缬沙坦对持续性不卧床腹膜透析者腹膜功能的影响

目的 探讨血管紧张素受体拮抗剂缬沙坦对长期腹膜透析者腹膜功能的影响.方法 选择在焦作市人民医院接受腹膜透析者51例,采用数字表法随机分为缬沙坦组（n=28）和对照组（n=23）,对照组未服用血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂类药物.观测并比较基线及1年后估计肾小球滤过率,行腹膜平衡实验,检测超滤量、透析液/血清肌酐（4 h）比值、透析液/葡萄糖浓度（4 h）比值.采用ELISA法检测隔夜腹膜透析液中转化生长因子β1以及血管内皮生长因子的含量.采用t检验进行数据统计.结果 基线时,两组患者临床资料差异无统计学意义（P＞0.05）.1年时,缬沙坦组与对照组估计肾小球滤过率均下降,分别为（3.1±1.8）、（2.1±1.9） ml/min,但对照组下降更为明显,与缬沙坦组比较差异有统计学意义（P＜0.05）.两组透析液/血清肌酐比值、透析液葡萄糖浓度比值差异无统计学意义,对照组超滤量增加更为明显,两组比较差异有统计学意义[对照组：基线时（351±210）ml/4 h,1年时（445±209） ml/4 h;缬沙坦组：基线时（336±198）ml/4 h,1年时（391±220）ml/4 h;P＜0.05].干预后,对照组转化生长因子β1和血管内皮生长因子的表达明显增加,与基线比较差异有统计学意义（P＜0.05）,而缬沙坦组干预前后转化生长因子β1和血管内皮生长因子的表达差异无统计学意义.结论 血管紧张素受体拮抗剂缬沙坦对腹膜透析者残余肾功能具有保护作用,可延缓腹膜透析者超滤衰竭的发生,抑制腹透液中腹膜纤维化相关因子的表达,进而抑制、延缓腹膜纤维化的发生和发展,保护腹膜功能.     

川芎嗪对慢性腹膜透析大鼠腹膜功能及间皮细胞形态的影响

目的 探讨不同剂量的川芎嗪对高糖透析液作用下慢性大鼠腹膜透析（腹透）模型腹膜间皮细胞的形态和功能的影响及它们之间的关系。方法 ４０只ＳＤ大鼠随机分为４．２５％腹透液（ＨＧ组）、４．２５％腹透液＋４０ｍｇ／Ｌ川芎嗪（ＨＧＬ组）、４．２５％腹透液＋１６０ｍｇ／Ｌ川芎嗪（ＨＧＨ组）、对照组。除对照组外,余３组每天分别腹腔内注入２０ｍｌ含不同剂量川芎嗪的４．２５％透析液［０（ＨＧ）、４０ｍｇ／Ｌ（ＨＧＬ）     

Effects of celecoxib on high-sensitivity C-reactive protein in chronic peritoneal dialysis patients

To evaluate the effects of celecoxib, a cyclooxygenase-2 inhibitor, on the level of high-sensitivity C-reactive protein (hs-CRP), D-dimer, von Willebrand factor (vWF) and troponin-T, 46 chronic peritoneal dialysis (CPD) patients with hs-CRP equal or greater than 0.25 mg/dL were randomized to the treatment group who took 200 mg of celecoxib daily for 4 weeks or to the control group who did not take the medication. The levels of hs-CRP, albumin, D-dimer, vWF and troponin-T were measured at baseline and at 4 weeks of the study. Baseline values of all the parameters were not significantly different between the two groups. In the control group, the levels of hs-CRP, albumin, D-dimer, vWF and troponin-T did not change. In the treatment group, administration of celecoxib for 4 weeks significantly reduced hs-CRP from median 0.77 (range 0.25-7.08) to 0.39 mg/dL (range 0.11-5.22, p<0.05). The levels of albumin, D-dimer, vWF and troponin-T levels were not affected by the administration of celecoxib. These results showed that celecoxib had an antiinflammatory effect in usual dosage in CPD patients.     

Effects of intraperitoneal heparin on peritoneal transport in a chronic animal model of peritoneal dialysis.

