高龄(≥70岁)早期非小细胞肺癌胸腔镜术后生存的预后因素分析

目的探讨影响高龄(≥70岁)Ⅰ期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者术后生存的预后因素。方法回顾性分析2003年4月~2013年12月我院211例70岁及以上Ⅰ期NSCLC的临床及随访资料,对影响术后生存的预后因素采用Kaplan-Meier生存分析、log-rank检验及Cox回归分析。结果中位随访时间39个月(0~93个月)。5年总生存率为66.9%,Kaplan-Meier生存分析和Cox单因素回归分析显示病变部位、病理分期、病变直径、分化程度、查尔森合并症指数(Chalson comorbidity index,CCI)对总生存期存在影响。Cox多因素回归分析显示:病变部位(HR=3.946,95%CI1.571~9.910)、病理分化(HR=2.003,95%CI 1.049~3.824)、肿瘤直径(HR=2.841,95%CI 1.478~5.462)及CCI(HR=3.920,95%CI 1.767~8.698)是影响高龄早期肺癌患者术后生存的独立预后因素。结论对于早期高龄NSCLC患者,CCI、病变部位、分化程度、肿瘤直径是影响术后生存的重要预后因素。CCI对长期生存预后有一定的价值。加强术前综合评估有利于指导预后。     

透析开始残余肾功能与维持性透析患者预后的关系

目的 评估终末期肾病患者透析开始残余肾功能与维持性透析预后的关系.方法 收集2005年1月1日至2009年9年30日新进入血透或腹透治疗的终末期肾病成年患者资料,随访至2010年3月31日.根据透析开始时估算肾小球滤过率(eGFR)分为≥10.5、8～＜10.5、6～＜8、＜6 ml· min-1·(1.73 m2)-1 4组.eGFR评估采用MDRD简化公式.终点事件为全因死亡和心脑血管死亡.结果 (1)共562例患者入选,透析开始中位eGFR为5.60(2.26～12.62) ml· min-1·(1.73 m2)-1;中位随访时间为17(0～58)个月 ;死亡141例,中位生存期为45.48(43.05 ～47.90)个月.随着透析开始eGFR下降,4组患者Scr、BUN、血尿酸(SUA)、血前白蛋白、血磷、血钙磷乘积、整段甲状旁腺激素(iPTH)、平均动脉压(MAP)逐渐升高 ;血红蛋白(Hb)、男性患者比例、并发糖尿病比例、Charison并发症指数≥5比例逐渐下降,差异均有统计学意义(均P＜ 0.05).随着透析开始eGFR下降,并发左室肥大比例有逐渐升高趋势,但差异无统计学意义.(2)Kaplan-Meier生存曲线显示4组患者总体生存率差异无统计学意义.Cox回归分析显示透析开始eGFR与透析预后无显著关系.对透析非早期(＞3个月)死亡患者进行Kaplan-Meier生存曲线分析,4组患者1年生存率差异无统计学意义.多因素Cox回归分析显示透析开始eGFR是透析1年生存预后的保护因素(HR =0.791,95％CI 0.669～0.935,P＜0.01).(3)以心脑血管死亡为终点事件,多因素Cox回归分析显示,透析开始eGFR是心脑血管生存预后(HR =0.868,95％CI 0.777～0.971,P＜0.05)和1年心脑血管生存预后(HR=0.937,95％CI 0.851～0.992,P＜0.05)的保护因素.(4)多因素Cox回归分析显示,透析开始eGFR增高1 ml·min-1·(1.73 m2)-1,腹膜透析患者死亡风险下降10％(HR=0.90,95％CI 0.81～0.99,P＜ 0.05).血液透析方式4组患者Kaplan-Meier生存率分析显示,差异有统计学意义(Log-rank检验,P=0.047),8～＜10.5组生存率最低,与6～＜8组、＜6组差异有统计学意义(Log-rank检验,P=0.033,P=0.005).多因素Cox回归分析并未显示透析开始eGFR与预后相关.多因素Cox回归分析提示透析开始eGFR增高1 ml·min-1·(1.73 m2)-1,慢性肾小球肾炎患者和慢性肾小球肾炎腹膜透析患者死亡风险分别降低16.6％(HR=0.834,95％CI 0.736～0.946,P＜0.01)和32.1％(HR=0.679,95％CI 0.535～0.862,P＜0.01).以心脑血管死亡为终点,多因素Cox回归分析显示透析开始eGFR增高1 ml·min-1·(1.73 m2)-1,慢性肾小球肾炎患者心脑血管死亡风险下降18.2％(HR=0.818,95％CI 0.669～0.999,P＜0.05).结论 本组患者透析时机明显晚于国际透析指南的标准.随着透析开始eGFR降低,并发症增多及程度加重.早期透析可能无法提高透析患者的总体生存率,但可能有助于改善患者心脑血管及1年总体生存预后和腹膜透析、慢性肾小球肾炎患者的预后.     

