黄芪改善腹透患者腹腔巨噬细胞功能的临床研究

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

IgG subclass levels in pediatric patients on chronic peritoneal dialysis

Patients maintained on chronic peritoneal dialysis (CPD) have been reported to have a variety of abnormalities of humoral immunity, including hypogammaglobulinemia, altered response to vaccination, and selective absence of IgG2. We measured serum immunoglobulin and IgG subclass levels in 22 pediatric CPD patients followed at our institution; 8 patients had low total IgG; 4 of these had low levels of IgG2 and 3 also had low IgG1, but IgG2 levels were detected in all patients. Thus, many pediatric CPD patients may have low IgG, and some may have low IgG1 and IgG2 as a reflection of low total IgG. However, we did not demonstrate a selective absence of IgG2 in these patients.     

Hyperlipidemia in pediatric patients undergoing peritoneal dialysis

We evaluated serial measurements of serum lipid levels in 68 patients aged 12.6±4.7 years undergoing treatment with continuous ambulatory peritoneal dialysis/continuous cycling peritoneal dialysis (CAPD/CCPD). Fasting mean levels of triglycerides (TG) and cholesterol (C) were elevated above the 95th percentile of published normal values by 102% and 19%, respectively, at the start of dialysis. Except for a shortterm decrease in TG levels at 6 and 9 months, no significant change in mean lipid levels was observed during a follow-up period of 2 years. At initiation of dialysis, elevated TG and C levels were present in 90% and 69% of the patients, respectively. The prevalence of hyperlipidemia (HL) varied between 63% and 88% (TG) and 61% and 93% (C), respectively, during the follow-up period. TG and C levels were not correlated with caloric intake (evaluated in 17 patients), serum albumin levels, treatment modality (CAPD or CCPD), a history of the nephrotic syndrome, or previous treatment with hemodialysis or transplantation. However, a significant inverse correlation was observed between age and serum lipids at the initiation of dialysis treatment and after 1 year (TG:r=–0.40; C:r=–0.44). Our data indicate a high prevalence of HL but no significant change of serum lipid levels during 2 years of treatment with CAPD/CCPD.     

Short PET in pediatric peritoneal dialysis

Peritoneal equilibration test (PET) is a common technique used in children to evaluate peritoneal membrane transport capacity and adequate the dialysis regimen. Considering that this is a laborious test, a shortened version has been proposed. Our goal was to evaluate the concordance between the 2-h (short) and 4-h (classical) PET values to determine whether the short PET could be used in the clinical setting. Eighty-one PET corresponding to 81 peritoneal dialysis patients from two pediatric nephrology centers were retrospectively analyzed. Peritoneal transport capacity was evaluated using the dialysate to plasma ratio (D/P) of creatinine and the ratio of dialysate glucose to baseline dialysate glucose (D/D(0)) at 2 and 4 h. The mean [+/- standard deviation (SD)] creatinine D/P ratio at 2 and 4 h were 0.41 +/- 0.13 and 0.66 +/- 0.17, respectively, and the mean (+/- SD) D/D(0) glucose were 0.64 +/- 0.11 and 0.39 +/- 0.12 at the same times. Applying McNemar chi(2) test to evaluate the association between the categories obtained at 2 and 4 h, we found no relationship between the 2- and 4-h PET for both D/P and D/D(0) (p > 0.05). These results suggest that the use of this abbreviated test is probably not reliable for estimating the transport capacity of the peritoneal membrane in the pediatric population.     

