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.     

Effect of the interaction between estimated glomerular filtration rate and serum uric acid on all-cause and cardiovascular mortality in patients on peritoneal dialysis

Objective To explore the effect of the interaction between estimated glomerular filtration rate (eGFR) and serum uric acid (SUA) on all-cause and cardiovascular mortality in patients on peritoneal dialysis (PD). Methods Patients who performed PD catheterization at the PD center of the First Affiliated Hospital of Sun Yat-sen University and had initiated PD therapy for over 3 months from January 2006 to December 2016 were enrolled and followed up until December 2018. Demographic data, baseline clinical and laboratory examination results of the patients were collected. Kaplan-Meier survival curve and Cox regression analysis were used to explore the correlation between SUA and all-cause mortality, cardiovascular mortality in different eGFR groups of PD patients. Results A total of 2 124 PD patients were enrolled with age of (47.0±15.2) years, among whom 1 269 patients were male and 536 patients had diabetes. The SUA level was (429±96) μmol/L and the median level of eGFR was 6.69(5.17, 8.61) ml?min-1?(1.73 m2)-1. After a median follow-up time of 42 months, 554 patients died, among whom 275 patients were cardiovascular death. The Cox regression analysis revealed that there was a significant interaction between eGFR and SUA on all-cause mortality (P=0.043). The Kaplan-Meier curve showed that the tertile 1 (SUA＜384 μmol/L) and tertile 3 (SUA＞460 μmol/L) group had significantly higher all-cause mortality (P=0.009) than the reference group of tertile 2 (SUA 384-460 μmol/L) in the higher eGFR group [eGFR＞6.69 ml?min-1?(1.73 m2)-1]but not in the lower eGFR. After adjusting for relevant demographic data, complications, biochemical results and other variables, in patients with higher eGFR, the risk of all-cause mortality increased by 0.2% (HR=1.002, 95%CI 1.000-1.003, P=0.019) for every 1 μmol/L increase in SUA. In addition, compared with the tertile 2 reference group, the tertile 3 group was independently correlated with higher risk of all-cause mortality (HR=1.670, 95%CI 1.242-2.245, P=0.001). Conclusions The eGFR and SUA level significantly interacts with all-cause mortality, and the higher SUA level in higher eGFR group is an independent risk factor for all-cause mortality in PD patients.     

Effects of serum uric acid level on all-cause death and cardiovascular death in patients of maintaining peritoneal dialysis

Objective To investigate the effects of serum uric acid (SUA) on all-cause death and cardiovascular death in patients of maintaining peritoneal dialysis (PD). Methods One thousand and sixty-three PD patients in the First Affiliated Hospital of Zhejiang University Medical College were included. The SUA levels at 6 months after PD start were measured. Patients with SUA≥420 μmol/L were grouped in hyperuricemia group (492 cases) and patients with SUA＜420 μmol/L were grouped in normal uric acid group (571 cases). The effects on all-cause mortality and cardiovascular mortality were retrospectively analyzed. Results The median age of the patients was 51(41, 62) years; 557 cases were male (52.40%); the median follow-up time was 33(20, 54) months (6-96 months); 167 cases (15.71%) died during the follow-up period, including 64 cases (6.02%) with cardiovascular causes. The mortality in hyperuricemia group was 19.11%(94/492) and the cardiovascular mortality was 7.93%(39/492), both rates were higher than those in normal uric acid group, and the differences were statistically significant (P=0.005, P=0.015, respectively). Hyperuricemia (SUA≥420 μmol/L) at 6 months after PD start (HR=1.572, 95%CI 1.155-2.141, P=0.004), high uric acid level (continuous variable) at 6 months after PD start (HR=1.002, 95%CI 1.001-1.004, P=0.008), and age≥65 years (HR=3.571, 95%CI 2.556-4.990, P＜0.001), serum albumin≤30 g/L (HR=1.907, 95%CI 1.278-2.845, P=0.002), high Charlson comorbidity index (HR=1.209, 95%CI 1.032-1.417, P=0.019) at the beginning of PD start were independent risk factors for all-causes death in PD patients. Hyperuricemia (SUA≥420 μmol/L) at 6 months after PD start (HR=1.734, 95%CI 1.033-2.912, P=0.037) and age≥65 years (HR=1.761, 95%CI 1.024-3.209, P=0.041), with diabetes (HR=2.775, 95%CI 1.358-5.671, P=0.005) at the beginning of PD start were independent risk factors for cardiovascular death in PD patients. Conclusions SUA at 6 months after PD is an independent risk factor for all-cause death and cardiovascular death in PD patients.     