维持性腹膜透析与血液透析患者主动脉弓钙化的临床对比研究

目的:探讨腹膜透析(腹透)和血液透析(血透)患者主动脉弓钙化情况比较和危险因素分析,及主动脉弓钙化对两组患者生存预后影响。方法:177例腹透和147例血透患者入组,其中腹透组主动脉弓钙化病例66例,血透组88例。收集患者临床资料,评估残余肾功能,采用胸部X线检查评估主动脉弓钙化程度。分析比较两组患者主动脉弓钙化情况,二元logistics回归法分析主动脉弓钙化的独立危险因素; Kaplan-Meier生存分析主动脉弓对两组透析患者生存预后的影响及差异性。结果:血透组主动脉弓钙化发生率(59. 86%)高于腹透组(37. 29%),其轻度和重度钙化发生风险均高于后者,风险比分别为1. 884倍和2. 580倍;残余肾功能是影响两组透析患者主动脉弓钙化的独立因素(腹透组:OR=0. 762,95%CI0. 645~0. 901,P=0. 002;血透组:OR=0. 509,95%CI 0. 362~0. 717,P 0. 001),且腹透组残余肾功能平均水平显著高于血透组;两组透析患者中,中/重度主动脉弓钙化患者死亡风险显著高于无钙化者,其风险比,腹透组为17. 833倍,血透组为20. 056倍;中/重度主动脉弓钙化对透析患者死亡风险的影响在两组患者之间差异无统计学意义。结论:血透患者主动脉弓钙化发生率及钙化程度高于腹透患者,残余肾功能显著低于腹透患者是其主动脉弓钙化发生率及钙化程度高于后者的重要原因之一;两组中/重度主动脉弓钙化患者的死亡风险均显著高于同组无钙化患者。     

术前丙氨酸氨基转移酶与天冬氨酸氨基转移酶比值作为胰腺癌根治性胰十二指肠切除术预后标志物的临床研究

目的评估天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值(DRR)对于接受根治性胰十二指肠切除术的胰腺导管腺癌(PDAC)患者术后总生存的预测价值。方法回顾性分析2015年1月至2020年12月于解放军总医院行根治性胰十二指肠切除术且术后病理诊断为PDAC的137例患者临床资料, 其中男性97例, 女性40例, 年龄(58±10)岁。根据DRR最佳生存风险截断值将患者分组, 比较关键临床病理指标的组间差异。采用Kaplan-Meier法进行生存分析, 生存率比较采用log-rank检验。采用多因素Cox分析评估影响预后的危险因素。结果将137例PDAC患者依据DRR最佳截断值1.1分为两组:DRR≥1.1为高DRR组(n=29);DRR<1.1为低DRR组(n=108)。低DRR组患者累积生存率优于高DRR组, 差异有统计学意义(P=0.003)。多因素Cox回归分析结果显示, DRR≥1.1(HR=2.485, 95%CI:1.449～4.261, P=0.001)、术前胆道引流(HR=1.845, 95%CI:1.030～3.306, P=0.039)、淋巴结转移N2分期(HR=2....     

