dialysis Unit, between January 1, 2003 and December 31, 2008 with a median follow-up period of 30?±?23?months.

Results

Ninety-one patients (mean age 64?±?13 years-old) were included in this retrospective study. Patients were followed between 3 and 91?months (mean duration 30?±?23?months). During this period, 40 patients died. We found no statistically significant correlation between baseline predialysis HbA1c values and technique and patient survival. Time-averaged follow-up HbA1c in increments <6.5 %, 6.5?C8 %, and >8?% showed no significant survival difference among groups.

Conclusions

There was no significant correlation of baseline and time-averaged follow-up HbA1c values with patient and PD technique survival.     

Optimal use of peritoneal dialysis fluids in type 2 diabetes mellitus patients

The glucose side-effects, the main osmotic agent in conventional peritoneal dialysis (PD) solutions, are structural and functional changes of the peritoneal membrane, especially diabetic alterations in the microvasculature. Therefore, hyperpermeability with high small solutes transport and less ultrafiltration necessitates more and more high glucose concentration solutions. Glucose degradation products (PDF) and advanced glycation end-products (AGE) are formed and may induce peritoneal membrane alterations. More biocompatible solutions have to be used with less PDF and physiological pH. Icodextrin containing PD solutions have beneficial effect on sustained ultrafiltration for long dwells in PD, limitating fluid overload common in PD patients above all during peritonitis episodes. Amino acid-based PD solutions contribute to the prevention of malnutrition often observed in the diabetic PD population.     

Clinical characteristics and prognosis of peritoneal dialysis treatment in children with acute kidney injury

Objective To investigate the efficiency and safety of peritoneal dialysis (PD) in pediatric patients with acute kidney injury (AKI). Method A retrospective study of children who underwent PD for AKI in the First Affiliated Hospital of Xi’an Jiaotong University from 2003 to 2013 was performed, and the laboratory examinations, the causes, the complication, the prognosis and the risk factors were evaluated. Results The study included 48 children, with the age of (67.6±51.7) months (ranging from 3 months to 15 years old), including 31 males (64.6%) and 34 co-infections (70.8%). Primary glomerulonephritis (27.1%) was the most common cause of AKI, followed by the hemolytic uremic syndrome (18.7%) and drug induced AKI (18.7%). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. The duration of PD during hospitalization was 11(7,14) days. PD treatment was highly effective in attenuation of toxics retention and correction of electrolyte disturbances (all P＜0.05). There were 3 cases of PD-related complications, including 1 case of peritonitis, 1 case of catheter outflow obstruction, 1 case of catheter exit site hematoma, and no child patient died of PD complications. Among the AKI children, 37 cases (77.1%) recovered with the PD treatment and had the catheter successfully removed till discharge, 7 cases (14.6%) needed further peritoneal dialysis and 4 cases (8.3%) died. The serum albumin level was significantly higher in patients who got recovered with PD treatment than other unrecovered cases [(32.6±6.7) g/L vs (23.2±4.3) g/L, t=-3.994, P＜0.001]. Conclusions PD can be safely and efficiently performed for the treatment of pediatric AKI. Low albumin level may be related to poor prognosis of AKI.     

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.     

Comparisons of the peritoneal equilibration test and ultrafiltration in patients with and without diabetes mellitus on continuous ambulatory peritoneal dialysis

BACKGROUND/AIMS: To compare dialysance and ultrafiltration (UF) of peritoneum in diabetes mellitus (DM) and non-DM patients on continuous ambulatory peritoneal dialysis. METHODS: A total of 162 adult patients on continuous ambulatory peritoneal dialysis (40 DM and 122 non-DM patients) were studied with the peritoneal equilibration test (PET) using 2.5% glucose dialysis solution retained for 4 h. Patients using 2,000 or 1,500 ml of infusion volume were classified into groups A (23 DM and 63 non-DM patients) and B (16 DM and 41 non-DM patients), respectively. PET results were compared between DM and non-DM patients by unpaired t test. Using Pearson's correlation and least-square multiple regression, the most powerful predictors of UF rate were also evaluated in DM and non-DM patients. RESULTS: There were no differences between PET parameters and UF rate between DM and non-DM patients in the whole group (WG) and group A. The only significant difference (p < 0.05) was an increased D4/D0 value in DM patients in group B. The most simple but powerful method to predict UF rate was (100 - GAP)/(D4/D0), where GAP corresponds to the glucose absorption percentage and D4/D0 is the PET 4-hour dialysate glucose level/PET 0-hour dialysate glucose level. GAP and D4/D0 were two major determinants of UF rate in the DM group, non-DM group and WG. CONCLUSIONS: Peritoneal permeability did not differ between DM and non-DM patients, and GAP and D4/D0 were two major factors predicting UF rate.     

腹膜透析管出口感染的菌种和预后分析

目的 了解腹透管出口感染的菌种和预后。方法 定期随访规律性腹膜透析(腹透)患者的腹透管出口，将出口分为良好出口、可疑出口、感染出口(ESI)和隧道感染(TI)，并统计ESI的发生率、细菌种类、治疗效果和预后。结果 在18个月随访期间定期检查69例腹透患者的出口，共发生ESI 21例次，病原菌中以金黄色葡萄球菌(47．6％)和绿脓杆菌(28．6％)为主。经治疗，17例次治愈，4例次末愈(2例次为金葡菌，2例次为绿脓杆菌)并导致隧道感染(TI)。临床诊断TI发生率为0．012次／病人年，超声显像诊断TI发生率为0．036次／病人年。其中1例cuff剥离后出口愈合良好。3例拔管。结论 感染的细菌种类影响预后。隧道感染发生于出口感染末愈的病例中，超声显像检查能提高诊断阳性率。     

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.     

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.     

辅助腹膜透析的预后分析

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