血液透析及腹膜透析治疗慢性肾功能衰竭疗效对比分析

目的对比分析血液透析及腹膜透析治疗慢性肾功能衰竭疗效。方法选取2009年7月~2013年11月在本科进行透析治疗的96例慢性肾功能衰竭患者。随机分为血液透析组和腹膜透析组各48例,比较两组患者透析治疗前后的临床表现、肾功能、生化指标的变化情况,以及并发症发生情况和存活率等。结果两组患者经过治疗后临床症状均明显好转,肾功能均得到明显改善,血尿素氮(BUN)、血肌酐(Scr)明显下降,血红蛋白(Hb)、血红细胞(RBC)明显上升,其中腹膜透析组的血红蛋白和血红细胞的上升幅度高于血液透析组(P0.05),白蛋白(ALB)水平低于血液透析组(P0.05),腹膜透析组的心血管疾病、脑血管疾病的发生率低于血液透析组(P0.05),低蛋白血症、感染的发生率高于血液透析组(P0.05),以上结果差异均具有统计学意义。腹膜透析组治疗后的血尿素氮(BUN)、血肌酐(Scr)水平,并发症发生率,半年、1年、3年存活率与血液透析组相比,无显著性差异(P0.05)。结论两种透析方式治疗慢性肾功能衰竭均有其优缺点,在临床上应根据患者的具体情况选择适当的透析方式,以减少病人并发症,增加生存率。     

腹膜透析与血液透析治疗急性肾功能衰竭的比较

目的:评价腹膜透析(PD)治疗急性肾功能衰竭(ARF)的疗效及适应征。方法:66例急肾衰病人分为两组,腹透组24例,血透组42例,比较两组病人的临床资料、治疗方法和预后。结果:腹透组和血透组少尿期持续时间分别为(23.1±14.4)天和(19.8±10.4)天(P>0.05),病死率分别为25%和31%(P>0.05),其中“高分解代谢”病死率分别为27.2%和25%(P>0.05),腹透组和血透组肾功能完全恢复者分别为63%和64%(P>0.05)。结论:腹膜透析是治疗急性肾衰的有效方法之一,且也适用于“高分解代谢”及有并发症的急性肾衰。     

腹膜透析与血液透析对慢性肾功能衰竭贫血的疗效比较

[目的]对比慢性肾功能衰竭（CRF）患者行连续性不卧床腹膜透析（CAPD）及血液透析（HD）治疗时贫血纠正的疗效.[方法]分析在本科行透析治疗6个月以上的CRF患者,共42例入选,分为CAPD组（18例,占42.8%）和HD组（24例,占57.2%）.两组患者均同时给予重组人促红细胞生长素、硫酸亚铁、叶酸等药物规律抗贫血治疗.记录患者一般资料、比较透析治疗2,4,6个月后的Hb值.[结果]CAPD组6个月后Hb值回升较HD组较快,但两组各时段相比差异无显著性.[结论]与HD相比,CAPD治疗CRF,患者贫血的恢复平稳且稍快.     

腹膜透析治疗慢性肾功能衰竭患者119例临床分析

慢性肾功能衰竭患者由于代谢产物潴留,并发症较多,死亡率高,经腹膜透析(ＰＤ)治疗后,可延长病员生命。本文统计了本院1987～1996年收治的经ＰＤ治疗的慢性肾功能不全尿毒症期患者共计119例,现报道如下:1　临床资料119例诊断为慢性肾功能不全尿毒症期患者中,男性74例,女性45例,年龄18～68岁,平均43±10岁。原发病分别为慢性肾小球肾炎87例(占731%),其余为慢性肾盂肾炎、糖尿病肾病、原发性高血压、尿酸性肾病、狼疮性肾炎、紫癜性肾炎、肿瘤相关性肾炎及肾移植术后排斥反应共计32例(占269%)。并发症:心血管并发症69例(占5859%),表现为高血压…     

血液透析和腹膜透析治疗蜂中毒引起的急性肾功能衰竭疗效观察

蜂中毒易出现急性肾功能衰竭 (acuterenalfailure ,ARF)和急性肝功能衰竭。血液透析和腹膜透析均为治疗急性肾功能衰竭的有效方法 ,我们对此类病例分组进行血液透析和腹膜透析 ,更进一步观察两种方法对蜂中毒的疗效。1　资料与方法1.1　病例选择　 1998～ 2 0 0 2年间收治蜂中毒患者 33例 ,男性 15例 ,女性 18例 ,年龄 2 9～ 5 1岁 ,平均 4 2 .5岁 ,病程 2～ 4天。所有病例均在毒蜂咬伤后出现少尿甚至无尿 ,并在当地经利尿剂治疗无效。入院后均急查肝肾功能、电解质、血尿常规和大便潜血等 ,结果显示 33例蜂中毒者血尿素氮 (BUN)、血肌酐…     