血液透析与腹膜透析对终末期肾衰竭患者脂质影响的调查与分析

目的：调查血液透析和腹膜透析对终末期肾衰竭患者脂质代谢的影响。方法：采用回顾性分析的方法调查尿毒症患者共96例,腹透及血透各48例,比较其各自透析前后脂质改变及透析后两组脂质改变有无差异。结果：（1）腹透治疗组三酰甘油（TG）、低密度脂蛋白（LDL）、极低密度脂蛋白（VLDL）较透析前明显升高（P〈0.01）,总胆固醇（TC）较透析前升高（P〈0.05）,高密度脂蛋白（HDL）较透析前降低（P〈0.05）,LP（a）较透析前无统计学差异;（2）血透组LDL、TG、LP（a）较透析前明显升高（P〈0.05）,HDL较透析前降低无统计学意义;（3）腹透组与血透组血脂变化比较：TG、LDL二者的升高腹透组较血透组明显（P〈0.05）,LP（a）升高血透较腹透明显（P〈0.05）。结论：透析会加重终末期肾衰竭患者的脂质异常,腹膜透析表现更明显,腹膜透析与血液透析存在统计学差异。血液透析在LP（a）的升高应引起重视。     

显微镜下多血管炎进入维持性血液透析的影响因素分析

目的:分析显微镜下多血管炎患者的长期患病后透析情况,探讨影响显微镜下多血管炎长期肾脏预后的主要危险因素。方法:对2013年1月01日~2018年12月31日我科收住显微镜下多血管炎患者进行回顾性研究。应用Kaplan-Meier法、Cox回归模型分析患者的生存资料。结果:共65例显微镜下多血管炎患者,进入维持性血液透析35例。Kaplan-Meier生存曲线显示后续免疫抑制剂使用明显改善生存时间,log rank=30.719,P=0.000。而发生肺部感染会明显缩短生存时间,log rank=10.134,P=0.001。而使用激素患者则因剂量不同而显示显著不同生存曲线,log rank=11.356,P=0.01。Cox回归分析显示随访中出现肺部感染(HR=2.772,95%CI 1.166~6.593,P <0.05)、发病时血肌酐(HR=1.003,95%CI 1.000~1.005,P <0.05)、是否使用免疫抑制剂(HR=0.152,95%CI 0.062~0.373,P <0.05),是显微镜下多血管炎进入维持性血液透析的主要危险因素。结论:随访中出现肺部感染、发病时血肌酐水平,是否使用免疫抑制剂,可能是显微镜下多血管炎进入维持性血液透析的主要危险因素。     

中性粒细胞-淋巴细胞比值预测胆管结石相关的肝内胆管癌患者术后生存率

目的 探讨中性粒细胞-淋巴细胞比值（NLR）对胆管结石相关的肝内胆管癌（ICC）患者术后总体生存率的预测价值。方法 回顾性分析2009年1月至2017年10月温州医科大学附属第二医院肝胆外科收治的77例胆管结石相关的ICC患者临床资料。将患者分为高NLR组（NLR＞3，n=35）和低NLR组（NLR≤3，n=42），比较两组间临床病理因素，术后总生存时间和1年生存率的差异，通过Cox模型进行单因素、多因素分析，明确影响患者预后的独立危险因素。结果 高NLR组中位生存时间为8个月，低NLR组中位生存时间为17个月，Kaplan-Meier分析显示，低NLR组的术后总生存时间长于高NLR组（P＜0.05），高NLR组与低NLR组1年生存率分别为42.9%和66.7%，差异具有统计学意义（P＜0.05）。多因素分析显示，NLR＞3（HR 2.15，95%CI 1.23～3.73，P=0.007）、淋巴结转移（HR 2.04，95%CI 1.10～3.76，P=0.023）、血管侵犯（HR 2.10，95%CI 1.10～4.00，P=0.024）为胆管结石相关的ICC患者预后的独立危险因素。结论 NLR＞3可以作为胆管结石相关的肝内胆管癌患者不良预后的评价指标之一。     

