Prevalence and risk factors of sarcopenia in peritoneal dialysis patients

Objective To investigate the prevalence and risk factors of sarcopenia in peritoneal dialysis (PD) patients. Methods The patients who underwent regular peritoneal dialysis at Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine between November 2016 and March 2018 were enrolled. Handgrip strength (HGS) was measured to assess muscle strength. Bioelectrical impedance spectroscopy (BIS) was applied to measure the lean tissue index (LTI). Reduced LTI plus decreased HGS was defined as sarcopenia. The prevalence of sarcopenia in PD patients was evaluated. According to the presence or absence of sarcopenia, they were divided into the sarcopenia group and the non-sarcopenia group, and the differences in clinical indicators between the two groups were compared. Multivariate logistic regression was used to explore the risk factors of sarcopenia in PD patients. Results A total of 207 patients were enrolled in the study with age of (55.3±13.7) years and a median PD duration of 22.9(7.3, 60.9) months. Of them, 122 patients (58.9%) were male, 45 patients (21.7%) had diabetics and 32 patients (15.5%) suffered from cardiovascular diseases. There were 27 patients (13.0%) diagnosed with sarcopenia. These patients presented with longer PD duration, more prevalent diabetics, lower residual renal function (RRF) and serum pre-albumin, greater ratio of extracellular water to intracellular water (ECW/ICW) and high sensitive C-reactive protein in contrast with those in the non-sarcopenia group (all P＜0.05). Multivariate logistic analysis showed that male (OR=3.94，95%CI 1.35-11.50，P=0.012), longer PD duration (OR=1.01, 95%CI 1.00-1.02，P=0.029) and higher ECW/ICW (OR=1.09, 95%CI 1.05-1.14，P＜0.001) were independent risk factors of sarcopenia in PD patients. Conclusions Sarcopenia is common in PD patients. Male, longer PD duration and higher ECW/ICW were independent risk factors of sarcopenia in PD patients.     

Prevalence and risk factors of restless legs syndrome in maintenance peritoneal dialysis patients

Objectives To investigate the prevalence and its risk factors of restless legs syndrome (RLS) in maintenance peritoneal dialysis (PD) patients. Methods Patients who performed PD in the First Affiliated Hospital of Sun Yat-sen University were recruited by convenience sampling. International Restless Legs Syndrome Study Group diagnostic criteria and International Restless Leg Syndrome rating scale were used to diagnose and evaluate the RLS and its severity. Co-morbidities level, baseline demographic, clinical and biochemical data were collected to analyze the clinical characteristics of patients with RLS. Multivariate logistic regression analysis was used to assess the risk factors for RLS. Results A total of 421 PD patients were enrolled in this study. Their age was (46.3±12.8) years old, 44.2% were female and 17.3% with diabetes. The median vintage of PD was 46.8(28.0, 73.5) months. The prevalence of RLS was 14.0%, most of whom were affected with moderate or severe RLS. Logistic regression analysis showed that younger age, long-term dialysis duration, higher serum calcium and phosphorus were the risk factors associated with RLS in PD patients after adjustment for confounders (all P﹤0.05). Conclusions Prevalence of RLS in PD patients is 14.0%. Younger age, long-term dialysis duration, higher serum calcium and phosphorus were the risk factors associated with RLS.     

Prevalence and risk factors of restless legs syndrome in peritoneal dialysis patients

