Complications of gastrostomy feeding in children receiving peritoneal dialysis

 Gastrostomy tube (g-tube) feeding is recognized to improve the nutritional delivery to children with end-stage renal disease. A retrospective study was undertaken assessing the complications of g-tube feeding in children receiving peritoneal dialysis (PD). Twenty-three patients, mean age 3.8±3.2 years received PD and g-tube feeding for 758 patient-months, with 127 patients receiving PD for 1,969 patient-months used as controls. Peritonitis occurred every 18.4 patient-months in controls and 7.8 patient-months in those with a g-tube. Peritonitis occurred every 6.0 patient-months before and 8.1 patient-months after g-tube insertion in those undergoing g-tube insertion on PD. PD catheter exit site infection (PDESI) occurred every 18.7 patient-months in controls and 16.8 patient-months in those with a g-tube. PDESI occurred every 126 patient-months before and 16.2 patient-months following g-tube insertion. PD catheter replacement secondary to infection occurred every 109.4 patient-months in controls and 39.9 patient-months in those with a g-tube. It did not occur before g-tube insertion and occurred every 32.5 patient-months following insertion. Thirty-four episodes of g-tube exit site infection occurred, in 10 the same organism caused concurrent peritonitis. G-tube replacement occurred on 37 occasions. Hemodynamically significant gastrointestinal bleeding occurred in 3 patients, being terminal in 1. We conclude that, although not without risk, g-tube feeding in patients receiving PD is not contraindicated. Received: 15 May 1998 / Revised: 8 September 1998 / Accepted: 9 September 1998     

Impact of new dialysis solutions on peritonitis rates

Peritonitis remains a major cause of morbidity among patients on peritoneal dialysis (PD), yet there is little information about the effect of new biocompatible dialysis solutions on peritonitis rates and treatment. In our unit, information on each peritonitis episode is prospectively collected. Since 2003, bicarbonate/lactate dialysate has been gradually introduced for new patients and for patients experiencing abdominal pain with conventional lactate solutions. From 2002 to 2005, data from 121 episodes of peritonitis (71 automated PD and 50 continuous ambulatory PD) were analyzed; 107 episodes occurred in patients using standard lactate dialysate and 14 episodes in patients using bicarbonate/lactate solution. Patients using bicarbonate/lactate had a significantly lower peritonitis rate of 1 per 52.5 patient-months compared to those using standard lactate dialysate (1 per 26.9 patient-months) (P=0.0179). Response to treatment, however, was not affected by the type of dialysate; cure rates (71.4 and 69.1%, respectively) and recurrence rates (21.4 and 15.8%, respectively) were not significantly different. Catheter removal was required in three (21.4%) patients using bicarbonate/lactate and 23 (22.4%) patients using lactate solution. Use of biocompatible dialysate appears to reduce the peritonitis rate by 50%, although this has to be confirmed in a randomized study. The type of dialysate, on the other hand, does not affect response to treatment.     

Complications and catheter survival with prolonged embedding of peritoneal dialysis catheters.

BACKGROUND: Our centre uses a modification of the Moncrief technique of embedding peritoneal dialysis (PD) catheters. We undertook this study to test the hypothesis that catheter survival on PD is a function of the time a catheter is left embedded prior to use. METHODS: Data were retrospectively abstracted from review of patient records of those who received a first PD catheter over a 5-year period. Patients were divided into tertiles based on the number of days between insertion of the catheter and exteriorization to create three equal groups representing early (group 1, 11-47 days), mid (group 2, 48-133 days) and late (group 3, 134-2041 days) exteriorization strategies. RESULTS: 435 embedded PD catheters were inserted, 349 were exteriorized and total observation period was 5624 patient-months. Time to catheter loss was shortest in group 1 and longest in group 2 (P = 0.04). The overall rate of primary catheter failure was 6% and was significantly different in the three groups (6.9% in group 1, 1.7% in group 2 and 9.4% in group 3, P = 0.04). The time to first episode of peritonitis was longest in group 3 and shortest in group 1 (group 1 versus group 3, P = 0.009; group 2 versus group 3, P = 0.03). Adjusted peritonitis rates, however, were not different between the three groups. CONCLUSIONS: Mechanical complications and catheter loss are associated with the length of time a catheter is embedded. We recommend insertion 6 weeks to 5 months ahead of the need for PD to maximize catheter survival.     