糖尿病肾病致终末期肾病行维持性腹膜透析患者心脏瓣膜钙化及预后的临床研究

目的:探讨糖尿病肾病致终末期肾病行维持性腹膜透析患者的心脏瓣膜钙化及预后的影响。方法:166例行维持性腹膜透析(腹透)患者入组,其中DN患者60例,收集所有腹透患者的一般资料、评估残余肾功能和透析充分性、记录心脏超声结果和用药情况。采用二元Logistics回归分析腹透患者的心脏瓣膜钙化独立危险因素;Kaplan-Meier生存分析不同原发病对腹透患者生存预后的影响。结果:166例腹透患者中心脏瓣膜钙化病例48例(28.92%),其中DN腹透患者22例(36.67%),DN患者发生心脏瓣膜钙化的风险是慢性肾炎患者的2.688倍(95%CI 0.170~0.812,P=0.012);DN是影响腹透患者心脏瓣膜钙化发生的独立危险因素,其风险比达3.895倍;DN组患者生存率与高血压肾病组相比差异无统计学意义(χ2=0.951,P=0.329),但低于慢性肾炎组患者(χ2=4.065,P=0.044),且死亡风险为3.365倍。结论:DN是维持性腹膜透析患者心脏瓣膜钙化的独立危险因素,其生存率低于慢性肾炎组患者。     

狼疮肾炎腹膜透析患者的长期预后研究

目的 探讨狼疮肾炎(LN)腹膜透析(腹透)患者的长期预后.方法 入选1995年5月1日至2013年4月30日期间在本院开始腹透且资料完整的LN患者(n=33),同时入选与其年龄、性别、并发症匹配的非LN腹透患者(n=33)作为对照组.所有入选患者均随访至死亡、退出腹透、转其他中心或至研究终止.采用Kaplan-Meier生存分析和Log-Rank检验比较两组患者的生存率、技术生存率和无腹膜炎生存率.结果 腹透开始时,LN组患者的估算肾小球滤过率(eGFR)、抗双链DNA (anti-dsDNA)和高敏C反应蛋白(hs-CRP)水平均明显高于对照组(均P＜ 0.05).截至研究终止,LN组患者有13例(39.4％)死亡,8例(24.2％)转血液透析(血透),5例(15.2％)肾移植,2例(6.1％)转其他中心.LN组患者最常见的死亡原因是感染(9例,69.2％),其中又以腹膜炎最常见(6例,46.2％),而对照组患者最常见的死亡原因是心血管疾病(5例,83.3％).Kaplan-Meier分析显示LN组患者的1、3、5年患者生存率为82％、49％、49％,明显低于对照组(x2=8.455,P=0.004).LN组患者的技术生存率也明显低于对照组(x2=6.753,P=0.009).LN组腹膜炎发生率为1次/20.5病人月,而对照组腹膜炎发生率为1次/67.6病人月.LN组患者的无腹膜炎生存率显著低于对照组(x2=8.256,P=0.004).结论 LN腹膜透析患者的长期预后较差.腹膜炎是LN腹透患者死亡和技术失败的主要原因.     