血清铁调素25水平与腹膜透析患者冠状动脉钙化及心血管事件的关系

目的 探讨持续性腹膜透析患者血清铁调素25（hepcidin-25）水平和冠状动脉钙化（coronary artery calcification,CAC）及心血管事件的关系.方法 选择210例持续性非卧床腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）患者血清hepcidin-25的平均值为界,分为CAPD高hepcidin-25组107例、CAPD低hepcidin-25组103例;另选择在本院进行健康体检者90名作为健康对照组.通过酶联免疫法（enzyme-linked immunosorbent assay,ELISA）测定所有CAPD患者和健康对照组血清hepcidin-25水平.对所有入选者进行冠状动脉多层螺旋电子计算机断层扫描成像（multi-slice computed tomography,MSCT）钙化评价研究.结果 CAPD高hepcidin-25组在随访12个月内发生心血管事件71例次,因心血管事件死亡21例（占19.6%）;而CAPD低hepcidin-25组发生心血管事件27例次,因心血管事件死亡仅10例（占9.7%）.CAPD高hepcidin-25组和CAPD低hepcidin-25组心血管事件发生率比较,差异有统计学意义（P＜0.01）,以上2组无心血管事件生存率无统计学差异（P=0.055）.CAPD患者心血管事件发病率[46.7%（98/210）]与健康对照组心血管事件发病率[5.6%（5/90）]比较,差异有统计学意义（P＜0.01）.CAPD高hepcidin-25组CAC发病率均明显高于CAPD低hepcidin-25组（P＜0.01）;而且相关性分析显示,hepcidin-25水平与CAC积分呈正相关（r=0.980,P＜0.01）.多元逐步回归分析显示血清hepcidin-25水平[偏回归系数（B）=0.402,P＜0.01]和CAC（B=-0.015,P＜0.01）是CAPD患者心血管事件发生的重要危险因素.结论 血清hepcidin-25水平升高及CAC是CAPD患者发生心血管事件的重要原因,提示铁代谢紊乱可能参与,且促进了CAC的发生、发展,并最终导致心血管事件的发生.     

Proton pump inhibitor usage is associated with higher all-cause mortality and CV events in peritoneal dialysis patients

ObjectivesA long period of inappropriate proton pump inhibitors (PPI) treatment has been proved to be associated with adverse prognosis in general population and hemodialysis patients. This study was conducted to clarify the impact of PPI usage on mortality and adverse cardiovascular (CV) events in peritoneal dialysis (PD) patients.Methods and designThis is a retrospective study. A total of 905 patients were enrolled from two PD centers, including 211 patients on PPI treatment and 618 patients not on PPIs. Kaplan–Meier curves were used to identify the incidence of adverse outcomes. Multivariate Cox regression models and inverse probability of treatment weighting (IPTW) were applied to analyze hazard ratios (HRs) for adverse outcomes.ResultsDuring follow-up, 162 deaths and 102 CV events were recorded. Kaplan–Meier curve demonstrated all-cause mortality (log-rank test p = .018) and CV events (log-rank test p = .024) were significantly higher in PPI usage group. Multivariate Cox regression models and IPTW showed that PPI usage was an indicator for all-cause mortality (HR = 1.35, 95%CI = 1.09–1.67, p = .006) and CV events (HR = 1.78, 95%CI = 1.35–2.32, p < .001).ConclusionsPPI usage is associated with higher all-cause mortality and CV events in PD patients. Clinicians are supposed to be more careful when using PPI and need to master the indications more rigorously in patients receiving PD treatment.     

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.     