改良的腹膜透析导管固定方法在腹透置管术中的应用

目的观察改良的腹膜透析(peritoneal dialysis,PD)导管固定方法在PD置管术中的应用。方法收集2014年6月至2019年6月在扬州大学医学院附属泰兴市人民医院肾脏内科确诊为终末期肾病并选择PD治疗的大于18岁的患者,随机分为常规手术组与改良腹壁固定组,随访6个月,比较两组患者手术用时,术后导管漂管、网膜包裹、腹透液渗漏、疝气、血性腹水、腹膜炎、腹腔脏器损伤、切口感染或愈合不良发生率。结果共120例患者入组,两组各60例。两组患者性别、年龄、身高、体重、体重指数、体表面积、肌酐、尿素、肾小球滤过率、白蛋白以及血红蛋白水平比较均无差异。随访6个月,两组患者均未出现腹腔脏器损伤、腹透液渗漏、血性腹水、切口感染或愈合不良。两组患者手术时间、腹膜炎发生率、疝气发生率差异无统计学意义(P>0.05),但改良腹壁固定组无1例患者发生漂管及大网膜包裹,常规手术组发生了7例漂管,6例网膜包裹,两组差异具有统计学意义(P<0.05)。结论改良的PD导管固定方法可降低PD患者的漂管率及网膜包裹率,不增加手术时间及其他并发症,简易可行,值得基层医院推广使用。     

Long-term follow-up of patients randomized to biocompatible or conventional peritoneal dialysis solutions show no difference in peritonitis or technique survival

Peritonitis remains a common clinical problem for patients on peritoneal dialysis (PD). There are, however, retrospective studies with historical controls that suggest that biocompatible PD solutions may reduce the rates of peritonitis. We conducted a randomized controlled study comparing the use of biocompatible and conventional solutions, accumulating over 7000 patient-months experience. We included peritonitis episodes from patients who discontinued PD during the follow-up period. The study was powered to detect a reduction in the peritonitis rate of over half in the 267 randomized patients in demographically similar groups. There were no intergroup differences in PD technique survival irrespective of whether the outcome was censored for death. Peritonitis-free survival was 26.7 months using conventional compared to 23.1 months using biocompatible PD solutions. The peritonitis rates were also not statistically different when measured in patient-months. Thus, despite the finding of non-randomized studies suggesting benefits of the biocompatible PD solutions, we could not detect any clinically significant advantages in terms of technique survival or peritonitis. Although our study is the largest randomized study comparing different PD solutions to date, we do not exclude the possibility that our results are a consequence of the lack of statistical power. Meta-analysis of randomized control trials in this field is essential.     

Candida parapsilosis peritonitis has more complications than other Candida peritonitis in peritoneal dialysis patients

Candida parapsilosis is the most prevalent pathogen of fungal peritonitis in peritoneal dialysis (PD). The difference between C. parapsilosis peritonitis and other C. species for clinical outcomes and treatment responses to fungal peritonitis remains unclear. This retrospective study of fungal peritonitis attempts to answer that question. A total 22 patients with fungal peritonitis in 762 PD patients were enrolled in this study. The mean age of the 22 patients, 9 males and 13 females, was 54.7 +/- 12.5 years with a mean PD duration of 39.7 +/- 33.4 months. Candida species accounted for 86% (19 cases) of fungal peritonitis and 41% (9 cases) were C. parapsilosis. Thirteen (59%) patients received fluconazole as monotherapy; others received either amphotericin B alone or in combination with fluconazole. Catheters were removed for all patients. The mean duration from peritonitis onset to catheter removal was 5.8 +/- 4.1 days. Eleven (50%) patients developed severe complications, with abscess formation or persistent peritonitis after catheter removal. C. parapsilosis peritonitis had a higher complication rate than other Candida species (78% versus 20%, p = 0.012). In patients who received fluconazole as monotherapy, the rate of severe complications of C. parapsilosis peritonitis was statistically higher than those of other Candida species (100% versus 29%, p = 0.013). Because of different severity and prognosis, C. parapsilosis peritonitis in PD patients should be treated more aggressively than other Candida species.     

Comparison of infectious complications in peritoneal dialysis patients using either a twin-bag system or automated peritoneal dialysis.

BACKGROUND: Automated peritoneal dialysis (APD) and twin-bag (TB) systems are two major peritoneal dialysis (PD) modalities. Published data comparing the infectious complications of these modalities is limited. Subjects and methods. Ninety-five patients using APD (the APD group) and 117 patients using TB system (the TB group) were recruited. Among them, 35 patients used both modalities. The two groups' clinical characteristics, incidences of infectious complications, and the time intervals to first PD-related infection were compared. RESULTS: Clinical characteristics, incidence of exit-site infection (ESI), and time intervals to first ESI were similar in the TB and APD groups. The incidence of peritonitis in the APD group (1.22 episodes/100 patient-months) was significantly (P < 0.001) lower than that of the TB group (2.28 episodes/100 patient-months). Using the Cox proportional hazard model, APD was found to have a lower risk of peritonitis relative to TB systems, with marginal significance (RR 0.58, P = 0.051). CONCLUSION: APD was found to have a lower peritonitis rate than the TB system. Since reducing the peritonitis rate helps to maintain technical survival during PD, from this viewpoint, APD may be preferred for patients undergoing PD, unless contraindicated.     