放化疗在胆囊腺鳞癌治疗中的预后价值

目的 胆囊腺鳞癌的预后很差,本研究目的是寻找胆囊腺鳞癌预后的影响因素,评价放化疗对胆囊腺鳞癌预后的意义。方法 从SEER数据库中分析2004年1月至2015年12月214例胆囊腺鳞癌患者的临床病例资料,采用Kaplan-Meier法分析患者预后的影响因素,采用单因素和多因素Cox分析法探讨胆囊腺鳞癌的独立预后因素。结果 胆囊腺鳞癌患者中位生存时间为8个月,1年生存率为34.4%,3年生存率为17.1%。多因素分析结果表明,年龄（HR 1.407,95%CI 1.019~1.944,P=0.038）、M分期（HR 2.219,95%CI 1.595~3.086,P<0.001）、放疗（HR 1.609,95%CI 1.010~2.564,P=0.045）、化疗（HR 1.594,95%CI 1.101~2.307,P=0.013）是胆囊腺鳞癌患者预后的独立因素。42例患者同时接受了化疗和放疗,中位总生存期（OS）为16个月,明显优于未放化疗组（121例,中位OS为5个月）和仅化疗组（49例,中位OS为10个月）。放化疗可提高患者的生存时间（χ²=12.25,P<0.05）。在TNM分期II期和IV期亚组中,同时接受化疗和放疗的胆囊腺鳞癌患者OS比仅接受化疗的患者更长。结论 年龄、M分期、放疗、化疗是胆囊腺鳞癌患者的独立预后因素,放疗联合化疗可以有效改善胆囊腺鳞癌患者的预后。     

Prognostic analysis of aged end-stage renal disease patients receiving hemodialysis and peritoneal dialysis

Objective To compare the survival rates of elderly hemodialysis (HD) and peritoneal dialysis (PD) patients and identify their independent prognostic predictors. Methods Patients aging ＞60 years old who initiated dialysis between January 1, 2008 and December 31, 2014 were included. Propensity score method (PSM) was applied to adjust for selection bias. Kaplan-Meier method was used to obtain survival curves and a Cox regression model was used to evaluate risk factors for mortality. Results 447 eligible patients with maintenance dialysis were identified, 236 with hemodialysis and 211 with peritoneal dialysis. 174 pairs of patients were matched, with the baseline data [age, gender, Charlson comorbidity index (CCI) and the primary disease] between two groups showing no significant difference (P＞0.05). Cardiovascular events, cerebrovascular events and infection were major causes of death in both groups and there was no significant difference in the causes of death between two groups (P＞0.05). The overall survival rates at 1 and 5 year were 93.6% and 63.4% respectively in HD group, 91.9% and 61.5% in PD group. The differences of total survival rates between HD and PD patients were not significant (P＞0.05). Cox regression analysis showed age(≥80 year) (P＜0.001, HR=1.058, 95%CI 1.028-1.088), diabetic nephropathy (P=0.001, HR=2.161, 95%CI 1.384-3.373), CCI≥5 (P=0.007, HR=1.935, 95%CI 1.201-3.117) were independent prognostic risk predictors in HD patients; age(≥80 year) (P=0.022, HR=1.043, 95%CI 1.006-1.081), serum albumin level ＜ 35 g/L (P=0.025, HR=1.776, 95%CI 1.075-2.934), and prealbumin (P=0.012, HR=0.968, 95%CI 0.944-0.993) were independent prognostic predictors in PD patients. Conclusions The differences of total survival rates between aged HD and PD patients are not significant. Age, diabetic nephropathy, CCI≥5 and age, serum albumin＜35 g/L, prealbumin＞30 g/L respectively influence the survival of elderly HD and PD patients.     

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.     