BACKGROUND: Heparin has anti-inflammatory effects and is often added to the peritoneal dialysis fluid to prevent fibrin formation. Conjugation of heparin to the surface of biomaterials has been shown to improve its biocompatibility. In this study, we describe for the first time an experimental chronic peritoneal dialysis model with repeated dwell studies in non-uraemic rats and evaluate the effect of addition of heparin to glucose-based peritoneal dialysis fluid on peritoneal fluid and solute transport. METHODS: Wistar male rats, weighing 340+/-15 g, with implanted peritoneal catheters were infused during 1 month, twice per day with 20 ml of Dianeal 1.36%+antibiotics (AB; n = 10) or Dianeal 1.36%+antibiotics+heparin 2500 U/l (HAB; n = 9). After 10 (DS 1) and 30 days (DS 2), a dwell study was performed in rats with free access to drinking water, by infusing 30 ml of Dianeal 3.86%. Dialysate samples were obtained at 0, 2, 30, 60, 120 and 240 min. Blood samples were drawn before and at the end of the dwell. Radiolabelled serum albumin was used as macromolecular volume marker. RESULTS: Peritoneal volumes during DS 1 were significantly greater for the HAB group as compared with the AB group. No differences in ultrafiltration were found during DS 2 for HAB vs AB. However, peritoneal volumes were significantly higher for DS 2 compared with DS 1 in the AB group. The amount of glucose absorbed over time did not differ between the solutions, while fluid absorption tended to be lower in the HAB group. CONCLUSIONS: Heparin may improve peritoneal fluid transport possibly due to better healing and reduced peritoneal inflammation as shown in this novel animal model of chronic peritoneal dialysis with repeated dwell studies.     

Renal transplantation of patients on chronic peritoneal dialysis

A retrospective review of patients transplanted from peritoneal dialysis was performed to assess the risk of this form of dialysis for patients awaiting renal transplantation. Eighteen transplants have been performed in 16 patients, ages 6 to 57 years, undergoing chronic peritoneal dialysis over the past 4 years. Sixteen were from cadaver donors, and two were from living related donors (LRD). The patients had been undergoing intermittent peritoneal dialysis or continuous ambulatory peritoneal dialysis (CAPD) using permanent silastic catheters, from five days to 4 years. No patient had clinical evidence for peritonitis at the time of transplantation. The peritoneal catheter was removed at the time of transplant in all cadaver donor recipients without complication. One recipient of a LRD kidney had the catheter removed two days prior to transplant. Cultures of the catheter were sterile in 16 cases. Two patients had positive peritoneal catheter cultures at the time of transplant but were treated with appropriate antibiotics and never developed clinical peritonitis. Fourteen transplants had postoperative fevers. No definite source was found in 13; one had fever in relation to acute graft rejection. The fevers resolved in all patients either spontaneously or subsequent to therapy. Other complications were similar to those seen in patients transplanted from hemodialysis. Hemodialysis was performed as needed pretransplant and posttransplant using a temporary femoral vein catheter or arteriovenous fistula without complication. Nine patients are alive with a functioning kidney 1 to 36 months posttransplant (mean 17 months). Six transplants rejected (five patients), and one failed secondary to renal vein thrombosis. Two patients died posttransplant, one after a cerebrovascular accident, and one due to an unknown cause 1 month postnephrectomy for rejection. In conclusion, patients undergoing chronic peritoneal dialysis can be successfully transplanted without a significant incidence of complications related to their peritoneal dialysis.     

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.     

