腹膜透析在终末期糖尿病肾病治疗中的应用

目的：探讨腹膜透析在终末期糖尿病肾病治疗中的临床分析。方法选取我院收治的50例终末期糖尿病肾病患者,全部患者均行腹膜透析治疗,统计对比全部患者透析治疗前后血肌酐、尿素氮、血红蛋白、血白蛋白等指标的变化情况以及透析期间并发症的发生率。结果患者透析治疗后血肌酐（513.5±11.2）umol/L、尿素氮（20.3±1.5）mmol/L,明显小于透析治疗前的（725.6±12.3）umol/L、（25.4±1.9）mmol/L,两组比较差异有统计学意义（P〈0.05）;患者透析治疗后的血红蛋白（105.6±2.9）g/L、血白蛋白（31.7±2.0）mg/L,明显高于透析前的（93.8±3.1）g/L、（28.2±1.6）mg/L,两组比较差异有统计学意义（P〈0.05）。透析治疗期间感染、出血、腹膜炎、腹腔脏器粘连等并发症并发症发生率16.0%。结论腹膜透析治疗终末期糖尿病肾病具有较好的临床效果,切透析治疗期间安全性较好,操作方便,具有较好的临床应用价值。但是腹膜透析仍需要改善,降低并发症发生率,进一步推进腹膜透析治疗的发展。     

手工腹膜透析与自动化腹膜透析机在终末期肾病腹膜透析患者中的应用效果

目的 比较手工腹膜透析与自动化腹膜透析机在终末期肾病腹膜透析患者中的应用效果。方法 选取2020年3月至2022年3月于龙南妇幼保健院行腹膜透析治疗的60例终末期肾病患者为研究对象，按照随机数字表法分为手工腹膜透析组与自动化腹膜透析组，各30例，比较两组矿物质代谢指标[钙（Ca）、磷（P）、全段甲状旁腺激素（iPTH）]、矿物质代谢达标率、肾功能指标[血清尿素氮（BUN）、血清肌酐（Scr）]、并发症情况及随访结局。结果 自动化腹膜透析组Ca、P、iPTH指标低于手工腹膜透析组（P<0.05）；自动化腹膜透析组Ca、P、iPTH代谢达标率高于手工腹膜透析组（P <0.05）；自动化腹膜透析组Scr、BUN水平低于手工腹膜透析组（P <0.05）；自动化腹膜透析组并发症发生率低于对照组（P<0.05）。两组持续腹膜透析率、肾移植率、死亡率比较，差异无统计学意义（P>0.05），但自动化腹膜透析组转血液透析率低于手工腹膜透析组（P<0.05）。结论 相较于手工腹膜透析，自动化腹膜透析机在终末期肾病腹膜透析中的矿物质代谢效果更佳，可减轻肾功能损伤，且并发症...     

腹壁再固定的腹膜透析置管术临床观察

目的 比较常规腹膜透析置管术和腹壁再固定的腹膜透析置管术对漂管率的影响. 方法 随机选取2001-2006年常规腹膜透析置管术(对照组)患者28例、腹壁再固定置管术(治疗组)患者35例,后者在常规置管术的基础上在第一涤纶套下方3 cm处将Tenckhoff管以铬制肠线做腹壁再次固定,置管术后1年内将二者漂管率进行比较. 结果 治疗组术后仅1例漂管,漂管率2.9%,而对照组漂管率达17.9%(5/28),两组比较差异有统计学意义. 结论 常规腹膜透析置管术中采用腹壁再同定技术方法简便,不增加手术时间,漂管率低,优于常规腹膜透析置管术.     

腹膜透析置管术患者围手术期护理分析

目的 研究并分析肝病合并慢性肾功能衰竭患者接受腹膜透析置管术的围手术期护理,为临床护理质量的提升提供参考.方法 选取我院于2011年8月份至2012年8月份收治的16例肝病合并慢性肾功能衰竭患者,均接受腹膜透析置管术.观察在围手术期进行护理干预,评价其应用效果.结果 16例手术均成功,腹膜透析管良好放置,平均手术用时为48分钟.在精心护理下,无一例出现显著并发症,术后十天内患者全部出院,收到了积极的预后效果.结论 针对肝病合并慢性肾衰竭患者,在进行腹膜透析置管术时,提供全面的围手术期护理,可以巩固治疗效果,降低出现并发症的风险,有着积极的应用价值.     