腹膜透析联合血液透析治疗肾功能衰竭的临床观察

目的观察分析腹膜透析联合血液透析治疗肾功能衰竭的临床效果。方法选取我院2011年6月-2012年5月收治的97例肾功能衰竭患者的临床资料进行研究分析,按患者住院尾号分为治疗组（49例）和对照组（48例）。治疗组患者采用腹膜透析联合血液透析的方式进行治疗,对照组患者采用腹膜透析的方式进行治疗,对比两组患者治疗的临床效果。结果对比两组患者出现并发症发生率有显著性差异,治疗组患者出现并发症发生率为6.12%,对照组患者出现并发症发生率为14.59%,差异具有统计学意义（P〈0.05）。治疗组患者治疗后白蛋白、血红蛋白、尿素氮以及肌酐等状况均显著优于对照组,具有统计学意义（P〈0.05）。结论腹膜透析联合血液透析的方式可以显著减缓患者肾衰竭的进程、减少并发症的出现、有效改善患者的肾功能、提高患者生命质量。因此,腹膜透析联合血液透析的方式值得在治疗肾功能衰竭的临床上推广应用。     

个体化腹膜透析治疗慢性肾功能衰竭的疗效

作者 1999年 1月至 2 0 0 0年 12月对 2 5例慢性肾功能衰竭 (ＣＲＦ)患者采用透析方式和剂量个体化的腹膜透析 ,临床效果较好 ,总结如下。1　临床资料1.1　一般资料　 2 5例均系在本院行腹膜透析 (ＰＤ)的ＣＲＦ患者 ,其中男 2 0例 ,女 5例 ,平均年龄 4 8(2 4～72 )岁。引起ＣＲＦ的原发病 :慢性肾炎 12例 ,小动脉性肾硬化症 8例 ,慢性间质性肾炎 2例 ,双肾多发性囊肿 ,痛风性肾病 ,服止痛药引起肾病各 1例。腹透时间为 2周至 4 .5年。除 3例使用国产腹透液外 ,余 2 2例均使用美国Ｂａｔｅｒ公司生产的腹透液进行腹透。1.2　治疗调整依据　…     

心理护理干预对持续性非卧床腹膜透析慢性肾功能衰竭患者的影响

目的 分析持续性非卧床腹膜透析（CAPD）慢性肾功能衰竭患者心理状态,并探讨相应的心理护理干预措施对其的影响.方法 采用回顾性方法分析,选择我院2013年1～6月收治的50例患者作为对照组,给予肾内科常规护理;2013年7～12月收治的50例患者作为观察组,在给予肾内科常规护理的基础上增加心理护理干预.比较2组患者SAS、SDS评分情况及对护理的满意度.结果 护理干预后,观察组患者的SAS评分、SDS评分明显低于对照组,差异有统计学学意义;观察组护理满意度、出院后回归社会率、再次选择我院率及推荐他人来我院率均高于对照组,差异有统计学意义.结论 对CAPD慢性肾功能衰竭患者实施心理护理具有重要意义,可消除患者抑郁及焦虑情绪,提高护理满意度,值得临床推广应用.     