Objective To investigate the prevalence of restless legs syndrome (RLS) in peritoneal dialysis patients and analyze the related risk factors. Methods This study was a cross-sectional study. The patients receiving maintenance peritoneal dialysis from January 2017 to December 2017 in the Peritoneal Dialysis Center of the Second Hospital Affiliated to Soochow University were selected as the study subjects. RLS was screened for peritoneal dialysis patients by epidemiological field investigation based on the RLS diagnostic criteria of the International Restless Leg Syndrome Research Group in 2014. Clinical data and laboratory examinations of selected patients were collected and the differences of clinical indicators between RLS and non-RLS patients were compared. The risk factors related to RLS were analyzed by logistic regression. Results Seventy-six cases of RLS were screened out from 396 PD patients. The prevalence of RLS was 19.2%. Compared with non-RLS group, RLS group patients had longer dialysis age, less 24 hours urine volume, and elevated blood intact Parathormone (iPTH) and alkaline phosphatase (AKP) (all P﹤0.05). There was no significant difference in primary disease ratio, sex, age, body mass index, blood pressure, hemoglobin, creatinine, urea nitrogen, uric acid, ferritin, serum iron, transferrin saturation, blood calcium, blood phosphorus, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, eGFR, Kt/V, Ccr between RLS and non-RLS group patients (all P﹥0.05). Multivariate logistic regression analysis showed that long dialysis age (OR=1.010, 95%CI 1.001-1.018, P=0.022) and high blood AKP (OR=1.005, 95%CI 1.001-1.010, P=0.021) were independent risk factors for RLS in peritoneal dialysis patients (both P﹤0.05). Conclusions The prevalence of RLS is high in peritoneal dialysis patients. Long dialysis age and high blood AKP are independent risk factors for RLS.     

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.     

Prevalence and risk factors of exit-site infection in elderly peritoneal dialysis patients

Objective To explore the prevalence and risk factors of exit-site infection (ESI) in elderly peritoneal dialysis (PD) patients. Methods The status of exit-site was evaluated in elderly PD patients (≥60 years) who had catheter insertion in our center between January 1, 2009 and December 31, 2013, with follow-up for 1 year or withdrawing from peritoneal dialysis in this period. The patients were divided into ESI and non-ESI group. The data was collected including demographics, clinical features, and nursing care methods of the exit-site. Results A total of 247 patients were recruited in this study, aged (68.6±6.2) years, among whom there were 132 male (53.4%) and 119 diabetes (48.2%). Median follow-up time was 12.0 months. Thirty-two patients had 34 episodes of ESI with a rate of 82.5 patient-months per episode (0.15 episodes per year). Coagulase-negative Staphylococcus was the main pathogen, accounting for 35.3% of the ESI. No bacterial growth was found in 8.8%. The exit-site nursing care status included that poor compliance of exit-site care 23.5%, poor catheter immobilization 62.3%, history of catheter-pulling injury 9.7%, mechanical stress on exit-site 5.3%, improper frequency of nursing care 29.6%, mupirocin usage 13.8%, patients taking exit-site care 26.7%, exit-site caregiver instability 16.6%. There were no differences in demographic (such as age, gender, primary disease, etc) and laboratory data (hemoglobin, serum albumin, blood potassium, etc) between the ESI and non-ESI groups. Poor compliance with exit-site care (HR=2.352, 95%CI 1.008-5.488, P=0.048), poor catheter immobilization (HR=3.074, 95%CI 1.046-9.035, P=0.041) and exit-site caregiver instability (HR=2.423, 95%CI 1.004-5.845, P=0.049) were significantly correlated with increased risk of ESI. Conclusions The prevalence of ESI in elderly PD patients was 0.15 episodes per year. Educating PD patients to improve the compliance with exit-site care, maintain catheter immobilization and do exit-site care by a stable and trained caregiver may reduce ESI events in elderly PD patients.     

腹膜透析患者β 2微球蛋白水平变化及其影响因素

目的:分析持续不卧床腹膜透析患者血清β 2微球蛋白水平与临床指标的关系,探讨β 2微球蛋白升高的相关危险因素。 方法:本研究为回顾性研究,选取2015年1月至2019年8月于东莞东华医院血液净化科接受腹膜透析的患者,根据β 2微球蛋白三分位数水平分为3组,比较其临床和实验室...     

Prevalence and risk factors for hepatitis C virus infection in continuous ambulatory peritoneal dialysis patients