血液透析和腹膜透析治疗终末期肾病透析患者的临床疗效观察

目的观察血液透析和腹膜透析治疗终末期肾病透析患者的临床疗效。方法选取我院2015年5月至2016年1月期间收治的92例终末期肾病患者,分为血液透析组和腹膜透析组各46例。血液透析组接受常规血液透析,腹膜透析组接受非卧床持续腹膜透析。比较两组患者的生化指标、并发症、生存率及生活质量。结果与血液透析组比较,腹膜透析组的钙磷乘积较低,并发症发生率较高,差异均有统计学意义(P<0.05)。随访一年,两组患者的生存率比较差异无统计学意义(P>0.05)。血液透析组的生活质量优于腹膜透析组(P<0.05)。结论腹膜透析对终末期肾病透析患者钙磷代谢异常的改善作用优于血液透析,但其并发症发生率较高;两种方式的治疗效果相当,但从生活质量方面来看,血液透析方式更具有优势。     

对终末期肾病采取腹膜透析与血液透析治疗的研究进展

慢性肾脏病向终末阶段逐渐进展即为终末期肾病（ESRD）,目前主要采取透析治疗以维持生命。腹膜透析（PD）与血液透析（HD）各有优缺点,例如与PD相比,HD更加充分,但不适用于伴随出血性疾病、严重血管病变或心脏疾病者。透析技术的不断发展与成熟使终末期肾病患者的生存期逐渐延长,但透析治疗仍会引起诸多并发症,导致透析患者仍有较高的病死率。现从万方、中国知网等数据库中查阅大量资料,将HD与PD治疗ESRD的研究进展综述如下。     

终末期肾病血液透析和腹膜透析治疗经济学评价研究综述

为了给我国终末期肾病透析治疗经济学评价研究的发展提供可借鉴的经验,对国内外前期开展的血液透析和腹膜透析治疗的经济评价进行综合评述。通过比较发现,我国现有的评价研究在研究设计和方法选择方面存在不足,建议参考国外最新研究进展,进行严谨的评价项目设计,并选取适宜的分析方法。     

终末期肾病腹膜透析工作列入我国重大疾病医疗保障重点

我国终未期肾病患者约100万,腹膜透析和血液透析等血液净化治疗是改善终末期肾脏病患者生存质量的有效手段,与血液透析治疗相比．腹膜透析同样安全、有效。并且具有操作简单、易于管理、价格相对低廉的优势。积极推进腹膜透析。提高医疗机构特别是基层医疗机构腹膜透析服务能力,能够让更多患者受益。     

腹膜透析疗法对终末期糖尿病肾病患者的有效性和安全性研究

目的探究腹膜透析治疗终末期糖尿病肾病的临床疗效和不良反应。方法择取2017年1月-2019年1月期间在医院接受治疗的患者共102例,通过抛硬币方式进行完全随机分组,包括对照组和观察组,每组51例。对照组患者进行血液透析治疗,观察组患者进行腹膜透析治疗,比较两组患者临床治疗有效率以及不良反应发生率。结果观察组患者和对照组患者临床治疗有效率分别为82.35%和78.43%,组间差异输入统计学软件中无意义(P> 0.05);观察组患者和对照组患者不良反应发生率分别为9.80%和27.45%,组间差异输入统计学软件中有意义(P <0.05)。结论腹膜透析和血液透析对终末期糖尿病肾病的治疗效果相近,但是腹膜透析对该疾病的治疗安全性良好,因此值得在临床中进行大力推广普及。     

腹膜透析患者的门诊随访依从性分析及对策

目的调查维持性腹膜透析患者的门诊随访依从性及其影响因素。方法腹透护士采用问卷调查方式对104例腹膜透析患者的门诊随访依从性进行调查记录。结果门诊随访依从性良好者占67．3％,随访依从性较差者占32．7％。结论部分患者认为就诊远、费用高、嫌麻烦、没有必要来等,该类患者的门诊随访依从性差,应针对这一人群进行强化教育．建立多种有效的随访模式,同时提高腹透护士专业水平,与患者建立良好的沟通,以提高患者的生活质量。     