重症急性肾功能衰竭病人腹膜透析和持续性血液透析/滤过的比较

目的　比较腹膜透析 (PD)和持续性静脉静脉血液透析 /滤过 (CRRT)对于重症急性肾功能衰竭病人的治疗。方法　采用病例回顾性调查方法 ,收集就治于本院的 2 0例重症急性肾衰竭病人的病例资料 ,其中行CRRT者 8例 ,行PD者 1 2例。具体包括一般资料 (年龄、性别、原发病和透析方式 ) ,疾病严重程度 (多器官功能衰竭和急性生理学和慢性健康评分 ) ,透析前和透析后连续 5d血尿素氮、肌酐、钾、二氧化碳结合力水平的变化 ,预后 (肾功能恢复和存活 ) ,透析相关并发症 ,平均每日透析费用。结果　CRRT和PD组病人的年龄、性别构成和疾病严重程度无不同 (P >0 0 5 )。透析后连续 5d血尿素氮、肌酐、钾和二氧化碳结合力的变化并无差异 (P >0 0 5 )。两组病人中肾功能恢复及存活者所占比例无显著性差异 (P >0 0 5 )。但CRRT组中 75 %的病人合并透析相关并发症 ,明显高于PD组 (P <0 0 5 )。CRRT组病人平均每日透析费用为 (32 2 0 94±95 32 )元 ,明显高于PD组的 (6 1 9 2 7± 1 0 8 9)元 (P <0 0 1 )。结论　PD与CRRT治疗重症急性肾衰竭的疗效相当 ,但PD技术更为简单和经济 ,应作为我国急性肾衰竭的首选透析方式     

基层医院慢性肾功能衰竭腹膜透析治疗临床分析

对我院收治的24例慢性肾功能衰竭患者,应用腹膜透析治疗,观察对比患者治疗前后的尿量、血红蛋白、血白蛋白、血尿素氮、血肌酐等指标变化。24例患者除1例患者由于脑出血抢救无效死亡外,其余23例患者治疗后上述指标都出现明显的改善,且P<0.05。应用腹膜透析来治疗慢性肾功能衰竭,简单全安,疗效良好,可以在基层医院进行临床推广应用。     

Risk of Dementia in Peritoneal Dialysis Patients Compared with Hemodialysis Patients

♦ Background: Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) vs peritoneal dialysis (PD) in a large national cohort.♦ Methods: This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from the USRDS registry.♦ Results: Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% vs 2.7%, 2.5% vs 5.3%, and 3.9% vs 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model.♦ Conclusions: Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms.     

腹透患者低血压的原因及对策探讨

目的：了解持续非卧床腹膜透析（CAPD）患者低血压的原因、对策及转归。方法：比较有低血压的CAPD患者与对照组的一般资料、营养状况、透析充分性、心脏功能、治疗和转归等。结果：低血压组与对照组在性别、年龄、透析时间、原发病的组成、血红蛋白、血白蛋白、肱三头肌皮肤皱褶厚度、尿素清除指数、血尿素氮和血清肌酐等方面无显著差异。低血压组的射血分数小于对照组。低血容量引起的低血压易纠正。低血压组的病死率高于对照组。结论：CAPD患者的低血压主要与低血容量、降血压药、心衰等有关，有效防治低血压的发生可以改善CAPD患者的预后。     

Equivalent Fall Risk in Elderly Patients on Hemodialysis and Peritoneal Dialysis

♦ Background:

Accidental falls are common in the hemodialysis (HD) population. The high fall rate has been attributed to a combination of aging, kidney disease-related morbidity, and HD treatment-related hazards. We hypothesized that patients maintained on peritoneal dialysis (PD) would have fewer falls than those on chronic HD. The objective of this study was to compare the falls risk between cohorts of elderly patients maintained on HD and PD, using prospective data from a large academic dialysis facility.

♦ Methods:

Patients aged 65 years or over on chronic in-hospital HD and PD at the University Health Network were recruited. Patients were followed biweekly, and falls occurring within the first year recorded. Fall risk between the 2 groups was compared using both crude and adjusted Poisson lognormal random effects modeling.

♦ Results:

Out of 258 potential patients, 236 were recruited, assessed at baseline, and followed biweekly for falls. Of 74 PD patients, 40 (54%) experienced 86 falls while 76 out of 162 (47%) HD patients experienced a total of 305 falls (crude fall rate 1.25 vs 1.60 respectively, odds ratio [OR] falls in PD patients 0.78, 95% confidence interval [CI] 0.61 – 0.92, p = 0.04). After adjustment for differences in comorbidity, number of medications, and other demographic differences, PD patients were no less likely to experience accidental falls than HD patients (OR 1.63, 95% CI 0.88 – 3.04, p = 0.1).

♦ Conclusions:

We conclude that accidental falls are equally common in the PD population and the HD population. These data argue against post-HD hypotension as the sole contributor to the high fall risk in the dialysis population.     