BACKGROUND.: Studies on hepatitis C virus antibodies (Anti-HCV) in CAPD patientsare scarce and include a small number of patients. Nevertheless,risk factors related to Anti-HCV in these patients are stillsubject to controversy. PURPOSE OF THE STUDY.: To analyse the incidence and risk factors associated with thepresence of Anti-HCV in CAPD patients. METHODS.: We studied 255 patients from five different treatment centresof our region. The analysis was repeated after excluding 161patients who had previously received haemodialysis treatmentat least once. Anti-HCV testing was made by the 2nd-generationELISA. As a supplementary test we used RIBA-4 in three centersand INNOLIA in the other two. Risk factors were analysed usinglogistic regression model for multivariate analysis. RESULTS.: In the whole group, 29 patients (11.4%) were anti-HCV positive.Logistic regression analysis determined the following variablesas independent risk factors: hepatitis previous to CAPD (P<0.0001,odds ratio (OR): 44.9), Anti HBc positivity (P=;0.019, OR: 9.24),blood transfusions previous to CAPD (P=;0.015, OR: 1.05) andCAPD duration (P=0.025, OR: 1.02). When patients who had previouslyundergone haemodialysis were excluded, the prevalence of HCVantibodies was 8.5% (8/94). In this group multivariate analysisshowed that Anti-HCV positivity correlated with hepatitis previousto CAPD (P<0.0003, OR: 126) and Anti HBc positivity (P=0.002,OR: 41.9). CONCLUSIONS.: Our prevalence of hepatitis C virus (HCV) infection in CAPDpatients was lower than other renal replacement therapy modalities,and correlated to events occurring mainly before starting CAPDtreatment. This technique could be considered as low risk forHCV infection.     

Association of serum magnesium with cardiovascular mortality and all-cause mortality in peritoneal dialysis patients

Objective To investigate the association of serum magnesium with cardiovascular disease (CVD) and all-cause mortality in peritoneal dialysis patients. Methods A retrospective study was performed in patients who initiated peritoneal dialysis from January 1, 2013 to July 31, 2019 in the Shaoxing People's Hospital. According to the standard of serum magnesium, the patients were divided into control group (Mg≥0.7 mmol/L) and low-magnesium group (Mg﹤0.7 mmol/L). The differences in baseline biochemical variables, comorbidities, medications, and clinical outcomes between the two groups were compared. Logistic regression was used to analyze the related factors of hypomagnesemia. Kaplan-Meier survival analysis and Fine-Gray model were used to compare the difference in cumulative survival rate between the two groups. Cox regression model and competitive risk model were used to analyze the risk factors of all-cause mortality and CVD mortality. Results A total of 381 peritoneal dialysis patients were enrolled in this study. Among them, 321 patients were in control group and 60 patients in low-magnesium group. The total median follow-up time was 27(15, 43) months. There were significant differences in serum albumin, magnesium, phosphorus, intact parathyroid hormone, low-density lipoprotein chloesterol, high sensitivity C-reactive protein and 4-hour dialysate-to-plasma creatinine (4 h D/Pcr) between the two groups. CVD was the main cause of death in patients on peritoneal dialysis. Multivariate logistic regression analysis showed that hypoalbuminemia (OR=0.901, 95%CI 0.831-0.976, P=0.011), hypophosphatemia (OR=0.217, 95%CI 0.080-0.591, P=0.003), higher hsCRP (OR=1.276, 95%CI 1.066-1.528, P=0.008), and higher 4 h D/Pcr (OR=1.395, 95%CI 1.014-1.919, P=0.041) were independent risk factors for patients with hypomagnesemia. Kaplan-Meier survival curve analysis showed the cumulative survival rate of patients in low-magnesium group was significantly lower than that of control group (Log-rank χ2=5.388, P=0.020). Fine-Gray model analysis showed the cumulative CVD survival rate of low-magnesium group was significantly lower than that of control group (Gray=6.915, P=0.009). Multivariate-corrected Cox regression model and competitive risk model analysis showed that higher serum magnesium level was a protective factor for all-cause mortality and CVD mortality when serum magnesium was used as a continuous variable (HR=0.137, 95%CI 0.020-0.946, P=0.044; SHR=0.037, 95%CI 0.002-0.636, P=0.023, respectively). Hypomagnesemia was an independent risk factor for all-cause mortality and CVD mortality when serum magnesium was used as categorical variable (HR=1.864, 95%CI 1.044-3.328, P=0.035; SHR=2.117, 95%CI 1.147-3.679, P=0.029, respectively). Conclusions Hypomagnesemia is susceptible to peritoneal dialysis patients with hypoalbuminemia, hypophosphatemia, higher hsCRP and higher peritoneal transport characteristics. Hypomagnesemia is an independent risk factor for CVD mortality and all-cause mortality in peritoneal dialysis patients.     