Acinetobacter peritonitis during chronic peritoneal dialysis

Among gram-negative bacilli isolated during peritonitis in chronic peritoneal dialysis (CPD), Pseudomonas species are most common but Acinetobacter species are nearly as frequent. A survey of more than 450 patient-years' experience with CPD revealed 23 episodes of Acinetobacter peritonitis (AP), making this the second most common form of gram-negative peritonitis. Concomitant break in sterile technique and exit-site/tunnel infection were infrequent. AP appeared as the first peritonitis episode in five cases and as the second in six cases, and the duration of CPD at the time of AP ranged from less than 1 to greater than 56 months. However, AP was noted to appear shortly after treatment of another peritonitis episode or shortly after CPD access placement, within 2 months in 11 cases (47%) and within 3 months in 14 cases (61%). Treatment with intraperitoneal antibiotics succeeded in 21 cases (91%) without CPD interruption or catheter removal, with tobramycin or gentamicin alone in 16 cases, and with combined aminoglycoside and penicillin or cephalosporin in six cases. In two cases intraperitoneal antibiotics alone were insufficient therapy: one case with concomitant tunnel infection and dialysate leak and one case with bacteremia while receiving corticosteroids. The time-dependent incidence of AP suggests opportunistic infection during a vulnerable period in the first 2 to 3 months following another peritonitis episode, but AP also appears amenable to intraperitoneal antibiotic therapy alone without interruption of the CPD routine in the majority of cases.     

Coagulation abnormalities in chronic peritoneal dialysis

To determine whether children treated with chronic peritoneal dialysis have a hypercoagulable state, various coagulation and fibrinolytic factor concentrations or activities were measured in 17 children undergoing chronic peritoneal dialysis. The patients had significantly increased activities of factors VII and VIII and increased concentrations of von Willebrand factor (vWF), fibrinogen, factor XIIIA and factor XIIIS compared to reference values (P<0.001 in each case). The activated partial thromboplastin time was prolonged (P<0.001) and the thrombin clotting time was decreased (P<0.05) in these children. The prothrombin time and activities of factors XII, XI, IX, X, V and II were not significantly different from control values. Protein C concentrations were similar to normal, but antithrombin III concentrations were increased (P<0.05). Within the fibrinolytic pathway, decreased concentrations of plasminogen were found (P<0.001) and the concentrations of alpha-2-antiplasmin were increased (P<0.001). The plasma albumin concentration was below 33 g/l in 13 of the 17 children. The duration of treatment with peritoneal dialysis was directly correlated with vWF concentrations (P<0.001) and inversely correlated with factor VII concentrations (P<0.01). Of these patients 2 have since had clinical thrombotic episodes. The coagulation abnormalities found may have a role in the occurrence of thrombosis complicating renal transplantation.     

艾考糊精透析液对腹膜透析患者腹膜功能、容量负荷及代谢的影响

葡萄糖透析液是传统上广泛应用的腹膜透析液,在介导腹膜透析超滤、确保腹膜透析治疗成功中发挥重要作用.     

Eosinophilic peritonitis in children on chronic peritoneal dialysis

Eosinophilic peritonitis is a response of the peritoneum to foreign substances. It presents as cloudy dialysate and may be missed because not all laboratories report the eosinophil count, giving only the total number of polymorphonuclear cells. Over a 2-year period, eight children developed 13 episodes of eosinophilic peritonitis. Three episodes were asymptomatic other than cloudy fluid, five followed surgery and two were associated with gastroenteritis. Despite recurrent episodes, there were no adverse outcomes, although a raised peritoneal eosinophil count persisted in most cases. Eosinophilic peritonitis is under-diagnosed and may lead to unnecessary antibiotic therapy.     

黄芪改善腹透患者腹腔巨噬细胞功能的临床研究

目的：研究黄芪对尿毒症患腹腔巨噬细胞功能的影响。方法：对43例尿毒症初始行腹膜透析的患在腹透液中不加（对照组）和加入黄芪注射液（用药组）治疗1周,用ELISA法检测观察前后腹腔巨噬细胞分泌TNF－a能力和吞噬功能的变化。结果：黄芪用药组腹腔巨噬细胞吞菌率、吞噬指数、杀菌率和巨噬细胞分泌TNF－a水平和对照组相比均明显上升（P＜0．01）,巨噬细胞分泌TNF－a水平与用药前自身对比也显提高（P＜0．05）。结论：腹透液中加入黄芪注射液可提高腹透患腹腔巨噬细胞功能。     

Specialist pediatric dialysis nursing improves outcomes in children on chronic peritoneal dialysis