Surgical management of peritoneal dialysis catheters in children: five-year experience with 1,800 patient-month follow-up

Currently at our institution more than 90% of the children with end-stage renal disease are managed with continuous ambulatory peritoneal dialysis (CAPD) in preference to hemodialysis until a successful transplant is accomplished. Recent refinements in CAPD catheters and dialysis techniques have greatly added to the many medical, psychological, and economic advantages of CAPD compared with chronic hemodialysis. Ninety-three patients less than 21 years of age underwent insertion of 167 peritoneal dialysis (PD) catheters over a 5-year period. A variety of PD catheters were used, including 121 (73%) double-cuff Tenckhoff catheters, 22 (13%) single-cuff, and 24 (14%) column disc catheters (Lifecaths, Physio-Control Corp, Redmond, WA). There were three (3%) noncatheter-related mortalities and minimal significant morbidity during the 1,819 patient-months of catheter use. Exit site infections (61%) and peritonitis (59%) were frequent but minor complications, occasionally requiring catheter replacement. Other noninfectious complications included abdominal hernias (42%), dialysis leaks (14%), distal cuff extrusion (11%), catheter obstruction (7%), and hydrothorax (2%). Forty-five of the 60 hernias (75%) were surgically repaired in patients while receiving CAPD. Persistent or recurrent peritonitis was common with Pseudomonas, Serratia, and fungal infections and often resulted in catheter removal and loss of the peritoneal dialysis membrane. Catheter survival for the double-cuff Tenckhoff was significantly better (P .005) than the single-cuff or Lifecath. Based on this experience we have found that using specific operative techniques for CAPD catheter placement and early surgical management for severe peritonitis reduces the incidence of complications and modality failure.     

A ten-year single-centre experience in children on chronic peritoneal dialysis--significance of percutaneous placement of peritoneal dialysis catheters.

BACKGROUND: Chronic peritoneal dialysis (CPD) in children is an important modality of renal replacement therapy. The ideal method for inserting CPD catheters remains still controversial. Minimal invasive techniques are becoming more popular. This study was performed in order to evaluate the efficiency, the complication profile and the survey of percutaneously placed CPD catheters in children, retrospectively. METHODS: This study was carried out on 108 peritoneal catheters implanted in 93 patients (45 girls, 48 boys), aged 8.0+/-4.2 years (range: 3 months to 16 years) during the period between December 1995 and November 2005. In the study group, 32 children were transplanted, 15 were transferred to haemodialysis and 18 patients died. All catheters implanted by percutaneous route were Tenckhoff swan-neck double-cuff paediatric catheters. Placement procedure was performed in our unit by us. Statistical analysis was made by chi-square and Kaplan-Meier methods. RESULTS: During 2670 CPD months we observed a total of 108 catheter-related complications: 82 catheter infections including exit-site and/or tunnel infection (1/32.5 patient-months), 10 dislocations, six drainage problems and six kinks. The incidence of all complications was one complication every 24.72 dialysis months. Overall, the incidence of peritonitis was one episode per 18.1 patient-months. Pseudomonas spp. and Staphylococcus aureus were the two most common causes of infections. Fifteen catheters were removed due to catheter-related causes: drainage problems (six patients), catheter dislocation (three patients), omental capture (two patients) kink (two patients) and tunnel infection (two patients). The catheter survival rate was 92.4% at 1 year, 83% at 2 years and 63% at 10 years; patient survival in the 93 children was 91% at 1 year, 84% at 2 years and 48% at 10 years. Younger patients were at increased risk of exit-site and tunnel infections (P<0.05) but the difference in catheter survival time between the age groups was not significant (P>0.05). In complications, no statistical difference was observed between early and delayed catheter use groups (P>0.05). We compared the two periods (period 1, December 1995 to November 2000; period 2, December 2000 to November 2005), for complications of CPD. The risk of catheter migration was greater in period 1 than in period 2 (P=0.04). CONCLUSIONS: The percutaneous technique performed by experienced nephrologists is a reliable, safe and cost-effective method for placement of PD catheters. In our opinion, the skill for CPD catheter placement must be part of the paediatric nephrologist training.     

