Mechanisms of albumin loss during peritoneal dialysis in man.

Albumin loss in the dialysate was evaluated during a total of 5 peritoneal dialyses carried out on 3 uraemic patients. The measurements were made by two different methods, the first based on the evaluation in the dialysate of intravenously injected radioiodinated albumin, the second one based on a radioimmunoassay of the protein in the dialysate. The results obtained showed three main mechanisms of protein loss during peritoneal dialysis: 1) albumin shift from extravascular sites adjacent to the peritoneum, 2) direct passage of albumin from blood stream to peritoneal cavity, and 3) tendency of the inter-dialysis peritoneal fluid to equilibrate with plasma proteins. Furthermore, the observations made on a patient with evident peritonitis proved the importance of the intrinsic biological properties of the peritoneum in determining the amplitude of protein wasting by the dialysate.     

Double Isotope Measurement of Peritoneal Clearance of Iodide and Albumin Loss during Peritoneal Dialysis in Man

Summary. ¹³¹I-labelled Human Serum Albumin and ¹²⁵I-sodium iodide were used to measure protein loss from the peritoneum and peritoneal clearance of iodide in a group of 8 uraemic patients, each one being studied after a different number of dialyses. Both albumin loss and iodide clearance reached a maximum at about the 10th dialytic treatment and then tended towards the initial levels. Protein loss as determined isotopically was markedly lower than indicated by direct radioimmunoassay measurements performed in three cases. Fitting experimental points by a model which assumes direct passage of protein from plasma to peritoneal cavity suggests the presence of a “delay” pool between plasma and the peritoneal cavity itself (extravascular sites adjacent to peritoneum?). The shorter retention time of the dialysis solution in the abdomen (4–8 minutes) seemed to us to cause lower protein losses than reported by authors using longer retention times.     

Double isotope measurement of peritoneal clearance of iodide and albumin loss during peritoneal dialysis in man (labelled albumin loss in peritoneal dialysis).

Summary. ¹³¹I-labelled Human Serum Albumin and ¹²⁵I-sodium iodide were used to measure protein loss from the peritoneum and peritoneal clearance of iodide in a group of 8 uraemic patients, each one being studied after a different number of dialyses. Both albumin loss and iodide clearance reached a maximum at about the 10th dialytic treatment and then tended towards the initial levels. Protein loss as determined isotopically was markedly lower than indicated by direct radioimmunoassay measurements performed in three cases. Fitting experimental points by a model which assumes direct passage of protein from plasma to peritoneal cavity suggests the presence of a “delay” pool between plasma and the peritoneal cavity itself (extravascular sites adjacent to peritoneum?). The shorter retention time of the dialysis solution in the abdomen (4–8 minutes) seemed to us to cause lower protein losses than reported by authors using longer retention times.     

腹膜透析患者钙磷代谢紊乱临床分析

目的 探讨生理钙透析液对持续性不卧床腹膜透析(CAPD)患者钙磷代谢的影响.方法 回顾性分析2008年1月-2009年12月腹膜透析患者的钙磷指标,资料齐全的患者中使用钙浓度为1.25 mmol/L的腹膜透析液(生理钙组)的患者有30例,使用钙浓度为1.75 mmol/L的透析液(标准钙组)患者30例.对两组患者钙磷代...     

Interference of Peritoneal Dialysis Fluids with Cell Cycle Mechanisms

♦ Introduction:

Peritoneal dialysis fluids (PDF) differ with respect to osmotic and buffer compound, and pH and glucose degradation products (GDP) content. The impact on peritoneal membrane integrity is still insufficiently described. We assessed global genomic effects of PDF in primary human peritoneal mesothelial cells (PMC) by whole genome analyses, quantitative real-time polymerase chain reaction (RT-PCR) and functional measurements.

♦ Methods:

PMC isolated from omentum of non-uremic patients were incubated with conventional single chamber PDF (CPDF), lactate- (LPDF), bicarbonate- (BPDF) and bicarbonate/lactate-buffered double-chamber PDF (BLPDF), icodextrin (IPDF) and amino acid PDF (APDF), diluted 1:1 with medium. Affymetrix GeneChip U133Plus2.0 (Affymetrix, CA, USA) and quantitative RT-PCR were applied; cell viability was assessed by proliferation assays.