Survival analysis of pediatric dialysis patients in Taiwan

Aim: The long‐term survival of Taiwanese children with end‐stage renal disease (ESRD) has not been reported before. This study aimed to determine the long‐term survival, mortality hazards and causes of death in paediatric patients receiving dialysis. Methods: Paediatric patients (aged 19 years and younger) with incident ESRD who were reported to the Taiwan Renal Registry from 1995 to 2004 were included. A total of 319 haemodialysis (HD) and 156 peritoneal dialysis (PD) patients formed the database. After stratification by dialysis modality, multivariate Cox proportional‐hazards model was constructed with age, sex and co‐morbidity as predictive variables. Results: The annual paediatric ESRD incidence rate was 8.12 per million of age‐related populations. The overall 1‐, 5‐, and 10‐year survival rates for PD patients were 98.1%, 88.0% and 68.4%, respectively, and were 96.9%, 87.3% and 78.5% for HD patients. The survival analysis showed no significant difference between HD and PD (P = 0.4878). Using ‘15–19 years’ as a reference group, the relative risk (RR) of the youngest group (0–4 years) was 6.60 (95% CI: 2.50–17.38) for HD, and 5.03 (95% CI: 1.23–20.67) for PD. The death rate was 24.66 per 1000 dialysis patient‐years. The three major causes of death were infection (23.4%), cardiovascular disease (13.0%) and cerebrovascular disease (10.4%). Hemorrhagic stroke (87.5%) was the main type of foetal cerebrovascular accident. Conclusion: We conclude that there was no significant difference of paediatric ESRD patient survival between HD and PD treatment in Taiwan. The older paediatric ESRD patients had better survival than younger patients.     

Hemoglobin predicts long-term survival in dialysis patients: a 15-year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin

BACKGROUND: Dialysis patients have much higher mortality rates than the general population. Anemia is a common complication of uremia and a major contributor to morbidity and mortality in dialysis patients. The benefits of anemia correction using recombinant human erythropoietin (rHuEPO) are well established. Optimum hemoglobin level for dialysis patients remain controversial. We have investigated the association of enrollment hemoglobin with long-term survival in hemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS: We enrolled 529 HD and 326 PD patients from 1987 and followed them to April 2003. Demographics, enrollment, and clinical and laboratory data were recorded. The Kaplan-Meier method was used to compute observed survival, and the multivariate Cox regression analysis was used to identify the independent predictors of mortality risk. RESULTS: Mean ages of HD and PD patients were 60 +/- 16 (SD) and 54 +/- 16 (SD) years, respectively. Forty-seven percent of HD patients and 41% of PD patients were diabetic. Mean enrollment hemoglobin levels of HD and PD patients were 9.44 +/- 1.9 and 9.61 +/- 1.77 g/dL respectively. Cumulative 15 year observed survivals of HD (P = 0.05) and PD (P = 0.032) patients with hemoglobin levels greater or equal to 12 g/dL were higher than those with hemoglobin levels less than 12 g/dL. Hemoglobin <12 g/dL was a better predictor of mortality in nondiabetics than diabetics, particularly in HD patients. Both in HD and PD diabetic patients, hemoglobin was not a significant predictor of mortality. By Cox regression analysis, after adjusting for age, race, gender, and months on dialysis at enrollment, the relative risk of mortality of patients with hemoglobin <12 g/dL was 2.13-fold (P = 0.008) higher for HD and 1.85-fold (P = 0.06) higher for PD compared to those with hemoglobin >/=12 g/dL (P = 0.035). A logistic regression analysis revealed a strong inverse relationship between the hemoglobin level and the odds risk of death in HD (OR = 0.83, P = 0.008) and in PD (OR = 0.85, P = 0.02) patients. CONCLUSION: Enrollment hemoglobin is a predictor of long-term survival in HD and PD patients. Patients with hemoglobin levels that are higher than current treatment recommendations (>12 g/dL) may benefit from long-term survival. Survival of dialysis patients may be improved by better management of malnutrition and anemia.     