Risk factors for catheter-related complications in pediatric peritoneal dialysis

Catheter-related complications, including infection, dialysate leak, and malfunction, are the principal causes of peritoneal dialysis (PD) failure. To determine risk factors predisposing to these complications, we conducted a retrospective study of 90 children on chronic PD who received 127 catheters from January 1990 to December 2000. There was a significant risk for dialysate leak when PD catheters were used early (14 days post placement) versus delayed use (>14 days). There was no significant difference in malfunction and infection rate between early and delayed use groups. Weight and height <5th percentile, low serum albumin, and history of abdominal surgery were not associated with an increased risk of complications. History of dialysis prior to catheter placement and presence of a gastrostomy tube (G-tube) were both associated with significant infection risk. Patients 3 years old were more likely to have a G-tube and had an increased risk of infection. We conclude that delayed use of the PD catheter led to a lower incidence of dialysate leak but had no effect on infection rate. Young age, G-tube, and history of prior dialysis are risk factors for infection. Multi-center, prospective controlled studies involving larger numbers of children are important to confirm these findings.     

慢性肾衰竭腹膜透析患者的预后分析

目的分析慢性肾衰竭腹膜透析患者的生存率及预后影响因素。方法回顾性调查2003年1月至2011年6月在我院规律随访的353例腹膜透析患者,总结患者的预后和退出原因,比较死亡患者与继续腹膜透析患者临床指标差异,分析患者死亡的危险因素和独立危险因素。结果353例患者中退出159例,其中死亡74例,死亡原因主要是心血管疾病。腹膜透析患者1年、2年、3年、4年的生存率分别为92％、80％、68％、58％。Logistic回归分析显示,年龄、糖尿病肾病、血红蛋白、血白蛋白和血肌酐是患者死亡的危险因素。COX回归分析显示,年龄、血红蛋白和血肌酐是死亡的独立危险因素（均P〈0．05）。结论根据年龄、血红蛋白和血肌酐水平可以对腹膜透析患者预后做初步判断,重视患者的营养状况,有利于改善预后、降低死亡率。     

频发腹膜透析相关性腹膜炎的临床特征及危险因素的探讨

目的探讨频发腹膜透析相关性腹膜炎的临床特征及危险因素。方法回顾性分析2007年1月至2014年12月安徽医科大学附属省立医院腹膜透析置管后行持续性非卧床腹膜透析的尿毒症患者,选择1年内发生腹膜炎≥2次者定义为频发组,1年内仅发生1次腹膜炎者定义为单发组,比较2组临床及实验数据差异,并分析频发腹膜透析相关性腹膜炎的危险因素。结果频发组13例,发生感染性腹膜炎30例次,单发组57例,发生感染性腹膜炎57例次。频发组与单发组相比,患者血压和体质量指数明显升高(P0.05),未及时治疗者[7例(53.85%)比13例(22.81%)]及抗感染疗程不足者[5例(38.46%)比8例(14.04%)]增多(P0.05),无效拔管率[5例(38.46%)比7例(12.28%)]增加(P0.05),血红蛋白、血白蛋白显著降低(P0.05),全段甲状旁腺素水平升高(P0.05)。病原学检查分析频发组革兰阴性菌感染率(33.33%)及真菌感染率(10.00%)均较高,但以革兰阴性菌增加的趋势最明显(P=0.035)。2组间置管时年龄、性别、透析时间、文化程度、腹膜炎诱因、病死率、残余肾功能、外周血白细胞、血钙、血磷、C反应蛋白、血总胆固醇、三酰甘油、首次腹透液白细胞数比较差异均无统计学意义。Logistic回归分析显示高体质量指数、严重高血压、低血红蛋白、低血白蛋白为频发腹膜透析相关性腹膜炎的危险因素。结论营养不良、体质量指数过高、严重高血压为腹膜透析者频发腹膜炎的危险因素,积极纠正低蛋白血症、控制血压、保持标准体质量指数,积极按时规范治疗腹腔内源性感染有助于该病的预防和控制。     

Associations of low serum total bilirubin level with all-cause mortality and cardiovascular mortality in peritoneal dialysis patients