♦ Results:

The number of differentially expressed genes compared to medium was 464 with APDF, 208 with CPDF, 169 with IPDF, 71 with LPDF, 45 with BPDF and 42 with BLPDF. Out of these genes 74%, 73%, 79%, 72%, 47% and 57% were downregulated. Gene Ontology (GO) term annotations mainly revealed associations with cell cycle (p = 10^-35), cell division, mitosis, and DNA replication. One hundred and eighteen out of 249 probe sets detecting genes involved in cell cycle/division were suppressed, with APDF-treated PMC being affected the most regarding absolute number and degree, followed by CPDF and IPDF. Bicarbonate-containing PDF and BLPDF-treated PMC were affected the least. Quantitative RT-PCR measurements confirmed microarray findings for key cell cycle genes (CDK1/CCNB1/CCNE2/AURKA/KIF11/KIF14). Suppression was lowest for BPDF and BLPDF, they upregulated CCNE2 and SMC4. All PDF upregulated 3 out of 4 assessed cell cycle repressors (p53/BAX/p21). Cell viability scores confirmed gene expression results, being 79% of medium for LPDF, 101% for BLPDF, 51% for CPDF and 23% for IPDF. Amino acid-containing PDF (84%) incubated cells were as viable as BPDF (86%).

♦ Conclusion:

In conclusion, PD solutions substantially differ with regard to their gene regulating profile and impact on vital functions of PMC, i.e. on cells known to be essential for peritoneal membrane homeostasis.     

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。     

持续非卧床腹膜透析患者年龄与营养状况评价

目的 探索持续非卧床腹膜透析(CAPD)患者年龄与营养状况的关系,为营养教育提供指导.方法 对2007年8月-2010年1月腹膜透析177例患者的临床资料进行回顾性分析,包括血红蛋白(HGB)、血清白蛋白(ALB)、年龄、体重指数(BMI)、腹膜平衡试验(PET)、尿素清除指数(Kt/V)、24 h尿蛋白、腹透液漏出蛋...     

背向散射积分评价腹膜透析对腹膜的影响

目的 探讨背向散射积分(IBS)在评价腹膜透析对腹膜影响方面的应用.方法 腹膜透析组为30例尿毒症腹膜透析患者,对照组为30例尿毒症血液透析患者.以患者脐为中心十字交叉,将腹壁分为左上腹、左下腹、右下腹、右上腹4个象限,腹膜透析管均植于右下腹.对两组进行常规超声4个象限的腹膜壁层厚度及腹膜IBS测定.结果 (1)腹膜透析组右下腹腹膜壁层的厚度较对照组明显增厚(P＜0.01);腹膜透析组左上腹、左下腹、右上腹腹膜壁层的厚度较对照组增厚(P＜0.05);(2) 腹膜透析组右下腹腹膜的IBS%较对照组明显增高(P＜0.01);腹膜透析组左上腹、左下腹、右上腹腹膜的IBS%较对照组增高(P＜0.05).结论 背向散射积分可无创地有效地评价腹膜透析对腹膜的影响.     

腹膜透析病人的生存率及多变量预后分析

目的：调查腹膜透析病人的生存率及其独立的预后因素，识别病人死亡的高危人群，以指导临床治疗。方法：随诊腹膜透析病人268例，采用Kaplan-Meirie法分析生存率，采用COX模型多变量分析透析前各临床指标对预后的影响。结果：268例病人中位数随访时间为26个月；1年、2年、3年及4年总体生存率分别为85．6％、67．1％、56．9％及44．4％；经时序检验，透析前病人年龄、体重、经济状况、残余尿量、原发病、合并疾病、血红蛋白、血清白蛋白、血清尿素氮、肌酐及血磷浓度对生存率均有影响（P值均＜0．05）；经COX回归分析，透析前病人年龄、血清白蛋白及合并疾病成为独立的预后因素。结论：我国腹膜透析远期生存率稍低于西方发达国家。根据透析前年龄、血清白蛋白及有无合并疾病，可对腹透病人的预后进行初步判断。     

Selecting Peritoneal Dialysis in the Older Dialysis Population

Selecting peritoneal dialysis (PD) in older individuals is a complex, multi-step process. At each step, older individuals may not have the opportunity to receive PD unless care is optimized. Older individuals are less likely to complete a PD assessment, because of unstable medical conditions, consideration of palliative care, or reluctance to approach frail patients once they are established on hemodialysis (HD). Older individuals are also more likely to have medical or social conditions that contraindicate PD or to have barriers to self-care PD that may not be overcome with support. Older individuals who are eligible for PD may be reluctant to choose it, leaving HD as the default modality. Finally, receipt of PD may be compromised by urgent HD or PD catheter-related complications at the time of insertion. Despite all these challenges, older patients can do very well on PD, so each step should be well understood and optimized in renal programs to maximize PD use in older patients.     