Fatigue in chronic peritoneal dialysis patients

Fatigue is a common complaint in long termdialysis patients that may influence theirquality of life. The present study was carriedout in order to evaluate the prevalence andcourse of fatigue in a group of chronic PDpatients and to find the possible factor(s)related to its development. We retrospectivelyreviewed 100 charts of the patients previouslyon PD. The presence or absence of fatigue inthe 1st and last clinic visits and the 1st and2nd changes in fatigue state were studiedaccording to the monthly clinical records ofthe primary nurses. Data regarding dialysatevolume, urine volume, weekly erythropoietin(EPO) dose, hemoglobin, hematocrit, blood urea,serum creatinine, residual renal creatinine andurea clearances, dialysate to peritonealcreatinine ratio (D/P Cr), total weekly Kt/Vand total creatinine clearance/l.73 m² bodysurface area (TCrCl) were collected. Fifty-fivepatients were male and 45 female. The mean ageat the 1st clinic visit was 61.3 ± 16 years.At the 1st visit 55 patients had fatigue and 45did not. In 32 of the 55 patients fatiguedisappeared after a mean duration of 7.9 ± 8.4months and in 31 of the 45 patients fatigueappeared after a mean duration of 8 ± 6.8months. So at the last visit the frequency offatigue increased significantly from 55% to67% (p < 0.001). In patients with fatigue themean age and female percentage were higher(64.2 ± 14.1 vs 57.8 ± 17.6, p = 0.05 and 1.2vs 0.5, p < 0.05 respectively), mean hemoglobinconcentration was lower (104.4 ± 14.7 vs110.6 ± 14.2 g/L, p < 0.04) and mean EPO dosewas higher (6379.6 ± 7142 vs 3395.4 ± 4337.8units/week, p < 0.02) at the 1st clinic visit.EPO dose was also higher in patients withfatigue at the last visit (8253.7 ± 10317.3units/wk vs 4736.4 ± 5432.5, p < 0.03). Nocorrelation was found between dialysis adequacyaccording to either weekly Kt/V or TCrCl andnutritional state according to nPCR andfrequency of fatigue. We conclude that fatigueis a common symptom in PD patients and it'sprevalence increases over time. Anemia seemsto be the most important factor associated withfatigue. Dialysis adequacy and nutritionalstate did not show any correlation with thefrequency of fatigue in our study.     

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     

Infectious and catheter-related complications in pediatric patients treated with peritoneal dialysis at a single institution

Continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) are the predominant dialytic modalities for the majority of children while awaiting transplantation. Wide acceptability of peritoneal dialysis is hindered by infectious complications. A retrospective review of 367 pediatric patients treated with CAPD/CCPD for at least 3 months from September 1980 through December 1994 revealed that the peritonitis incidence ranged from 1.7 to 0.78 episodes per patient-year. No differences in peritonitis rates were observed between patients treated with CAPD or CCPD. Gram-positive organisms were responsible for the majority of peritonitis episodes. Age, sex, race, primary renal disease, presence of nephrotic syndrome, and serum albumin level were not associated risk factors. Longer time on treatment and diminished serum IgG level were associated with increased peritonitis incidence. Treatment was successfully completed at home in most cases. Almost half of the catheter losses were caused byStaphylococcus, Pseudomonas, and fungal peritonitis and tunnel/exit-site infections. Infectious complications are still the major causes of morbidity and treatment failure in patients treated with CAPD/CCPD. Thus, controlled studies are needed to assess methods for prevention or improvement of peritonitis rates in this patient population.     

Hyperkalemia in chronic peritoneal dialysis patients

Background. Chronic peritoneal dialysis (PD) patients often develop hypokalemia but less commonly hyperkalemia.Methods. We explored incidence and mechanisms of hyperkalemia in 779 serum samples from 33 patients on PD for 1 − 59 months. Normal serum potassium concentration was defined as 3.5 − 5.1 meq/l.Results. Mean monthly serum potassium concentrations were normal (except for 1 month), but we observed hypokalemia (<3.5 meq/l) in 5% and hyperkalemia (>5.1 meq/l) in 14% of 779 serum samples. Incidence of hyperkalemia did not change over time on PD: Year 1 (15%), Year 2 (11%), Year 3 (19%), Years 4–5 (22%). Hyperkalemia was mostly modest but occasionally extreme [5.2–5.4 meq/l (55%), 5.5–5.7 meq/l (21%), 5.8–6.0 meq/l (10%), >6.0 meq/l (14%)]. Of 31 patients (2 excluded due to brief PD time), 39% displayed hyperkalemia only, 23% displayed hypokalemia only, and the remainder (38%) displayed both or neither. Comparing hypokalemia-only with hyperkalemia-only patients, we found no difference in potassium chloride therapy, medications interrupting the renin-angiotensin system, small-molecule transport status, and renal urea clearance. We compared biochemical parameters from the hypokalemic and hyperkalemic serum samples and observed lower bicarbonate concentrations, higher creatinine concentrations, and higher urea nitrogen concentrations in the hyperkalemic samples (p < 0.001 for each), without difference in glucose concentrations.Conclusion. We observed hyperkalemia 3 times as frequently as hypokalemia in our PD population. High-potassium diet, PD noncompliance, increased muscle mass, potassium shifts, and/or the daytime period without PD might contribute to hyperkalemia.     