Significance of Levocarnitine Treatment in Dialysis Patients

Carnitine is a naturally occurring amino acid derivative that is involved in the transport of long-chain fatty acids to the mitochondrial matrix. There, these substrates undergo β-oxidation, producing energy. The major sources of carnitine are dietary intake, although carnitine is also endogenously synthesized in the liver and kidney. However, in patients on dialysis, serum carnitine levels progressively fall due to restricted dietary intake and deprivation of endogenous synthesis in the kidney. Furthermore, serum-free carnitine is removed by hemodialysis treatment because the molecular weight of carnitine is small (161 Da) and its protein binding rates are very low. Therefore, the dialysis procedure is a major cause of carnitine deficiency in patients undergoing hemodialysis. This deficiency may contribute to several clinical disorders in such patients. Symptoms of dialysis-related carnitine deficiency include erythropoiesis-stimulating agent-resistant anemia, myopathy, muscle weakness, and intradialytic muscle cramps and hypotension. However, levocarnitine administration might replenish the free carnitine and help to increase carnitine levels in muscle. This article reviews the previous research into levocarnitine therapy in patients on maintenance dialysis for the treatment of renal anemia, cardiac dysfunction, dyslipidemia, and muscle and dialytic symptoms, and it examines the efficacy of the therapeutic approach and related issues.     

The Cost-Effectiveness of Lanthanum Carbonate in the Treatment of Hyperphosphatemia in Patients with End-Stage Renal Disease

OBJECTIVE: To assess the cost-effectiveness of lanthanum carbonate (LC) as a second-line therapy for hyperphosphatemia in end-stage renal disease (ESRD) patients not achieving target phosphorus levels. METHODS: A cohort of ESRD patients not adequately maintained on calcium carbonate (CC) and three subgroups of patients with baseline phosphorus levels of 5.6 to 6.5 mg/dl, 6.6 to 7.8 mg/dl, and more than 7.9 mg/dl were modeled. The following policy options were considered: continued CC (Policy 1); LC trial-if successful continue LC, if unsuccessful switch to CC (Policy 2). The survival benefit of using second-line LC to improve phosphorus control has been extrapolated from the relationship between hyperphosphatemia and mortality. Lifetime UK National Health Service drug and monitoring costs, expected survival, and quality-adjusted life-years (QALYs) were examined (discounting at 3.5% per annum). RESULTS: Policy 2 had a cost-effectiveness ratio (cost/QALY) of pound25,033 relative to Policy 1. The results show it is particularly cost-effective to treat patients with phosphorus levels above 6.6 mg/dl. The outcomes did not vary significantly during the one-way sensitivity analysis carried out on important model parameters and assumptions except when the utility value for ESRD was decreased by more than 30%. CONCLUSIONS: Applying a cost-effectiveness threshold of pound30,000 per QALY, the model shows it is cost-effective to follow current treatment guidelines and treat all patients who are not adequately maintained on CC (serum phosphorus above 5.6 mg/dl) with second-line LC. This is particularly the case for patients with serum phosphorus above 6.6 mg/dl. Our estimates are probably conservative as the possible compliance difference in favor of LC and the reduced number of hypercalcemic events with LC relative to CC was not considered.     

Economic Evaluation of Palliative Management versus Peritoneal Dialysis and Hemodialysis for End-Stage Renal Disease: Evidence for Coverage Decisions in Thailand

OBJECTIVE: To examine the value for money of including peritoneal dialysis (PD) or hemodialysis (HD) into the universal health insurance scheme of Thailand. METHODS: A probabilistic Markov model applied to end-stage renal disease (ESRD) patients aged 20 to 70 years was developed to examine the incremental cost-effectiveness ratio (ICER) of palliative care versus 1) providing PD as an initial treatment followed by HD if complications/switching occur; and 2) providing HD followed by PD if complications/switching occur. Input parameters were extracted from a national cohort, the Thailand Renal Replacement Therapy Registry, and systematic reviews, where possible. The study explored the effects of uncertainty around input parameters, presented as cost-effectiveness acceptability frontier, as well as the value of obtaining further information on chosen parameters, i.e., partial expected value of perfect information. RESULTS: Using a societal perspective, the average ICER of initial treatment with PD and the average ICER of initial treatment with HD were 672,000 and 806,000 Baht per quality-adjusted life-year (QALY) gained (52,000 and 63,000 purchasing power parity [PPP] US$/QALY) compared with palliative care. Providing treatments for younger ESRD patients resulted in a significant improvement of survival and gain of QALYs compared with the older aged group. The cost-effectiveness and cost-utility ratios of both options for the older age group were relatively similar. CONCLUSIONS: The results suggest that offering PD as initial treatment was a better choice than offering HD, but it would only be considered a cost-effective strategy if the social willingness-to-pay threshold was at or higher than 700,000 Baht per QALY (54,000 PPP US$/QALY) for the age 20 group and 750,000 Baht per QALY (58,000 PPP US$/QALY) for age 70 years.     