Objective To investigate the association of low serum total bilirubin (TBIL) level with all-cause mortality and cardiovascular mortality in peritoneal dialysis patients. Methods As a single-center, retrospective, cohort study, all the patients who underwent peritoneal dialysis catheterization in the Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University and started peritoneal dialysis for more than 3 months from January 1, 2006 to December 31, 2010 were included. Demographics, baseline clinical and laboratory test results were collected. All patients were followed up until December 31, 2012. Patients were divided into 4 groups according to their baseline serum TBIL levels (interquartile range). Kaplan-Meier method was used to compare the survival rate of each group. Cox regression model was used to analyze the association of TBIL with all-cause mortality and cardiovascular mortality. Logistic regression was used to analyze the influencing factors of low TBIL level. Results A total of 880 peritoneal dialysis patients with baseline TBIL data were enrolled in this study, with age of (48.0±15.4) years old, among whom 59.0% were male. Median TBIL was 4.5 μmol/L and interquartile range was 3.4-5.8 μmol/L. The comparison between TBIL quartile groups showed that the difference in proportion of diabetics, Charlson comorbidity index, hemoglobin, serum albumin, serum calcium, intact parathyroid hormone, urea nitrogen, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was statistically significant (all P＜0.05), while the difference in body mass index (BMI), estimated glomerular filtration rate, serum creatinine, urea nitrogen, uric acid and phosphorus was not statistically significant. After a median follow-up of 31 months, 194 patients died, 104 of which were cardiovascular deaths. Kaplan-Meier curves showed higher all-cause mortality in patients with TBIL≤3.4 μmol/L (Q1 group) (P=0.032) and there was no statistical difference in the cardiovascular mortality among different groups. After adjusting for biochemical indicators such as demographics, comorbidities, and liver function, taking baseline TBIL Q2 level (3.4＜TBIL≤4.5 μmol/L) as a reference, the hazard ratio for all-cause death in patients with TBIL≤3.4 μmol/L was 1.702 (95%CI 1.093-2.650, P=0.019), and the hazard ratio for cardiovascular death was 1.760 (95%CI 0.960-3.227, P=0.068). Multiple logistic regression analysis results showed that diabetes (OR=1.065, 95%CI 1.010-1.122, P=0.019) and high BMI (OR=1.838, 95%CI 1.056-3.197, P=0.031) were risk factors for baseline serum TBIL≤3.4 μmol/L. However, high hemoglobin (OR=0.990, 95%CI 0.982-0.998, P=0.011), high serum albumin (OR=0.950, 95%CI 0.916-0.985, P=0.006) and high ALT (OR=0.998, 95%CI 0.976-0.999, P=0.036) were the protective factors for patients with baseline serum TBIL≤3.4 μmol/L. Conclusion Baseline serum TBIL≤3.4 μmol/L in peritoneal dialysis patients is independently associated with all-cause mortality, and is not significantly associated with cardiovascular mortality; and baseline serum TBIL≤3.4 μmol/L occurred is associated with diabetes, high body mass index, low levels of hemoglobin, serum albumin and ALT.     