Chronic peritoneal dialysis (PD) for children in Singapore was instituted in 1988 at the National University Hospital with adult nurses providing dialysis services during the first 10 years. In 1998, a specialist pediatric dialysis nursing team was recruited. This study was conducted to determine the impact of dialysis nursing service on PD-related outcomes during the two nursing periods. Comparing the adult (group 1) and pediatric (group 2) nursing periods, the peritonitis rate was significantly higher in group 1 (RR 1.90; 95%CI 1.27–2.84), and this association did not weaken after adjusting for age, gender, and exit site infections. Exit site infection rate (RR 2.16; 95%CI 1.44–3.23), risk of peritonitis during the first year (RR 3.65; 95%CI 1.68–7.90), and multiple peritonitis attacks (RR 2.45; 95%CI 1.32–4.55) were higher in group 1. The peritonitis rates for adult patients cared for by the same adult nurses declined sharply from 1.05 episodes per patient-year between 1989 and 1992 to 0.41 episodes per patient-year between 1995 and 1997, however the corresponding pediatric rates did not change (1.48 to 1.06 episodes per patient-year, respectively) until the second era when specialized pediatric nurses were available. In conclusion, establishment of a specialist pediatric dialysis nursing team resulted in significant improvement in infection-related PD outcomes.     

Consequences of chronic inflammation in peritoneal dialysis

The mortality of end-stage renal disease (ESRD) patients, including those receiving long-term peritoneal dialysis (PD), has remained unacceptably high owing to the prevalence of cardiovascular disease. It is well recognized that both traditional Framingham risk factors and kidney disease-related risk factors may contribute to the high prevalence of cardiovascular disease in these patients. Of the different risk factors, chronic inflammation frequently is observed in long-term PD patients. The causes of inflammation are usually complex and multifactorial, involving both dialysis-related and dialysis-unrelated factors. Inflammation is strongly associated with cardiovascular disease and malnutrition, and has been shown consistently to be a powerful predictor of mortality and adverse cardiovascular outcomes in PD patients. In this article we review the prevalence and potential causes of chronic inflammation in PD patients. More importantly, we provide emerging evidence that shows the serious consequences of chronic systemic inflammation in PD patients and the important contribution of inflammation to adverse clinical outcomes.     

腹膜透析对心脏结构及功能的影响

腹膜透析(PD)、血液透析和肾移植是终末期肾病(CKD5期)的3种主要替代治疗方法.心血管疾病已成为CKD5期患者常见并发症和主要死亡原因之一.血液透析和肾移植在这方面的研究相对较多,而PD患者心脏的改变目前国内相关研究比较有限,本研究旨在探讨PD对CKD5期患者心脏结构与功能的影响.     

腹膜透析对心脏结构及功能的影响

腹膜透析(PD)、血液透析和肾移植是终末期肾病(CKD5期)的3种主要替代治疗方法.心血管疾病已成为CKD5期患者常见并发症和主要死亡原因之一.血液透析和肾移植在这方面的研究相对较多,而PD患者心脏的改变目前国内相关研究比较有限,本研究旨在探讨PD对CKD5期患者心脏结构与功能的影响.     

腹膜透析对心脏结构及功能的影响

腹膜透析(PD)、血液透析和肾移植是终末期肾病(CKD5期)的3种主要替代治疗方法.心血管疾病已成为CKD5期患者常见并发症和主要死亡原因之一.血液透析和肾移植在这方面的研究相对较多,而PD患者心脏的改变目前国内相关研究比较有限,本研究旨在探讨PD对CKD5期患者心脏结构与功能的影响.     

Serum and peritoneal dialysate thyroid hormone levels in patients on continuous ambulatory peritoneal dialysis

Thyroid function tests were performed on 16 clinically euthyroid patients with end-stage renal failure undergoing regular haemodialysis or continuous ambulatory peritoneal dialysis and compared with 8 healthy subjects. The patient groups were carefully matched, especially regarding relative duration of dialysis (mean of 24 months). Total serum thyroxine, total triiodothyronine, free thyroxine, free triiodothyronine and reverse triiodothyronine were significantly lower in both patient groups than control. The thyrothrophin response to the standard thyrotrophin-releasing hormone test was delayed and blunted. Using a novel concentration technique we measured loss of T4 in peritoneal dialysate effluent and found it to be approximately 10% of daily thyroidal T4 release.     

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。