腹主动脉钙化评分预测腹膜透析患者心脑血管预后的价值

【目的】 探讨腹主动脉钙化评分(abdominal aortic calcification score,AACS)与腹膜透析患者心脑血管预后的关系。方法 研究对象来自2011年7月至2014年7月期间在上海交通大学医学院附属仁济医院接受规律腹透治疗的患者。采用腹部侧位X线摄片评估所有入选者腹主动脉钙化程度,并根据Kauppila评分系统行AACS评分。根据AACS三分位数将患者分为无钙化组(AACS=0)、轻中度钙化组(0相似文献   

The risk factors of mortality in peritoneal dialysis patients in different periods

Objective To explore the risk factors and characteristics in patients with peritoneal dialysis who died in different periods. Methods The clinical data of new peritoneal dialysis patients in the Department of Nephrology and Peritoneal Dialysis Center of the First Affiliated Hospital of Nanchang University from November 1, 2005 to February 28, 2017 was retrospectively analyzed. The patients were divided into two groups according to the time of death: those who died within one year and died after one year. The risk factors of mortality between the two groups were analyzed by Cox regression model. Results A total of 997 patients were enrolled and 244 patients died. There were 69 patients (28.3%) died within one year and 175 patients (71.7%) died after one year. Cardiovascular and cerebrovascular disease was the dominating reason of death in both groups, accounting for 59.4% (died within one year group) and 51.4% (died after one year group) respectively. Cox regression analysis showed that for died within one year group, old age (HR=1.035, 95%CI: 1.016-1.055, P＜0.001), low blood total calcium (HR=0.167, 95%CI: 0.053-0.529, P=0.002), low albumin (HR=0.899, 95%CI: 0.856-0.943, P＜0.001) and low apolipoprotein A1 (HR=0.274, 95%CI: 0.095-0.789, P=0.016) were risk factors associated with mortality. However, for died after one year group, old age (HR=1.053, 95%CI: 1.038-1.069, P＜0.001), combined with diabetes (HR=2.181, 95%CI: 1.445-3.291, P＜0.001) and hypertriglyceride (HR=1.204, 95%CI: 1.065-1.362, P=0.003) were risk factors associated with mortality. Conclusions The risk factors of mortality for peritoneal dialysis patients of different periods were not exactly the same. For died within one year patients, old age, low blood total calcium, low albumin and low apolipoprotein A1 were independent risk factors for mortality.However, for died after one year patients, old age, combined with diabetes, and high triglycerides were independent risk factors for mortality.     

Association of serum magnesium level with all-cause mortality in maintenance hemodialysis patients

Objective To investigate the association of serum magnesium (Mg) level with all-cause mortality in maintenance hemodialysis patients. Methods A multicenter retrospective cohort study was conducted in seven hemodialysis centers of Guizhou province. The adult outpatients who underwent hemodialysis for more than 3 months were included from June 2015 to June 2016. Demographics, baseline clinical and laboratory test results were collected. All patients were followed up until June 30, 2018. Patients were divided into 4 groups according to their baseline serum Mg levels (interquartile range). Kaplan-Meier method was used to compare the survival rates of the four group. Cox regression model was used to analyze the association of Mg with all-cause mortality. Logistic regression was used to analyze the influencing factors of low Mg level. Results A total of 868 hemodialysis dialysis patients with baseline Mg data were enrolled in this study, with age of (55.47±16.17) years old, among whom 59.4% were male. There were 11 (1.3%) patients with hypomagnesemia (Mg＜0.7 mmol/L), 432(49.8%) patients with hypermagnesemia (Mg＞1.05 mmol/L), and 16(1.8%) patients with Mg＞2.0 mmol/L. Median Mg was 1.05 mmol/L and interquartile range was 0.95-1.24 mmol/L. The comparison between Mg quartile groups showed that the difference in age, hemoglobin, serum albumin, serum calcium, parathyroid hormone (PTH), serum creatinine, uric acid and urea nitrogen was statistically significant (all P＜0.05). After a median follow-up of 24 months, 207 patients died. Kaplan-Meier curves showed higher all-cause mortality in patients with Mg≤0.95 mmol/L (Q1 group) (Log-rank test χ2=15.11, P=0.002). However, after adjusting for age, comorbidities and biochemical indicators(especially albumin), there was no statistically significant difference in the hazard ratio for all-cause death among the four groups. Multiple logistic regression analysis results showed that low serum albumin (OR=0.946, 95%CI 0.913-0.979, P=0.002) and low serum uric acid (OR=0.994, 95%CI 0.992-0.997, P＜0.001) were the risk factors for baseline Mg≤0.95 mmol/L. Conclusions Hypomagnesemia is rare in MHD patients, while hypermagnesemia is more common. Baseline serum Mg≤0.95 mmol/L in MHD patients is correlated with increased risk of all-cause death, but it may be not an independent risk factor. Baseline serum Mg≤0.95 mmol/L that occurred is associated with low levels of albumin and serum uric acid.     