Reasons for the dropout of peritoneal dialysis patients

Objective To explore the reasons for withdrawal from peritoneal dialysis (PD) in our hospital. Methods This was a single-center, retrospective cohort study. Patients who started PD in the Department of Nephrology, the First Affiliated Hospital of Nanchang University from November 1st, 2005 to February 28th, 2017, were enrolled, and followed up to May 31, 2017. Patients who continued PD after May 31, 2017 were as the control group. Patients who withdrew from PD were divided into 4 subgroups: death group, hemodialysis group, kidney transplantation group and loss of follow-up group. The clinical characters of 4 subgroups were compared with the control group. Results A total of 998 patients were enrolled with age of (49.36±14.94) when PD started and median dialysis duration of 27.13(12.84, 42.29) months, in whom 570 patients (57.11%) were male. Five hundred and seventeen dropout events were recorded, and the dropout rate was 51.80%. The main reason for withdrawal from PD was death (258 patients, 49.90%), followed by hemodialysis (166 patients, 32.11%), kidney transplantation (66 patients, 12.77%) and loss to follow-up (27 patients, 5.22%). The leading cause of death was cardio-cerebro-vascular diseases (136 cases, 52.71%), followed by infection (42 cases, 16.28%), dyscrasia (20 cases, 7.75%) and tumor (5 cases, 1.94%). The main reason for transfering to hemodialysis was insufficient dialysis (76 cases, 45.78%), followed by peritonitis (55 cases, 33.13%) and catheter dysfunction (24 cases, 14.46%). Compared with those in the control group, in the death group patients were older at PD commencement, and had higher proportions of hypertension, diabetes and cardio-cerebro-vascular diseases (all P＜0.05). The proportions of male and diabetes mellitus were higher in the hemodialysis group than those in the control group (both P＜0.05). Biochemical indicators showed that serum albumin and blood phosphorus were lower in the death group than those in the control group (both P＜0.05); blood albumin was significantly lower in the hemodialysis group than that in the control group (P＜0.05). Conclusions The main reasons for withdrawal from PD in our center are death and transfering to hemodialysis. The cardio-cerebro-vascular disease is the leading cause of death, and inadequate dialysis is the main reason for transfering to hemodialysis.     

Association between red cell distribution width and mortality in patients undergoing continuous ambulatory peritoneal dialysis

Objective To investigate the association of red cell distribution width (RDW) with all-cause and cardiovascular disease (CVD)-related mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods A retrospective analysis was performed on 207 patients who initiated CAPD for more than 3 months between July 2005 and March 2016 in the First Hospital Affiliated to Zhengzhou University. Baseline data on demographic, clinical and biochemical variables as well as comorbidities were obtained; medications and clinic outcomes were recorded. According to receiver operator characteristic curve (ROC) analysis, patients were divided into high RDW (RDW＞15.1%) and low RDW (RDW≤15.1%) groups. The data of two groups were compared and Spearman's correlation analysis was used to explore the association of RDW with clinical and biochemical parameters. Survival curves were calculated using Kaplan-Meier method. Cox regression model was employed to analyze risk factors of all-cause and CVD-related mortality. Results In this study, 207 CAPD patients were enrolled. The overall median survival time was 80 months. And the median survival time of high RDW group (68 patients) and low RDW group (139 patients) were 59 months and 96 months, respectively. There were statistical differences in diastole pressure, hemoglobin, hematocrit, serum albumin, intact parathyroid hormone (iPTH), eGFR, cholesterol, lipoprotein a, 4-hour dialysate-to-plasma ratio for creatinine (4hD/Pcr), total Ccr (P＜0.05, respectively); the two groups also varied in the proportion of chronic obstructive pulmonary disease, cardiovascular disease and hyperlipidemia, as well as in the use of iron supplements, angiotensin-converting enzyme (ACE) inhibitors or angiotensin Ⅱ receptor blockers (ARB), and beta-receptor blockers (P＜0.05, respectively). Cardiovascular event was a leading cause of mortality. Kaplan-Meier survival curves showed that the high RDW group had higher all-cause and CVD-related mortality compared with the low RDW group (P＜0.01). The 1-year, 3-year, and 5-year patient survivals of the high RDW and low RDW group were 87.97% vs 97.01%, 58.02% vs 81.53%, and 41.62% vs 67.96%, respectively, demonstrating significant differences (P=0.001). Multivariate Cox regression analysis showed that high RDW was independent risk factor for all-cause mortality (HR=1.212, 95%CI: 1.007-1.458, P=0.042) and CVD-related mortality (HR=1.697, 95%CI:1.030-2.795, P=0.038). Conclusion RDW is associated with mortality risks in CAPD patients and can be stratified as a valuable indicator for the risk of death.     