蛋白质摄入水平对腹膜透析患者早期营养状况的影响

目的 观察每日蛋白质摄入(DPI)分别为0.8≤DPI≤1.0 g&#8226;kg-1&#8226;d-1和1.0<DPI≤1.2 g g&#8226;kg-1&#8226;d-1对新进入腹膜透析患者的营养状况的影响。 方法 选取2004年6月至2005年6个月期间进入腹膜透析且透析后1个月DPI 水平在0.8≤DPI≤1.2 g&#8226;kg-1&#8226;d-1范围的腹膜透析患者进入研究。分别于透析后1、3、6个月分别评估患者营养状况。血生化测定仪检测血红蛋白(Hb)、血白蛋白(Alb)、尿素氮(BUN)和血肌酐(Scr)水平。人体测量法测量上臂围(AC)、三头肌皮褶厚度(TSF)和上臂肌围(AMC)。肌酐动力学方法测定瘦体质量。同时监测影响营养状况的一些重要因素并进行评价，包括DPI和每日能量摄入（DEI）水平、透析充分性[总的和残肾尿素清除指数（tKt/V和rKt/V）; 总的和残肾的标准化肌酐清除率,（tCcr和rCcr）]、代谢性酸中毒（血CO2CP）、炎性反应状态[血C反应蛋白（CRP）]、容量指标[生物电阻抗法测定并计算细胞外液/总体水（ECW/TBW）；身高标化的细胞外液（nECW）]。 结果 82例腹透患者进入本研究，其中39例为0.8≤DPI≤1.0 g&#8226;kg-1&#8226;d-1， DEI（108.24±17.99） kJ&#8226;kg-1&#8226;d-1； 43例为1.0<DPI≤1.2 g&#8226;kg-1&#8226;d-1，DEI（126.82±19.92） kJ&#8226;kg-1&#8226;d-1。两组患者基础的DPI和DEI水平，3个月时DPI，6个月时DPI和DEI值差异有统计学意义(P < 0.01或0.05)。透析后半年内两组平均tKt/V和rKt/V、tCcr和rCcr、CRP、CO2CP、ECW/TBW、nECW差异均无统计学意义（P ＞ 0.05）。两组患者透析半年内均保持营养状况稳定，分别于1、3及6个月时比较各项营养指标，两组患者血Alb、BUN、Scr、Hb、AC、AMC、TSF和LBM水平差异均无统计学意义(P ＞ 0.05)。 结论 新入的腹透患者不论其0.8≤DPI≤1.0 g&#8226;kg-1&#8226;d-1或1.0<DPI≤1.2 g&#8226;kg-1&#8226;d-1，均可保持透析早期的营养状况稳定，且不同DPI水平的患者透析半年内各项营养指标差异均无统计学意义。     

改良腹膜平衡试验在腹膜透析患者中的应用

目的 观察改良腹膜平衡试验(改良PET)在腹膜透析(腹透)患者中的应用,初 步建立改良PET转运参数的参考值,探讨其评估腹膜溶质转运特性的准确性及临床意义。方法 97例腹透患者用高渗腹透液(4．25％葡萄糖)进行改良PET,分别测定4 h透析液肌酐与血肌酐 比值(4h D／Pcr)、计算物质转运面积系数(MTAC)、1 h透析液钠与血钠比值(1h D／PNa+)及记录 净超率量(nUF)。其中有14例患者在1个月内曾行标准腹膜平衡试验(标准PET),其结果与改 良PET进行自身比较。所有患者在研究时及研究前1个月内均无腹膜炎。结果 97例腹透患 者中有90例nUF大于400 ml,这些患者的转运参数经正态分布校正后建立了改良PET的参考 值。改良PET的4 hD／Pcr为0．70±0．15,标准PET4 hD／Pcr为0．68±0．13,两者非常接近,差异 无统计学意义。两种PET对患者腹膜转运特性分型结果相似。7例nUF小于400 ml的患者中有 5例有效腹膜表面积增大;2例存在水通道介导的水转运障碍,其中1例同时存在有效腹膜表面 积增大,还有1例患者改良PET转运参数在正常范围内。结论 与标准PET相比,用高渗腹透 液进行改良PET能够准确地评估腹膜小分子溶质转运特性,此外还能提供更多更敏感的液体转 运信息,为临床诊断超滤衰竭,以及进一步鉴别其原因提供了有力的手段。     