终末期肾脏病腹膜透析患者的心血管疾病

目的 了解终末期肾脏病（ESRD）腹膜透析患者的心血管疾病（CVD）发病率和有关高发危险因素,以及并发CVD的腹膜透析患者治疗时需关注的问题。 方法 研究对象为上海交通大学医学院附属仁济医院慢性肾脏病（CKD）5期接受腹膜透析的患者,共254例入选,采用横断面回顾性调查分析方法。平均随访时间中位数为49个月。采集病史、血生化检测结果、腹膜透析充分性评估、颈动脉及心脏彩色多普勒超声检测结果。评估CVD事件的发生、发展和预后,以及进行相关因素分析。 结果 CVD事件发生率为37%（93/254）。发生CVD的患者多伴有糖尿病、透析龄较长、血三酰甘油水平较高、血清白蛋白较低、前白蛋白较低。彩色多普勒超声显示,发生CVD组的左房内径（LAD）（mm）、室间隔厚度（LVST）（mm）、左室心肌质量指数（LVMI）（g/m2）显著高于未发生CVD组（43.16±4.93比 38.02±4.77、11.19±2.05比10.01±1.45、中位数192.03比150.28,均P < 0.05）;颈动脉内膜中层厚度（IMT）较厚（中位数0.80比0.65）,颈动脉内径增宽;收缩期峰值流速（SPV）和舒张期峰值流速（DV）流速降低。既往无CVD的患者在随访过程中发生CVD时,其Ccr、Kt/V、D/Pr、理想体质量校正的蛋白分解率（nPCR）及血清白蛋白水平与无发生CVD组差异有统计学意义（P = 0.045、0.015、0.051、0.029及0.005）。在随访过程中出现新发CVD或CVD病情恶化的原有CVD的患者,都是透析龄较长以及三酰甘油水平较高者。LAD、LVST、LVMI及IMT在新发CVD和未发CVD两组间差异有统计学意义（P=0.033、0.022、0.045及0.029）。Kaplan-Meier生存分析显示,既往CVD史和CVD症状是生存的独立危险因素。血清白蛋白<330 g/L、LAD>39.6 mm及曾患腹膜炎的患者生存率较低。 结论 ESRD腹膜透析患者是CVD的高发群体,需了解这些患者的病史和伴随症状;保持透析的充分性;同时要防止腹膜炎的发生。     

Associations between home blood pressure and mortality in peritoneal dialysis

Objective To investigate the association between the home blood pressure (BP) and morality in peritoneal dialysis (PD). Methods PD patients from the First Affiliated Hospital of Zhejiang University from January 1, 2008 to June 30, 2016 were studied. Over the first 6 months PD therapy, systolic SB (SBP) and diastolic BP (DBP) averaged as 5 (＜120 to≥150 mmHg in 10 mmHg increments) and 4 (＜70 to≥90 mmHg in 10 mmHg increments) categories, respectively, as well as continuous measures. All-cause and cardiovascular mortality were assessed by using Cox regression models adjusted for demographics, laboratory measurements, comorbid conditions and antihypertensive medications. The relationships between home BP and all-cause and cardiovascular mortality were assessed by restricted cubic spline regression model. Results A total of 1663 PD patients were included with a median follow-up of 29.9 months, in which 737 patients (44.3%) were female. The SBP and DBP were (135.2±15.8) mmHg and (83.1±10.5) mmHg, respectively. Two hundred and twenty-one PD patients died during the study period, of which 102 patients (46.2%) died of cardiac-cerebral vascular events. With 130≤SBP＜140 mmHg as a refernece, SBP≥150 mmHg (HR=1.83, 95%CI 1.19-2.82, P=0.005) and SBP＜120 mmHg (HR=2.05, 95%CI 1.29-3.27, P＜0.001) were associated with significantly higher risks of all-cause morality, but not cardiovascular morality. With 80≤DBP＜90 mmHg as a refernece, patients with DBP≥90 mmHg exhibited significantly higher risks of all-cause mortality (HR=1.80, 95%CI 1.21-2.68, P=0.009). SBP presented a U-shaped association with all-cause mortality. DBP presented a J-shaped association with all-cause mortality. Conclusions Higher SBP, lower SBP and higher DBP are associated with higher risks of all-cause mortality in PD patients. However, neither SBP nor DBP is observed statistically significant relationship with the risk of cardiovascular mortality. Further prospective and randomized clinical trials are needed to determine the optimal BP targets and improve the management of hypertension in PD patients.     