腹膜透析患者动脉硬化评价及其影响因素分析

目的评估中青年(19~60岁)非糖尿病腹膜透析患者动脉硬化情况,并分析其危险因素。方法研究对象为中青年(19~60岁)非糖尿病腹膜透析患者86例,收集患者基础资料(患者身高、体质量指数、血压、透析时间、用药史、尿量等)、臂-踝脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)及各项实验室指标(肝肾功能、血脂、电解质、甲状旁腺素、超敏C反应蛋白、缺血修饰白蛋白),并对相关指标进行分析。结果依据患者baPWV是否升高(baPWV1 400 ctn/s为升高)分为高baPWV组(39例)和正常baPWV组(47例)。高baPWV组患者较正常baPWV组baPWV明显升高[(1 961±412)cm/s比(1 349±234)cm/s],且透析时间、缺血修饰白蛋白水平[(95.8±6.0)kU/L]、超敏C反应蛋白[(5.1±1.0)mg/L]较正常baPWV组高,总尿素清除指数(1.8±0.9)、总肌酐清除率[(56.5±11.4)L·周~(-1)·(1.73 m~2)~(-1)]、残余肾小球滤过率[(3.8±1.0)L·周~(-1)·(1.73 m~2)~(-1)]、血白蛋白[(31.6±5.3)g/L]较正常baPWV组低,差异均有统计学意义(P0.05)。Pearson相关分析显示腹膜透析患者baPWV与透析时间、血钙、缺血修饰白蛋白、超敏C反应蛋白呈正相关(r值分别为0.54、0.48、0.49、0.51,P值均0.05),与总尿素清除指数、残余肾小球滤过率、血白蛋白呈负相关(r值分别为-0.36、-0.55、-0.59,P值均0.05)。Logistic回归分析显示透析时间、残余肾小球滤过率、超敏C反应蛋白是腹膜透析患者baPWV最主要影响因素。结论腹膜透析时间、残余肾功能、微炎症是青中年非糖尿病腹膜透析患者动脉硬化最主要的影响因素。保护残余肾功能、改善炎症状态、改善腹膜透析的充分性可以降低腹膜透析患者动脉硬化风险,减少心血管疾病的发生。     

Risk factors for encapsulating peritoneal sclerosis in patients who have experienced peritoneal dialysis treatment

Background The present study was conducted to clarify the clinical risk factors related to the development of encapsulating peritoneal sclerosis (EPS), which is one of the most serious complications in patients undergoing peritoneal dialysis (PD).Methods The records of 78 patients with a history of PD treatment, including 18 with EPS, were retrospectively analyzed (male/female, 51:27; age, 51.8 ± 11.0 years; PD treatment, 94.1 ± 42.7 months). The inclusion criteria were: duration of PD more than 24 months; 36-month follow up after discontinuation of PD; available data for dialysate-to-plasma creatinine ratio (D/P Cr), by fast peritoneal equilibration test within 3 months before PD discontinuation; and absence of EPS at PD discontinuation. Analytical parameters included age, sex, underlying renal disease, duration of PD, membrane transport state (higher transporter or lower transporter: D/P cr ratio more than or less than 0.75), number of episodes of peritonitis during PD treatment, performance of peritoneal lavage after PD discontinuation, and reasons for PD withdrawal (ultrafiltration failure, acute peritonitis, social matters).Results Significant differences were noted regarding the PD duration, D/P cr, higher membrane transport state, and number of peritonitis episodes during PD. On receiver operating characteristic curves, the cutoff points for EPS were: D/P cr ratio, 0.74; number of peritonitis episodes, 2; and PD duration (months), 115.2. Multivariate analysis, employing the factors age, PD duration, higher membrane transport state, and number of peritonitis episodes, which were selected by stepwise analysis, identified the latter two factors as significant for the development of EPS (odds ratio [OR], 4.0; P = 0.046 and OR, 12.0; P = 0.049, respectively).Conclusions A higher transporter membrane state and the number of peritonitis episodes are factors contributing to the occurrence of EPS in patients who have experienced PD treatment.     