持续性非卧床腹膜透析患者退出原因的分析

【目的】探讨持续性非卧床腹膜透析（CAPD）患者退出治疗的原因及防治对策。【方法】回顾1997年5月至2009年2月因终末期肾病接受CAPD患者临床资料56例,统计分析患者腹膜透析（PD）退出原因。【结果】因各种原因退出PD共43例,退出率为76．78％（43／56）。其中主要原因为：①死亡,26例（60．47％）;②转血透10例（23．26％）;③肾移植3例（6．97％）;④经济原因2例（4．65％）。【结论】死亡是CAPD患者退出PD的主要原因。而心脑血管疾病、腹膜炎是导致CAPD患者退出的重要原因,因此应积极制定CAPD患者个体化透析方案。     

The Effect of Fluid Overload on Clinical Outcome in Southern Chinese Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

♦ Background:

Fluid overload is frequently present in dialysis patients and one of the important predictors of patient outcome. This study aimed to investigate the influence of fluid overload on all-cause mortality and technique failure in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD) patients.

♦ Methods:

This was a post hoc study from a cross-sectional survey originally designed to investigate the prevalence and associated risk factors of fluid overload defined by bioimpedance analysis (BIA) in CAPD patients from January 1, 2008, to December 31, 2009. All 307 CAPD patients completing the original study were followed up until December 31, 2012.

♦ Results:

With a median follow-up period of 38.4 (19.2 – 47.9) months, 52 patients died. Patients with fluid overload (defined by extracellular water/total body water [ECW/TBW] ≥ 0.40) had a significantly higher peritonitis rate (0.016 vs 0.011 events/month exposure, p = 0.018) and cerebrovascular event rate (3.9 vs 1.1 events/100 patient years, p = 0.024) than the normal hydrated patients. Moreover, the results showed a significant rising of all-cause mortality (log-rank test = 5.59, p = 0.018), and a trend of increasing cardiovascular disease (CVD) mortality (log-rank test = 2.90, p = 0.089) and technique failure (log-rank test = 3.78, p = 0.052) in the patients with fluid overload. Fluid overload independently predicted all-cause mortality (hazard ratio [HR] = 12.98, 95%, confidence interval [CI] = 1.06 – 168.23, p = 0.042) and technique failure (HR = 13.56, 95% CI = 2.53 – 78.69, p = 0.007) in CAPD patients after adjustment for confounders.

♦ Conclusions:

Fluid overload defined by BIA was an independent predictor for all-cause mortality and technique failure in CAPD patients. Continuous ambulatory peritoneal dialysis patients with fluid overload had a higher peritonitis rate, cardiovascular event rate, and poorer clinical outcome than those patients with normal hydration.     

慢性肾功能衰竭伴大量腹水患者行腹膜透析的护理

目的探讨慢性肾功能衰竭(chronic renal failure,CRF)伴大量腹水行腹膜透析(peritoneal dialysis,PD)患者的护理方法。方法回顾性分析并总结1993年9月至2013年11月,南京军区福州总院肾脏病科收治的28例CRF伴大量腹水行PD患者的临床资料。结果经PD治疗后,患者自觉腹胀症状改善明显,胸水、下肢浮肿消退,食欲改善;尿量增加,血清尿素氮(serum urea nitrogen,BUN)、肌酐(creatinine,SCr)下降;切口愈合好,未发生漏液。结论精心周到的护理是CRF伴大量腹水行PD患者手术成功和术后康复的重要保障。     

Cost Analysis of Hemodialysis and Peritoneal Dialysis Access in Incident Dialysis Patients

♦ Background: Although several studies have demonstrated the economic advantages of peritoneal dialysis (PD) over hemodialysis (HD), few reports in the literature have compared the costs of HD and PD access. The aim of the present study was to compare the resources required to establish and maintain the dialysis access in patients who initiated HD with a tunneled cuffed catheter (TCC) or an arteriovenous fistula (AVF) and in patients who initiated PD.♦ Methods: We retrospectively analyzed the 152 chronic kidney disease patients who consecutively initiated dialysis treatment at our institution in 2008 (HD-AVF, n = 65; HD-CVC, n = 45; PD, n = 42). Detailed clinical and demographic information and data on access type were collected for all patients. A comprehensive measure of total dialysis access costs, including surgery, radiology, hospitalization for access complications, physician costs, and transportation costs was obtained at year 1 using an intention-to-treat approach. All resources used were valued using 2010 prices, and costs are reported in 2010 euros.♦ Results: Compared with the HD-AVF and HD-TCC modalities, PD was associated with a significantly lower risk of access-related interventions (adjusted rate ratios: 1.572 and 1.433 respectively; 95% confidence intervals: 1.253 to 1.891 and 1.069 to 1.797). The mean dialysis access-related costs per patient-year at risk were €1171.6 [median: €608.8; interquartile range (IQR): €563.1 - €936.7] for PD, €1555.2 (median: €783.9; IQR: €371.4 - €1571.7) for HD-AVF, and €4208.2 (median: €1252.4; IQR: €947.9 - €2983.5) for HD-TCC (p < 0.001). In multivariate analysis, total dialysis access costs were significantly higher for the HD-TCC modality than for either PD or HD-AVF (β = -0.53; 95% CI: -1.03 to -0.02; and β = -0.50; 95% CI: -0.96 to -0.04).♦ Conclusions: Compared with patients initiating HD, those initiating PD required fewer resources to establish and maintain a dialysis access during the first year of treatment.     