Effects of seasonal changes on peritoneal dialysis associated peritonitis in peritoneal dialysis patients

Objectives To investigate the effects of seasonal changes on peritoneal dialysis associated peritonitis (PDAP) in patients on peritoneal dialysis (PD), and to provide evidence for clinical prevention and treatment of PDAP. Methods All episodes of PD-related peritonitis during clinic follow-up in maintenance PD patients from Jan 1st, 2007 to Dec 31st, 2015 in Peking University People's Hospital were reviewed. The incidence of peritonitis, laboratory indexes, pathogens and clinical outcomes in different seasons were recorded and analyzed. One-way ANOVA and chi square test were employed to compare the incidence of PDAP and related data in different seasons, and Pearson correlation was used to analyze correlations between PDAP rate and monthly mean temperature and mean humidity. Results During nine years, a total of 119 PD patients occurred 190 times of peritonitis during home PD. The PDAP rate in summer was the highest, 0.21 episodes/year, followed by spring (0.16 episodes/year) and autumn (0.16 episodes/risk year), but there was no significant difference among peritonitis rates in four seasons. There were significant positive correlation between monthly mean temperature, monthly mean humidity and the peritonitis rate (mean temperature: r=0.828, P＜0.01; mean humidity r=0.657, P＜0.05). (2) As for bacteria, in Summer the PDAP rate caused by Staphylococcus aureus and Coagulase negative staphylococcus (CoNS), and Gram-negative bacteria was higher than that in other seasons, but there was no statistical difference. There were significant positive correlation between monthly mean temperature, mean humidity and the rate of CoNS peritonitis (mean temperature: r=0.704, P＜0.05; mean humidity: r=0.607, P＜0.05). (3) There were no statistical difference among results of PD related peritonitis in different seasons about general situation, clinical manifestation, causes of peritonitis and laboratory index before peritonitis episodes. PD procedure-related problems were the main cause of peritonitis in summer and autumn. (4) The cure rate of all peritonitis was 90%. The highest cure rate was in autumn and winter, while the lowest cure rate was in summer, but no statistical difference. Among the peritonitis episodes with treatment failure, 52.6% occurred in summer. Conclusions There is some correlation between the rate of PDAP and seasons. Higher temperature and higher humidity were significantly correlated with higher peritonitis rate, especially the rate of CoNS peritonitis. The prognosis of PDAP in summer was relatively poor, with higher proportion of hospitalization and lower cure rate.     

Recombinant human erythropoietin therapy in pediatric patients receiving long-term peritoneal dialysis

We evaluated the impact of (s.c.) recombinant human erythropoietin (r-HuEPO) therapy on the hematological status, exercise capacity, and dietary intake of nine pediatric patients (mean age 12.4±3.2 years) receiving long-term peritoneal dialysis. Five children without medical illness served as controls for the exercise testing portion of the study. Following 7.9±2.8 weeks of twice weekly r-HuEPO (50 units/kg per dose), the hematocrit increased from 21.9±3.5% to 31.3±2.5% (P<0.001). A further increase to 33.2±3.0% occurred after 2 months of once weekly therapy. The blood transfusion requirement decreased from 0.5 transfusions per patient-month to 0.05 transfusions per patient-month (P<0.01). Graded exercise testing demonstrated an increase in peak oxygen consumption from 17.8±5.2 to 24.0±7.6 ml/kg per min (P<0.01). The oxygen consumption at anaerobic threshold increased from 13.1±3.9 to 17.1±3.5 ml/kg per min (P<0.02). Treadmill time increased from 5.3±1.2 to 7.5±1.3 min (P<0.001). In each case, the percentage improvement was significantly greater than the improvement seen in the control population. Dietary evaluation revealed no significant change in caloric or protein intake, despite a subjectively improved appetite. r-HuEPO, given by the s.c. route, corrects the anemia and improves the exercise capacity of pediatric patients receiving long-term peritoneal dialysis.     