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.     

Differences in survival on peritoneal dialysis between oriental Asians and Caucasians: One center's experience

BACKGROUND: Recently it has been suggested that the survival of dialysis patients may differ among different races. Both registry data and data from Asian countries indicates that Asians on peritoneal dialysis may survive longer than their Caucasian counterparts. In the present study, we performed a detailed analysis of survival differences between oriental Asians and Caucasians on peritoneal dialysis in our multiethnic, multicultural program. METHODS: Retrospectively we analyzed the survival data for patients who started peritoneal dialysis after January 1, 1996 and before December 31, 1999, in our hospital. They were followed for at least for two years. Excluded from the present analysis were those who survived for less than three months on peritoneal dialysis. The patient demographic characteristics, comorbidities, and residual renal function at the start of dialysis were collected. Indices for adequacy of dialysis were collected 1-3 months after the initiation of dialysis. Actuarial survival rates were determined by the Kaplan-Meier method. The Cox proportional hazards model was used to classify risk factors for a high mortality. RESULTS: There were 87 Caucasians and 29 Oriental Asian peritoneal dialysis patients. No differences were found in age, gender, primary renal disease, and residual renal function between the two groups. The Caucasians had significantly higher body surface area and urea volume and higher incidence of cardiovascular diseases. Even with slightly higher dialysis dose, the peritoneal creatinine clearance was significantly lower among the Caucasians than among Asians. There was no difference in the peritoneal D/P value between the two groups. However, compared to the Caucasians, the 24hr peritoneal fluid removal and total fluid removal volumes were significantly lower in the Asian patients. The one, two, three and four year survival rates were 95.8%, 91%, 86% and 80% for Asians and 91.3%, 78.1%, 64.7% and 54.1% for Caucasians. Significant predictors for a higher mortality were the presence of cardiovascular disease (42% increase in risk), Caucasians (39% increase in risk) and older age (37% increase in risk for age older than 65). CONCLUSIONS: Our study confirms that oriental Asians on peritoneal dialysis patients survive much longer than their Caucasian counterparts; this was partly due to the fact that Asian patients have less cardiovascular disease when they began peritoneal dialysis. Due to their smaller body size, the Asians tended to have a higher peritoneal small solute clearances despite their smaller dialysis doses, indicating that, to achieve the same solute clearance targets, Asians need a smaller dialysis dose compared to Caucasians.     

腹膜透析患者血清铁蛋白水平与微炎症及透析效果相关性分析

目的分析腹膜透析患者血清铁蛋白与C反应蛋白(CRP)之间的相关性,探讨血清铁蛋白对腹膜透析效果的影响。 方法回顾性分析2009年6月至2015年7月在广西医科大学第一附属医院腹膜透析中心规律随诊的腹膜透析患者120例,根据血清铁蛋白浓度将其分成三组,Ⅰ组：男性患者血清铁蛋白≤200 μg/L或女性患者血清铁蛋白≤150 μg/L;Ⅱ组：男性患者血清铁蛋白浓度为200～500 μg/L或女性患者150～500 μg/L;Ⅲ组：血清铁蛋白≥500 μg/L,将三组的临床资料进行分析。根据CRP值,将120例患者分为A组(CRP ≤8 mg/L)和B组(CRP > 8 mg/L),比较两组间血清铁、转铁蛋白饱和度、总铁结合力和血红蛋白水平差异。血清铁蛋白与各相应临床指标进行相关性分析。采用SPSS 16.0统计学软件进行数据分析。 结果(1)与Ⅰ组及Ⅱ组比较,Ⅲ组C反应蛋白水平显著升高,血红蛋白及Kt/V值均低于Ⅰ组及Ⅱ组(P<0.05),Ⅰ组与Ⅱ组比较无显著性差异(P>0.05)。(2)Ⅰ组总铁结合力明显高于Ⅱ组和Ⅲ组(P<0.05),Ⅱ组与Ⅲ组比较无显著性差异(P>0.05)。(3)相关性分析提示血清铁蛋白与血红蛋白及总铁蛋白结合力呈负相关(r＝－0.194,r＝－0.298;P<0.05),与血尿素氮、年龄及C反应蛋白呈正相关(r＝0.234,r＝0.238,r＝0.203;P<0.05)。(4)与A组比较,B组患者血清铁蛋白水平显著升高(t＝2.271, P<0.05),两组间总铁结合力、转铁蛋白饱和度及血红蛋白无显著性差异(t＝0.391,t＝0.371, t＝0.835; P>0.05)。 结论腹膜透析患者血清铁蛋白水平受微炎症状态的影响,高浓度的血清铁蛋白可影响腹膜透析患者的透析充分性,应该联合年龄、转铁蛋白饱和度、血红蛋白及CRP等指标,正确的判断患者缺铁情况。     