Comparison of Direct Medical Costs Between Automated and Continuous Ambulatory Peritoneal Dialysis

♦ Objective: We set out to estimate the direct medical costs (DMCs) of peritoneal dialysis (PD) and to compare the DMCs for continuous ambulatory PD (CAPD) and automated PD (APD). In addition, DMCs according to age, sex, and the presence of peritonitis were evaluated.♦ Methods: Our retrospective cohort analysis considered patients initiating PD, calculating 2008 costs and, for comparison, updating the results for 2010. The analysis took the perspective of the Mexican Institute of Social Security, including outpatient clinic and emergency room visits, dialysis procedures, medications, laboratory tests, hospitalizations, and surgeries.♦ Results: No baseline differences were observed for the 41 patients evaluated (22 on CAPD, 19 on APD). Median annual DMCs per patient on PD were US$15 072 in 2008 and US$16 452 in 2010. When analyzing percentage distribution, no differences were found in the DMCs for the modality groups. In both APD and CAPD, the main costs pertained to the dialysis procedure (CAPD 41%, APD 47%) and hospitalizations (CAPD 37%, APD 32%). Dialysis procedures cost significantly more (p = 0.001) in APD (US$7 084) than in CAPD (US$6 071), but total costs (APD US$15 389 vs CAPD US$14 798) and other resources were not different. The presence of peritonitis increased the total costs (US$16 075 vs US$14 705 for patients without peritonitis, p = 0.05), but in the generalized linear model analysis, DMCs were not predicted by age, sex, dialysis modality, or peritonitis. A similar picture was observed for costs extrapolated to 2010, with a 10% - 20% increase for each component—except for laboratory tests, which increased 52%, and dialysis procedures, which decreased 3%, from 2008.♦ Conclusions: The annual DMCs per patient on PD in this study were US$15 072 in 2008 and US$16 452 in 2010. Total DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were attributable to the dialysis procedure, hospitalizations, and medications. In a multivariate analysis, no independent variable significantly predicted a higher DMC.     

Predictors and Outcomes of Transfers from Peritoneal Dialysis to Hemodialysis

♦ Introduction:

Peritoneal dialysis (PD) patients are commonly required to transfer to hemodialysis (HD), however the literature describing the outcomes of such transfers is limited. The aim of our study was to describe the predictors of these transfers and their outcomes according to vascular access at the time of transfer.

♦ Methods:

A retrospective cohort study using registry data of all adult patients commencing PD as their initial renal replacement therapy in Australia or New Zealand between 2004 – 2010 was performed. Follow-up was until 31 December 2010. Logistic regression models were constructed to determine possible predictors of transfer within both 6 and 12 months of PD commencement. Cox analysis and competing risks regression were used to determine the predictors of survival and transplantation post-transfer.

♦ Results:

The analysis included 4,781 incident PD patients, of whom 1,699 transferred to HD during the study period. Logistic models did not identify any clinically useful predictors of transfer within 6 or 12 months (c-statistics 0.54 and 0.55 respectively). 67% of patients commenced HD with a central venous catheter (CVC). CVC use at transfer was associated with increased mortality (hazard ratio 1.37, 95% confidence interval (CI) 1.11 – 1.68, p = 0.003) and a borderline significant reduction in the incidence of transplantation (subhazard ratio 0.76, 95% CI 0.58 – 1.00, p = 0.05).

♦ Conclusions:

It is difficult to predict the transfer to HD for incident PD patients. PD patients who commence HD with a CVC have a higher risk of mortality and a lower likelihood of undergoing renal transplantation.