重新评价腹膜平衡试验以确定腹膜透析患者的溶质转运类型

目的 确定由Twardowski提出的腹膜平衡试验（PET）的转运类型评判值是否适合本中心患者。方法 选取我院自1995年来首次进行PET测试的患者158例。首先依据Twardowski的评判标准（值）判断患者的转运类型,再根据本组患者实际4hD/Pcr的χ±s来确定患者的溶质转运类型,然后将患者重新分组:按两种数值均符合高转运为H1组,均符合平均转运为A组,均符合低转运为L1组,部分高转运患者经重新评价后符合平均转运为H2组,部分平均转运患者经重新评价后符合低转运为L2组。通过与临床情况（溶质和水的清除）进行对照,以进一步评价更适合本中心患者的评判标准。结果 按照Twardowski的标准,高转运、高平均转运、低平均转运及低转运患者的比例分别为21.5％、44.9％。27.8％及5.7％。本研究患者群中4hD/Pcr的均值和标准差为0.70和0.14,据此重新评判后,各组的比例分别为14.6％、33.5％、33.5％及18.4％。经与临床结果相对比,L2组对水份的清除能力明显高于A组（P<0.005）,与L1组差别无显著性意义。结论4hD/Pcr在不同的地区和人群中表现出不同的均数和标准差值,因而产生了不同的腹膜转运类型。根据本中心患者人群确定的值更适合本中心患者的临床情况。     

Aminoglycoside ototoxicity in pediatric patients receiving long-term peritoneal dialysis

We evaluated 14 children on long-term peritoneal dialysis for ototoxicity associated with aminoglycoside (AG) therapy. Baseline evaluation of all patients and 7 controls included pure-tone audiometry (PTA) and click-evoked auditory brain stem response (ABR). Nine patients had repeat PTA and ABR evaluations and vestibular testing 1 year after study entry. Five patients had an additional assessment following intraperitoneal AG therapy. The baseline auditory function of the patients was significantly poorer than controls at 6.0 and 8.0 kHz by PTA (p<0.05), whereas the results of ABR testing were not different. Of the 14 patients, 4 (28%) had hearing loss, 3 of whom had a history of intravenous AG therapy. In contrast, none of the patients who received intraperitoneal AG therapy only, or without a history of AG therapy, had hearing loss (P<0.005). There was no evidence of progressive loss of hearing acuity with time or associated with intraperitoneal AG therapy. One patient had findings of vestibular dysfunction. We conclude that children receiving peritoneal dialysis are at risk of AG ototoxicity. While intraperitoneal administration of AG may be associated with less ototoxicity than intravenous administration, further study is necessary to verify this finding and close monitoring of AG levels remains mandatory irrespective of the route of administration. PTA rather than click-evoked ABR appears to be the best indicator of abnormal hearing acuity in this population.     

长期腹膜透析患者转归临床分析

目的研究长期腹透患者临床转归,分析其临床特点。方法对本院1994年1月至2003年8月腹透龄超过3年以上的58例腹透患者进行分析。根据其临床转归分为继续腹透组、转向移植组、转向血透组及死亡组。比较各组间近期营养指标（半年以内血清白蛋白水平）、近期透析充分性指标（Kt／V、Ccr）、水清除指标及残肾功能等临床特点。对死亡组同时做回顾性前后自身对照研究（死亡前半年以内与死亡前1年资料比较）。对继续腹透组回顾性分析比较1年前资料,并前瞻性追踪随访1年。结果死亡组总Kt／V显著低于其余3组（P〈0．05）;总Ccr显著低于继续腹透组（P〈0．01）。继续腹透组、移植组及血透组3组间总Kt／V、总Cer及血清白蛋白水平差异无统计学意义。血透组水清除指标显著低于继续腹透组及移植组;继续腹透组水清除指标稍高于死亡组但无显著性差异。死亡组近期总Kt／V显著低于死亡前1年总Kt／V（P〈0．05）;近期总Ccr显著低于死亡前1年总Ccr（P〈0．01）。继续腹透组近期总Kt／V及总Ccr与1年前及1年后指标比较差异均无统计学意义,但残肾Kt／V或残肾Ccr随时间推移而显著下降（P〈0．05）。继续腹透组残肾Kt／V或残肾Ccr显著高于死亡组及血透组（P〈0．05）。死亡组血清白蛋白水平较其余3组降低但差异无统计学意义。死亡组13例中有7例死于心脑血管疾病。结论腹透3年以上患者大部分仍可继续腹透。透析不充分是长期腹透患者死亡的重要原因。死亡的病因主要为心脑血管疾病。残肾功能可影响长期腹透患者的转归。     