护理干预对腹膜透析两种管路系统的影响

对使用“O”型管组和双联系统的长期行持续可活动腹膜透析治疗的病人,采取积极的护理干预,包括理论指导,操作示教,反示考核,居家跟踪随访及动态护理管理,观察两种管路系统的并发症发生率,透析效果,回归社会等方面,结果显示：两组差异无统计学意义（P＞0．05）。且本组腹膜炎发生率明显低于国内报道,说明了改善管路系统固然重要,而为病人提供有效的护理干预同样重要。     

腹膜透析在急性出血坏死性胰腺炎治疗中的应用价值

目的：探讨腹膜透析(PD)对急性出血坏死性胰腺炎(AHNP)的疗效及机制。方法：24例AHNP患者．在接受常规综合治疗的同时，行间歇性腹膜透析(IPD)治疗。PD治疗前后监测病情及生化指标的变化，并测定血中细胞因子和炎症介质水平。结果：PD治疗后患者心动过速，呼吸窘迫、腹痛、腹胀等症状明显缓解；总胆红素(TB)、淀粉酶(AMS)、脂肪酶(LPS)、尿素氮(BUN)、肌酐(Cr)明显降低；血肿瘤坏死因子α(TNF-α)、白细胞介素-1β(1L-1β)、C-反应蛋白(CRP)和内毒素水平明显下降；24例患者中19例治愈，5例死亡．死亡率为20.8％。结论：PD治疗能降低AHNP并发MODF的病死率，提高抢救的成功率。     

The Gut in Older Patients on Peritoneal Dialysis

Age-related changes in gastrointestinal symptoms need to be considered in peritoneal dialysis (PD) patients. A diminishing appetite is associated with aging and may be exacerbated by renal failure and PD treatment, meaning that attention to dietary adequacy is important in the older patient. Constipation and its treatment may increase the risk of peritonitis, but is important for comfort as well as trouble-free dialysis. Diverticulosis increases with age, and whilst there may be ethnic differences in the patterns of this condition, there is conflicting evidence regarding the risks of peritonitis associated with asymptomatic disease. Hernias, urinary incontinence, and prolapse are also common and made worse by PD, so it is important to know about these issues prior to starting. Whilst data around these topics are scant and some studies conflicting, further understanding these issues and considering mitigation strategies may improve technique survival and quality of life.     

Pilot Experience in Senegal with Peritoneal Dialysis for End-Stage Renal Disease

♦ Introduction: Peritoneal dialysis (PD) is occasionally used in western sub-Saharan Africa to treat patients with end-stage renal disease (ESRD). The present study is a retrospective review of the initial six years’ experience with PD for ESRD therapy in Senegal, a West African country with a population of over 12 million.♦ Material and Methods: Single-center retrospective cohort study of patients treated with PD between March 2004 and December 2010. Basic demographic data were collected on all patients. Peritonitis rates, causes of death and reasons for transfer to hemodialysis (HD) were determined in all patients.♦ Results: Sixty-two patients were included in the study. The median age was 47 ± 13 years with a male/female ratio of 1.21. Nephrosclerosis and diabetic nephropathy were the main causes of ESRD. The mean Charlson score was 3 ± 1 with a range of 2 to 7. Forty five peritonitis episodes were diagnosed in 36 patients (58%) for a peritonitis rate of 1 episode/20 patient-months (0.60 episodes per year). Staphylococcus aureus and Pseudomonas aeruginosa were the most commonly identified organisms. Touch contamination has been implicated in 26 cases (57.7%). In 23 episodes (51%), bacterial cultures were negative. Catheter removal was necessary in 12 cases (26.6%) due to mechanical dysfunction, fungal or refractory infection. Sixteen patients died during the study.♦ Conclusion: Peritoneal dialysis is a suitable therapy which may be widely used for ESRD treatment in western sub-Saharan Africa. A good peritonitis rate can be achieved despite the difficult living conditions of patients. Challenges to the development of PD programs include training health care providers, developing an infrastructure to support the program, and developing a cost structure which permits expansion of the PD program.     