Comparison of cognitive function between patients with hemodialysis and peritoneal dialysis

Objective To evaluate whether dialysis modality will affect cognitive function in dialysis population. Methods This was a cross-sectional study. Chronic dialysis patients in our center was screened from July 2013 to July 2014. All of the subjects received brain magnetic resonance imaging (MRI) examination and comprehensive cognitive function evaluation. Results A total of 189 chronic dialysis patients were enrolled in this study, 122 cases on hemodialysis (HD) and 67 cases on peritoneal dialysis (PD). There was no significant difference in age between HD and PD groups [(56.4±13.2) years vs (56.4±16.1) years, t=0.004, P=0.997]. The dialysis vintage and serum albumin of HD patients was higher than those of PD patients[58.0(16.8, 107.5) months vs 31.0(7.0, 67.0) months, Z=-3.490, P＜0.001; (39.6±3.9) g/L vs (35.3±3.8) g/L, t=7.328，P＜0.001, respectively]. The prevalence of cerebral small vessel diseases (CSVDs) was comparable between HD and PD groups (all P＞0.05). Compared with HD patients, PD patients presented a 11.90-fold risk of immediate memory impairment (95%CI 1.40-101.08, P=0.023) and a 6.18-fold risk of long-delayed memory impairment (95%CI 2.12-18.05, P=0.001). After adjusting for age, educational lever, dialysis vintage, serum creatinine, and CSVDs, the influence of dialysis modality on memory still worked. PD patients presented a 43% risk of executive function impairment of HD patients (OR=0.43, 95%CI 0.17-1.04, P=0.061). Conclusions HD patients manifested better memory than PD patients, while PD probably performed better in executive function than HD patients. There was no significant difference in language function between the two groups. The difference in cognitive function may not be related to CSVDs.     

Survival and morbidity of HIV patients on hemodialysis and peritoneal dialysis: one center’s experience and review of the literature

Background Controversy continues concerning the morbidity and mortality of HIV-infected ESRD patients on the two dialysis options. This article presents our experience with complications and survival rate among our HIV-infected ESRD patients on peritoneal dialysis and hemodialysis. We reviewed the literature on this subject. Methods The charts of seven and eight HIV-infected ESRD patients on peritoneal dialysis and hemodialysis respectively, between January 1989 and November 2004, were reviewed retrospectively for specific clinical and demographic data. Their survival was calculated using the Kaplan-Meier method. Results Total follow-up of HIV-infected PD and HD patients was 248.3 and 207 patient months, respectively. There was no significant difference in hospitalization rate between HIV-infected PD and HD patients (1.01 and 1.39 admission/year, respectively, P = NS). Survival of HIV-infected patients on PD at one, two and three years was 100, 83, and 50%, and for HD patients was 75, 33, and 33%, respectively. HIV-infected patients on HD had more prevalent advanced HIV disease. Two out of seven PD patients were on PD for more than five years and one of the HD patients was on that form of dialysis for more than nine years. Median survival of patients with advanced (Stage IV) AIDS (both HD and PD) was 15.1 months (range 1.6–17.3) while this value for non-advanced (Stage II, III) patients was 61.2 months (range 6.8–116.6). Conclusion Type of renal replacement therapy does not have a significant effect on the morbidity and mortality of HIV-infected ESRD patients. Survival is worse in patients with advanced HIV disease. Both dialysis options provide similar results in HIV patients; hence, the choice of dialysis modality should be based on patient’s preference and social conditions.     

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.     