Acute dialysis-associated peritonitis in children with D+ hemolytic uremic syndrome

Acute peritoneal dialysis (PD) is the preferred therapy for renal replacement in children with post-diarrheal hemolytic uremic syndrome (D+ HUS), but peritonitis remains a frequent complication of this procedure. We reviewed data from 149 patients with D+ HUS who had undergone acute PD with the aim of determining the prevalence and risk factors for the development of peritonitis. A total of 36 patients (24.2%) presented peritonitis. The median onset of peritonitis manifestations was 6 (range 2–18) days after the initiation of dialysis treatment, and Gram-positive microorganisms were the predominant bacterial type isolated (15/36 patients). The patients were divided into two groups: with or without peritonitis, respectively. Univariate analysis revealed that a longer duration of the oligoanuric period, more days of dialysis, catheter replacement, stay in the intensive care unit, and hypoalbuminemia were significantly associated to the development of peritonitis. The multivariate analysis, controlled by duration of PD, identified the following independent risk factors for peritonitis: catheter replacement [p = 0.037, odds ratio (OR) 1.33, 95% confidence interval (CI) 1.02–1.73], stay in intensive care unit (p = 0.0001, OR 2.62, 95% CI 1.65–4.19), and hypoalbuminemia (p = 0.0076, OR 1.45, 95% CI 1.10–1.91). Based on these findings, we conclude that the optimization of the aseptic technique during catheter manipulation and early nutritional support are targets for the prevention of peritonitis, especially in critically ill patients.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

Clinical outcomes of systemic lupus erythematosus patients undergoing continuous ambulatory peritoneal dialysis.

OBJECTIVES: The purpose of this study was to evaluate the outcome of systemic lupus erythematosus (SLE) patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS: Eighteen SLE patients who had been undergoing CAPD for at least 3 months in our unit were compared with 36 other age- and gender-matched non-diabetic CAPD patients with an underlying primary chronic glomerulonephritis (CGn). The clinical outcome, infective complications, lupus activities, biochemical parameters, haemoglobin level and the use of erythropoietin were reviewed. RESULTS: The duration of dialysis of the two studied groups was not different, with a mean of 35.4 months for the SLE group and 36.7 months for the CGn group. Before dialysis, SLE patients had a significantly lower albumin level (30.4+/-6.6 vs 35.4+/-5.59 g/dl, P<0.01), while the mean haemoglobin levels of the two groups were similar (8.5+/-1.8 g/dl for SLE vs 9.0+/-1.9 g/dl for the control group). However, the weekly dose of erythropoietin (EPO) used was significantly higher in the SLE group (6000 vs 3818 U/week, P<0.01) to maintain a similar haemoglobin level during dialysis. Regarding the infective complications, the SLE group had a higher peritonitis rate (5.7 episodes/100 patient-months vs 2.4 episodes/100 patient-months, P<0.05), and an increase in the non catheter related infection rate (6.67 episodes/100 patient-months vs 1.1 episodes/100 patient-months, P<0.001). However, no significant difference could be demonstrated in the Tenckhoff catheter exit site infection rate (2 episodes/100 vs 1.7 episode/100 patient-months). The number of patients who received a kidney transplant or required a change of mode to haemodialysis was similar among the two groups. Seven patients died during the follow-up period, and the overall mortality rate was much higher in the SLE group than in the control group (0.83/100 vs 0.15/100 patient-months, P<0.05). CONCLUSIONS: SLE patients on CAPD have a significantly lower pre-dialysis serum albumin level and use a higher dose of Epo to achieve a comparable haemoglobin level than other non-diabetic CGn CAPD patients. They also have a poorer prognosis in terms of infective complications and mortality rate.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.     

两种腹膜透析管在腹膜透析时的技术生存率比较

目的 比较传统Tenckhoff双涤纶套直管(直管)与鹅颈卷曲管(卷曲管)在腹膜透析(PD)时的技术生存率.方法 回顾分析1999年1月至2007年12月在北京协和医院PD中心接受PD并获长期随诊的208例患者的资料.按置入PD管形态的不同将患者分2组,比较组间的技术生存率及透析管相关并发症.结果 置入直管者122例,卷曲管者86例.直管和卷曲管出口感染率分别为22.1%和19.8%(P=0.786);腹膜炎发生率分别为31.1%和22.1%(P=0.159),卷曲管组略低于直管组,但差异无统计学意义.共有27例患者(13.0%)拔管,其中直管17例(13.9%),卷曲管10例(11.6%)(P=0.680).直管和卷曲管的中位数生存时间分别为25个月和22个月,技术生存差异无统计学意义(P=0.103).结论 直管与卷曲管的出口感染率、腹膜炎发生率及技术生存率差异均无统计学意义.鹅颈卷曲管价格较高,医生可根据患者具体情况选择透析管.