Sclerosing encapsulating peritonitis in pediatric peritoneal dialysis patients

The aim of this study was to define the incidence and characteristics of sclerosing encapsulating peritonitis (SEP) in pediatric peritoneal dialysis (PD) patients in Japan. A questionnaire was sent to all dialysis units with at least two pediatric PD patients. Among 687 patients registered, 11 cases (1.6%) of SEP were diagnosed. The mean age of patients with SEP at the start of PD was 9.7±3.6 years and at SEP diagnosis, 19.1±3.8 years. All patients had undergone PD for more than 5 years, and the mean PD duration was 9.6±3.3 years. SEP was diagnosed in 6.6% and 12% of patients dialyzed for >5 years and >8 years, respectively. The incidence of peritonitis among patients with SEP was not different from that among the Japanese pediatric registry. All patients had virtually no residual urine volume and 9 had impaired peritoneal ultrafiltration. Peritoneal calcification was the most-frequent radiological finding. Peritoneal biopsy was performed in 7 patients and confirmed sclerotic peritonitis in all. Ten patients transferred to hemodialysis, and only 1 patient underwent surgery. Three patients died. We recommend that patients on PD for more than 5 years who have impaired peritoneal ultrafiltration or peritoneal calcification should be carefully managed as presumptive cases of SEP. Received: 25 February 1999 / Revised: 9 July 1999 / Accepted: 13 July 1999     

Incidence and risk factors of left ventricular hypertrophy in peritoneal dialysis patients with different hydration statuses

Objective To investigate the incidence of left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients with different hydration statuses, and analyze the risk factors of LVH in PD patients. Methods PD patients in Renji Hospital, Shanghai Jiao Tong University School of Medicine from September 2016 to January 2017 were enrolled. Demographic data of patients were collected and biochemical parameters were measured. Hydration status index overhydration (OH) was measured by bioimpedance spectroscopy, and LVH was diagnosed by echocardiography. Logistic regression was used to analyze the risk factors of LVH. Results A total of 113 PD patients aged 58.98(48.89, 65.33) years with median PD duration 46.20(18.08, 72.75) months were enrolled in present study, among whom 60 patients (53.1%) had LVH. OH＞1.1 L was detected in 80 patients (70.8%), among whom 34 patients (42.5%) had subclinical overhydration (SCOH). LVH was however diagnosed in 33(71.7%) clinical overhydrated (COH) patients and 17(50.0%) SCOH patients (n=34). In the normal hydrated (OH≤1.1 L) patients (n=33), LVH was detected in 10 patients (30.3%). Multivariate logistic regression showed that high OH (OR=1.730, 95%CI 1.274-2.348, P＜0.001) and low hemoglobin (OR=0.965, 95%CI 0.940-0.991, P=0.008) were the independent risk factors of LVH. Conclusions LVH is common in PD patients, especially in overhydrated patients. High OH and low hemoglobin were the independent risk factors of LVH.     

178例腹膜透析患者超滤量的相关因素分析

目的腹膜透析(peritoneal dialysis,PD)患者超滤量可受到腹膜功能、尿量、营养状态、透析方式等诸多因素的影响,而且有无残肾功能患者的超滤量显然会受到不同因素的影响,故分析这些因素在超滤中发挥的作用可为控制PD患者体液平衡和改善其生存状况提供参考。方法选择武汉市第一医院符合纳入标准的PD患者178例,以UF的四位数将入选患者分成四组(UF1、UF2、UF3、UF4),再将所有患者按有无残肾功能(residual renal function,RRF)分为2组,有RRF组和无RRF组。收集各项临床资料,并计算残肾Kt/V、残肾肌酐清除率(Ccr)等值。最后将具有统计意义的相关因素与总UF、有RRF组UF、无RRF组UF做多重线性回归,评估各因素在UF中发挥的作用。结果无RRF患者组与UF相关的因素有体质量指数(body/mass index,BMI)(P0.01)和留腹时间(P0.05);有RRF患者组与UF呈正相关的因素有2.5%葡萄糖透析液(P0.01)、腹膜运转功能(D/P值)(P0.05),呈负相关的因素为残肾Kt/V(P0.01)和SGA评分(P0.05)。D/P值随腹膜炎发生次数的增多而逐渐增加。多重线性回归分析发现D/P和2.5%葡萄糖透析液是影响总UF的因素,D/P的影响更大;残肾Kt/V、D/P和2.5%葡萄糖透析液是有RRF者UF的影响因素,残肾Kt/V的影响最大;BMI是无RRF患者UF的独立影响因素。结论 D/P是影响PD患者'UF的主要因素,RRF是有RRF者UF的主要影响因素,BMI是无RRF者UF的独立影响因素。因而保护PD患者的腹膜功能和RRF,监测无RRF患者的体质量,避免其增长或减少过快是合理控制PD患者UF的重要方式。