腹膜透析联合血液透析对终末期肾脏疾病患者心血管病变的改善作用

目的通过对腹膜透析联合血液透析(peritoneal dialysis combined with hemodialysis,PHD)后与联合治疗前相关指标进行比较,探讨联合治疗对终末期肾脏疾病(end stage renal disease,ESRD)患者心血管病变的改善作用。方法回顾性分析济宁医学院附属医院肾内科14例腹膜透析(peritoneal dialysis,PD)治疗不充分的ESRD患者,改用PHD治疗后的临床疗效。随访观察患者的一般状况、临床表现、营养状态,收集其治疗前后生化指标、甲状旁腺素、β_2微球蛋白(β_2-microglobulin,β_2-MG)、颈动脉内中膜厚度(carotid intima media thickness,CIMT)、收缩压、舒张压、左室射血分数、B型钠尿肽(B type natriuretic peptide,BNP)进行分析。结果经过PHD治疗后患者饮食好转,恶心、呕吐等消化道症状消失,曾反复心力衰竭的3例患者行PHD治疗后未再出现,皮肤瘙痒及不宁腿症状明显减轻。PHD前与PHD治疗后比较,血磷:(1.76±0.41)mmol/L与(1.48±0.28)mmol/L,P0.05;甲状旁腺素:(367.93±166.66)ng/L与(237.07±76.21)ng/L,P0.05;BNP:(1 521.7±701.0)μg/L与(712.1±535.0)μg/L,P0.01;左室射血分数:(49.7±3.1)%与(52.2±1.8)%,P0.05;颈动脉内中膜厚度:(1.65±0.36)mm与(1.72±0.33)mm,P0.05,PHD治疗后较PHD前无明显改变。结论 PHD能减轻患者的临床症状,改善患者的营养状态,降低血磷,减轻继发性甲状旁腺功能亢进,延缓动脉硬化进展,可作为一种新的肾脏替代治疗模式在临床推广。     

Risk factors for mortality in patients undergoing peritoneal dialysis: a systematic review and meta-analysis

AimInconsistent investigations of the risk factors for all-cause mortality in patients undergoing peritoneal dialysis (PD) were reported. The present meta-analysis aimed to assess the impact of some clinical characteristics on the risk of mortality in PD patients.MethodsPubMed and Embase were systematically searched for studies evaluating the risk factors for all-cause mortality in PD patients. Hazard ratio (HR) and 95% confidence interval (CI) were derived using a random-effect or fixed-effect model considering the heterogeneity across studies.ResultA total of 26 studies were included in this meta-analysis in accordance with the inclusion and exclusion criteria. Age, primary cardiovascular diseases, diabetes mellitus, and high level of alkaline phosphatase showed significant positive associations with elevated risk of all-cause and cardiovascular mortality in PD patients, while hemoglobin acted as a benefit factor. Furthermore, early onset of peritonitis, high peritoneal transport status, elevated body mass index and high-sensitivity C-reactive protein could also considerably increase the risk of all-cause mortality. The absolute serum level of magnesium, potassium, and uric acid required to improve survival in PD patients should be verified further.ConclusionsMultiple factors could affect the risk of mortality in PD patients.     