Association of Albumin and Globulin with Mortality Risk in Incident Peritoneal Dialysis Patients

Background: Nutrition and inflammation have been implicated in predicting mortality in patients on peritoneal dialysis (PD). Serum albumin and globulin can be regarded for the nutritional and inflammatory status. However, there is lack of data to evaluate the synergistic effect of albumin and globulin on mortality prediction. Methods: In 554 patients initiating PD from January 2001 to July 2016, we divided them into four groups by the combination of two categories of low vs. high albumin and low vs. high globulin. The median values for albumin and globulin were chosen to classify them into low or high groups. Their associations with all-cause and cardiovascular (CV) mortality were examined in Cox regression models adjusted for confounding clinical and laboratory data. Results: Patients, 52.91 ± 15.2 years old and 47.8% men, had a median (interquartile range) value of 3.3 (2.9–3.8) g/dL for albumin and 2.8 (2.5–3.2) g/dL for globulin, respectively. Patients with low albumin and high globulin had the highest all-cause mortality and CV mortality, with adjusted hazard ratios of 3.87 (95% CI 1.83–8.20, p < 0.001) and 5.65 (95% CI 2.23–14.34, p < 0.001), respectively, compared with those with a high albumin and low globulin having the lowest mortality rate. Sensitivity analyses further confirmed this relationship. Conclusions: A patient profile of either low albumin or high globulin is linked to a higher risk for mortality, particularly for a profile of both low albumin and high globulin compared with one without either of them. Further studies are needed to explore the mechanisms underlying this phenomenon and how to improve clinical outcomes in those high-risk patients.     

腹膜透析置管手术方式改进后对患者早期预后效果分析

目的探讨腹膜透析置管方法改进后对长期肾脏替代治疗患者早期预后的影响。方法将我科2009年4-12月腹膜透析置管方法改进后的手术患者44例作为观察组,另选择1992年1月-1994年3月腹膜透析置管手术患者131例作为对照组,术后观察腹透置管成功后一月内并发症情况。结果观察组与对照组相比,观察组术后早期并发症的发生率明显降低（P〈0.05）。结论腹膜透析置管方法改进后可改善长期肾脏替代治疗患者早期预后。     

Underweight and Weight Change Increases End-Stage Renal Disease Risk in Patients with Diabetes: A Nationwide Population-Based Cohort Study

Weight variability has known as a risk factor for cardiovascular events and mortality. However, its effect on end-stage renal disease (ESRD) development remains controversial. We investigated the relationship between weight change and ESRD risk. Overall, 97,029 patients with DM aged >20 years were selected from the Korean National Health Screening Program 2009–2012. Weight change was defined as differences in body weight from the index year to 2 years later. Newly diagnosed ESRD was observed until 2017 end. Over a 5.1-year median follow-up period, ESRD was newly diagnosed in 7932 (4.81%) DM patients. BMI < 18.5 kg/m² and waist circumferences <85/80 and >100/95 cm were ESRD risk factors. ESRD risk increased with increasing weight change; ≥10% weight loss (hazard ratio [HR], 1.247) followed by ≥10% weight gain (1.247) was associated with a higher HR than ≤5% weight change after adjusting for several confounding factors. The association between weight change and ESRD risk in a subgroup analysis was significantly stronger in patients aged <65 years, without proteinuria, with BMI ≥ 25, with DM duration <5 years, and prescribed less than 3 classes of DM medication. Underweight patients showed higher ESRD risks than overweight patients. Weight loss >10% was associated with the fastest decline in renal function.