40例在院退出腹膜透析患者的相关临床分析

目的：调查我院腹膜透析患者死亡和转HD治疗的原因及相关影响因素。方法：收集腹膜透析患者在我院死亡14例,转HD治疗2 6例;查阅40例患者在我院的完整病历资料,调查其死亡及转HD治疗的原因及感染病原菌、营养等指标。结果：14例腹膜透析死亡患者主要原因为肺部感染合并心脑血管疾病及消化道出血,均占（29%,4/14）。64.3%（9/14）的死亡患者HB〈90 g/L,ALB〈30 g/l;71.4%（10/14）的腹膜透析死亡患者合并钙磷失调。26例腹膜透析患者转HD的首要原因和次要原因分别为腹透相关性腹膜炎（50%,13/26）和透析液引流不畅（42%,11/26）。72.7%透析液引流不畅的腹透患者经影像学诊断漂管,27.3%患者为拔管手术证实网膜堵塞管口。结论：1.肺部感染性疾病合并合并心脑血管系统及消化系统,为腹膜透析患者死亡的主要原因,与全身营养状况不良,钙磷失调有关。2.腹膜透析相关性腹膜炎仍为腹膜透析患者退出转HD治疗的主要原因。3.因透析液引流不畅而拔管为转HD治疗的第二位原因,漂管和网膜阻塞管口为透析液引流不畅的原因。     

The Impact of Timing of Dialysis Initiation on Mortality in Patients with Peritoneal Dialysis

♦ Background:

The impact of timing of dialysis initiation on mortality is controversial in patients with peritoneal dialysis (PD). In this study, we analyzed the impact of timing of dialysis initiation on mortality in the incident PD population.

♦ Methods:

Incident patients with PD were selected from the Clinical Research Center (CRC) registry for end-stage renal disease (ESRD), a prospective cohort study on dialysis in Korea. Patients were categorized into 3 groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD using the Modification of Diet in Renal Disease (MDRD) equation. Group A was defined as eGFR < 5 mL/min/1.73m², group B as eGFR 5 – 10 mL/min/1.73m², and group C as eGFR > 10 mL/min/1.73m². Cox regression analysis was used to calculate the adjusted hazard ratio (HR) of mortality with group B as the reference. The primary outcome was all-cause mortality.

♦ Results:

A total of 495 incident PD patients were included. The number of patients in group A was 109, group B was 279, and group C was 107. The median follow-up period was 23 months. Multivariate Cox regression analysis showed that group A had a significantly higher risk of all-cause mortality compared with group B (HR 4.13, 95% confidence interval [CI], 1.55 – 11.03, p = 0.005) after adjustment for age, gender, cause of ESRD, serum albumin level, diabetes mellitus, and cardiovascular disease. There was no significant difference in mortality between group C and group B (HR 1.50, 95% CI, 0.59 – 3.80, p = 0.398) after adjustment for clinical variables.

♦ Conclusion:

An eGFR < 5 mL/min/1.73m² at the initiation of PD was a significant risk factor for death, while an eGFR >10 mL/min/1.73m² at the initiation of PD was not associated with improved survival compared with an eGFR of 5 – 10 mL/min/1.73m² at the initiation of PD.     

腹膜透析和血液透析患者心脏负荷的临床分析

目的初步评估行腹膜透析（PD）和血液透析（HD）的终末期肾病（ESRD）患者心脏负荷的状况;并比较PD、HD患者心脏负荷的差异。方法对上述两组患者通过测定平均动脉压（MAP）、血浆B型利钠肽（BNP）、超声心动图、心胸比（CTR）等进行比较。结果两组患者的MAP、BNP、超声心动图、CTR改变均高于正常对照组（P〈0．05）而PD组MAP、BNP、超声心动图、CTR改变轻于HD组（P〈0．05）。结论ESRD透析患者普遍存在心脏负荷过重,PD患者心脏超负荷状态较HD患者轻。