腹透液总蛋白量是持续不卧床腹膜透析患者新发心血管事件的预测因子

目的 研究持续不卧床腹膜透析（CAPD）患者24 h腹透液总蛋白量与临床心血管疾病（CVD）的关系。 方法 选择我中心随访的CAPD患者178例,完成24 h腹透液总蛋白量检测及有关病史采集,完成颈动脉彩超和心脏彩超检测,并进行前瞻性随访≥12个月,观察新发临床CVD的发生。 结果 CAPD患者24 h腹透液总蛋白量平均为（5.0±1.8） g。CAPD患者有既往心血管疾病史或糖尿病史者或有颈动脉硬化者24 h腹透液总蛋白量均较无相应病史者多（分别是t = 2.082,P = 0.039;t = 2.601,P = 0.010;t = 2.217,P = 0.029）。CAPD患者24 h腹透液总蛋白量与舒张末期左室内径（LVDd,单位：mm）、舒张末期室间隔厚度（IVSd,单位：mm）、舒张末期左室后壁厚度（LVPWd,单位：mm）、左室心肌重量指数（LVMI,单位：g/m2）均呈正的直线相关关系（分别是r = 0.222,P＝0.040;r = 0.217,P＝0.043; r = 0.339,P ＝ 0.002;r = 0.305,P ＝ 0.007）,与左室射血分数（LVEF）呈负的直线相关关系（r = －0.221,P ＝ 0.040）。其中114例CAPD患者完成了前瞻性随访,平均随访（15.3±1.5）个月。以24 h腹透液总蛋白量的第50位数（P50）为界分为高腹透液蛋白组和低腹透液蛋白组,卡方检验显示,高腹透液蛋白组新发CVD发生率显著高于低腹透液蛋白组（40.4％比19.3％,χ2 = 6.035,P = 0.014）。多因素logistic回归分析显示,24 h腹透液总蛋白量与年龄、血清白蛋白、LVDd均为CAPD患者新发CVD的独立危险因素。 结论 CAPD患者24 h腹透液总蛋白量与既往心血管疾病史、糖尿病史、颈动脉硬化有关,且与左心室结构和功能障碍相关,是CAPD患者新发CVD的独立危险因素。     

Association between metabolic syndrome and prognosis in patients with peritoneal dialysis

Objective To investigate the incidence situation of metabolic syndrome (MS) in patients with continuous ambulatory peritoneal dialysis (CAPD), and analyze the correlation between MS and prognosis of patients. Methods The patients who received peritoneal dialysis from June 1, 2002 to April 30, 2018 and followed up regularly were divided into MS group and non-MS group according to the diagnostic criteria of MS. Follow-up was until July 31, 2018. The differences of clinical data, metabolic indexes and clinical outcomes between the two groups were compared. The survival rates of the two groups were compared by Kaplan-Meier survival curve, and the risk factors of all-cause death and cardiovascular disease (CVD) death were analyzed by Cox regression analysis. Results A total of 516 patients with CAPD were enrolled in this study, including 340 males (65.9%) and 176 females (34.1%). Their age was (47.29±12.20) years. The median follow-up time was 20 (9, 39) months. According to the diagnostic criteria of MS, the patients were divided into MS group (210 cases, 40.7%) and non-MS group (306 cases, 59.3%). At baseline, there was no significant difference in age, educational background, duration of peritoneal dialysis, smoking history and drinking history between the two groups (P＞0.05), but the patients in MS group were more exposed to high glucose peritoneal dialysate (P＜0.05). The body mass index (BMI), blood phosphorus, blood glucose, blood potassium, triglyceride, cholesterol and systolic blood pressure in MS group were significantly higher than those in non-MS group (all P＜0.05), and HDL-C level was significantly lower in MS group than in non-MS group (P＜0.05). There were no significant differences in other indicators between the two groups (P＞0.05). Kaplan-Meier survival curve showed that the cumulative survival rate in MS group was significantly lower than that in non-MS group, and the difference was statistically significant (Log-rank χ2=14.87, P＜0.001). If CVD death was taken as the end event, the cumulative survival rate in the non-MS group was significantly higher than that in the MS group (Log-rank χ2=14.49, P＜0.001). Multivariate Cox regression analysis showed that MS and high 4 h dialysate creatinine/serum creatinine ratio (4hD/Pcr) were independent risk factor for all-cause death (HR=1.982, 95%CI 1.240-3.168, P=0.004; HR=3.855, 95%CI 1.306-11.381, P=0.015) and CVD death (HR=2.499, 95%CI 1.444-4.324, P=0.001; HR=5.799, 95%CI 1.658-20.278, P=0.006) in patients with CAPD. Conclusion The prevalence of MS in patients with CAPD is high, and MS and high 4hD/Pcr are independent risk factor for all-cause and CVD death in CAPD patients. They can be used as valuable indicators to predict the treatment outcomes and long-term prognosis of patients with CAPD.