Risk factors for mortality in diabetic peritoneal dialysis patients

Objective To investigate the risk factors of all-cause mortality in diabetic patients on peritoneal dialysis (PD). Methods As a single-center retrospective cohort study, all incident PD patients who were catheterized at the First Affiliated Hospital of Nanchang University between November 1, 2005 and February 28, 2017 were included. Patients were divided into diabetes mellitus group (DM group) and non-diabetes mellitus group (NDM group). Outcomes were analyzed by Kaplan-Meier method. Multivariate Cox proportional hazards models were utilized to assess the risk factors of all-cause mortality. Results A total of 977 patients were enrolled. Compared with NDM group, patients in DM group were older (47.5±14.4 vs 59.3±11.3, P＜0.01), had more cardiovascular disease (CVD) (7.5% vs 20.3%, P＜0.01), higher levels of serum hemoglobin (78.2±17.2 vs 82.3±14.6 g/L, P＜0.01) , and lower levels of serum albumin (36.1±5.0 vs 32.7±5.6 g/L, P＜0.01). The one-, three- and five-year patient survival rates of DM and NDM group were 89.7%, 56.0%, 31.9% and 94.7%, 81.3%, 67.4%, respectively.Survival rate was significantly lower in DM group than in NDM group ( χ2=63.51, P＜0.01). Stratified analysis showed that DM group had significant lower survival rate than NDM group in patients younger than 70 years old ( χ2= 73.35, P＜0.01), while survival rate was similar between the two groups patients older than 70 years old ( χ2= 0.003, P=0.96). Multivariate Cox proportional hazards model analysis showed that DM (HR: 1.74, 95%CI: 1.27-2.38, P＜0.01), age (HR: 1.05, 95%CI: 1.04-1.06, P＜0.01), leukocyte (HR: 1.06, 95%CI: 1.00-1.12, P=0.04) and triglyceride (HR: 1.19, 95%CI: 1.07-1.32, P＜0.01) were all independent risk factors for all-cause mortality of PD patients. However, age (HR: 1.05, 95%CI: 1.04-1.07, P＜0.01) and alkaline phosphatase (HR: 1.01, 95%CI: 1.00-1.01, P=0.02) were independent risk factors for all-cause mortality of diabetic patients. Conclusions Long-term survival rate was lower in diabetic PD patients than in non-diabetic PD patients. DM, age, leukocyte and triglyceride were independent risk factors of mortality in PD patients. Age and alkaline phosphatase were independent risk factors of mortality in diabetic patients.     

Development and validation of a prognostic model for survival in peritoneal dialysis patients

Objective To develop and validate a nomogram for predicting the 1-and 3-year survival rates of patients receiving peritoneal dialysis. Methods Patients who underwent peritoneal dialysis for the first time in Zhujiang hospital from January 1, 2010 to December 31, 2017 were enrolled. The patients from January 1, 2014 to December 31, 2017 were enrolled in a training dataset. Baseline clinical data were collected and the primary endpoint was all-cause death. Cox proportional hazard regression models were used to analyze risk factors affecting the survival rates. Nomograms were generated using the R rms package. The Harrell' concordance index (C-index), receiver operating characteristic curve and calibration curve were used to verify the performance of the model. Patients who underwent peritoneal dialysis from January 1, 2010 to December 31, 2013 were then selected to validate the external predictive accuracy of the prediction models. Results The prediction cohort enrolled 457 patients, with a median follow-up time of 27.67(18.37, 39.22) months, and 64 patients (14.00%) died during follow-up. The 1-and 3-year cumulative survival rates were 96.4% and 83.0%. Multivariate analysis showed that aging (every 1 year old increase, HR=1.07, 95%CI 1.04-1.09, P﹤0.001), stroke (HR=3.63, 95%CI 1.93-6.85, P﹤0.001), higher cholesterol (every 1 mmol/L increase, HR=1.51, 95%CI 1.20-1.89, P﹤0.001), higher neutrophil-to-lymphocyte ratio (every 1 increase, HR=1.12, 95%CI 1.05-1.20, P=0.001), and lower albumin (HR=0.89, 95%CI 0.82-0.95, P=0.001) were independent risk factors affecting the survival rates of PD patients. The C-index of the prediction cohort and the validation cohort were 0.815(95%CI 0.765-0.865) and 0.804(95%CI 0.744-0.864, respectively). Both internally and externally verified calibration curves showed that the predicted results were close to the actual survival rates. Conclusion Based on age, blood total cholesterol level, stroke history, and NLR, the prognosis prediction model of peritoneal dialysis patients established with nomogram can help predict the 1-year and 3-year survival rates of peritoneal dialysis patients.