抑郁障碍对腹膜透析患者的影响

目的：研究腹膜透析（腹透）患者产生抑郁障碍的可能因素及其对腹透的影响,尝试药物治疗,以期改善生活质量,方法：选择无精神病史的规律性腹透患者43例,进行汉密顿抑郁量表（HAMD）和抑郁自评量表（SDS）评分,并分为抑郁组和非抑郁组,在组间进行性别,年龄,文化程度和医疗付费情况的比较,观察患者透析充分性,营养,感染率,主不业率及顺应性在组织间的差异,并选择重度抑郁状态者预以抗抑郁治疗（Prozac20mg/d),观察疗效,结果：（1）37．2％的患者存在抑郁障碍,（2）通过比较,两组的年龄,性别,文化,程度,婚烟障碍和医疗付费情况均无显著差异,（3）两组间的顺应性差异有显著性意义（不顺应者在抑郁组中占53．3％,非抑郁组仅7．7％,P＜0．01）,感染率差异也有显著性意义（抑郁组：0．04）,SAG评分示抑郁组营养不良占62％,非抑郁组占4．3％,（P＜0．05）,（4）在16例中选6例预Prozac治疗1月后重测HAMD和SDS评分,相关因子分下降（例少未统计）,结论：抑郁状态在腹透患者中常见,它可造成腹透患者的营养不良,顺应性下降,透析不充分,感染率上升,抗抑郁的药物治疗可望改善患者的抑郁状态。     

浅谈腹膜透析患者的血压管理

腹膜透析患者的高血压患病率达80%以上,难治性高血压导致卒中、心血管事件发病率不断增加,是患者死亡和退出腹膜透析的主要原因。2015年国际腹膜透析协会(ISPD)关于成人腹膜透析患者心血管和代谢指南指出,持续腹膜透析患者目标血压应<140/90 mmHg,并与年龄无关。腹膜透析患者血压控制不佳的影响因素纷繁复杂,但常见原因是容量超负荷和残肾功能减退。腹膜透析患者高血压防治策略包括容量负荷的准确评估与干预、残余肾功能的有效保护、透析处方的及时调整,降压药物的正确选择以及以病人为中心的团队管理等五个方面。     

Renal cell carcinoma in peritoneal dialysis patients

Renal cell carcinoma is a rare but serious complication in ESRD patients. In these patients the incidence of renal cell carcinoma (RCC) is 20-40 times higher than in the general population. We performed a retrospective study to measure the incidence rate, prevalence, characteristics and survival among our peritoneal dialysis (PD) patients diagnosed with renal cell carcinoma. The study was carried out among 607 patients who were on the PD program from January 1997 to June 2002. RCC was detected in eight patients (four males and four females) with mean age of 52.1 +/- 10.6 years. Among these eight patients four were new cases that were diagnosed before the patients were started on dialysis (three in native kidneys and one in a transplanted kidney). In the other four patients the RCC was diagnosed after they had been on dialysis for 33-204 months (mean 60.75 +/- 50.48). We found an incidence rate of 1.3 per 1000 patients per year and a prevalence of 1.3%. Six of the eight patients had renal cysts. Tumor size was less than 7 cm in seven patients and in the other patient it was 8.5 cm. Seven of eight patients were alive at the time of study with a survival time ranging from 3-138 months (mean 122.25 +/- 88.2) months. In one patient, the RCC metastasised to the scalp, and, in two other patients, the tumors subsequently involved the second kidney. A cardiovascular complication was the cause of one death. Two patients received a renal transplant 36 and 66 months after diagnosis. We conclude that despite the low rate of metastases and mortality in our study, regular ultrasonography should be added to the follow-up of PD patients. Renal transplantation can be considered in these ESRD patients with RCC; however, close follow-up for metastases is recommended.