居家持续性不卧床腹膜透析患者的护理指导

对30例居家持续性不卧床腹膜透析患者进行护理指导，透析期间均无腹膜炎发生，20例（66.7％）生存期〉5年。提出做好针对性的心理指导、加强饮食指导、予以活动锻炼指导、预防腹膜炎及出口处感染和隧道感染的发生、进行随访与继续教育等护理措施，是获得良好透析效果的重要因素。     

持续不卧床腹膜透析患者血浆瘦素水平与营养状态的研究

新近发现，脂肪组织可分泌一种称为“瘦素”（ｌｅｐｔｉｎ）的蛋白，具有抑制食欲、增加蛋白质降解和抵抗胰岛素话性的作用［１］。尿毒症患者瘦素的血浆浓度明显升高［２］。研究中，我们通过检测２４例持续不卧床腹膜透析（ＣＡＰＤ）患者血浆瘦素浓度，并与３０例健康志愿者对照，以观察ＣＡＰＤ患者血浆瘦素水平的变化，并研究血浆瘦素水平与临床常用的评价营养指标之间存在的关系。 一、材料与方法 １．ＣＡＰＤ组：２４例ＣＡＰＤ患者，男７例，女１７例，平均年龄（６３．０ ±１１．３）岁，平均透析龄（３２±１８）个月。患者均…     

多囊肾致终末期肾病的腹膜透析治疗

我们对本院进行腹膜透析（PD）的多囊肾致终末期肾病患者进行了分析，发现患者进行腹膜透析治疗可取得良好的疗效，不会诱发或加重一些相关并发症，相对安全。     

血液透析和腹膜透析患者生存比较

目的 比较血液透析和腹膜透析患者的生存情况,探讨影响透析患者生存的主要危险因素。 方法 研究对象为2005年1月1日至2008年12月31日期间新进入透析且年龄≥18岁患者,随访至2009年3月31日。应用Kaplan-Meier法、log-rank检验及Cox回归模型分析患者的生存资料。 结果 共460例透析患者入选,其中247例起始采用血透治疗,213例起始采用腹透治疗。两组患者的基线资料,包括开始透析年龄、体质量指数（BMI）、估算肾小球滤过率（eGFR）、平均动脉压、进入透析治疗前心脑血管事件、Charlson并发症指数（CCI）等的差异均无统计学意义。中位随访时间为17.9（0.25,51）个月。意向治疗分析结果中,Kaplan-Meier生存曲线显示血透总体生存率优于腹透（P ＜ 0.05,log-rank检验）;透析1年内两组生存率差异无统计学意义（P = 0.14）,而透析1年后腹透患者的生存率显著低于血透患者（P ＜ 0.05）。亚组分析结果显示,≥65岁的非糖尿病肾病血透组生存率显著高于腹透组（P ＜ 0.05）。Cox回归分析显示,经混杂因素调整后,两种透析方式本身对透析生存无明显影响（HR,HD：PD = 0.778,95%CI 0.483~1.254,P = 0.303）;而年龄（HR = 1.051,95%CI 1.030~1.073,P ＜ 0.01）、透前有脑血管意外史（HR = 2.032,95%CI 1.125~3.670,P ＜ 0.05）、透前CCI≥5（HR=2.592,95%CI 1.230~5.465,P ＜ 0.05）、前白蛋白（HR = 0.022,95%CI 0.001~0.768,P ＜ 0.05）为透析患者生存率的主要影响因素。 结论 透析龄≤1年的血透和腹透生存率无显著差异;透析龄>1年的血透患者生存率可能逐渐高于腹透患者。老年非糖尿病患者血透生存率可能高于腹透。年龄、透前脑血管意外史、透前CCI≥5为影响透析生存率的主要危险因素。     

腹膜腔免疫系统与持续性不卧床腹膜透析

持续性不卧床腹膜透析 (ＣＡＰＤ)在治疗终末期肾衰 (ＥＳＲＤ)中的主要问题是存在相当高的腹膜炎发生率。据此 ,肾病学家对腹膜免疫机制进行了研究 ,腹膜免疫应答初期由腹膜腔内三种主要细胞即巨噬细胞、淋巴细胞及间皮细胞系统参与 ,免疫应答的出现使外周血白细胞通过间皮细胞层游入腹膜腔 ,但此免疫应答过程受腹膜腔内非生理性透析液交换 (ｃｏｍｍｅｒｃｉａｌｄｉａｌｙｓｉｓｓｏｌｕｔｉｏｎ ,ＣＤＳ)的影响 ,本文就ＣＡＰＤ中腹膜局部免疫的研究进展作一综述。1　腹膜巨噬细胞 (ＰＭ )通常腹膜腔内仅有少量液体 ,约 1 0 0ｍｌ。在Ｃ…     

连续性卧床腹膜透析充分性的评价

对于连续性非卧床腹膜透析充分性评价的指标，近年来的许多研究表明，不能仅以几个孤立的参数来衡量，必须根据患者尿毒症的病状和体征，接受透析治疗后的自我感觉、以及ＫＴ／Ｖ，肌酐清除率，蛋白分解率和透膜平衡试验等指标作综合的评价，本文仅就有关指标的研究进展及应用价值作一文献复习。     

终末期肾病血液透析转腹膜透析原因及预后分析

目的：分析终末期肾病（ESRD）血液透析转腹膜透析的原因,并探讨影响其预后的因素。方法：调查21例由血液透析转腹膜透析的CAPD患者,以分析其原因,并以COX回归法分析影响患者死亡预后的因素。结果：21例转腹膜透析患者中血管通路条件不佳占16例。糖尿病患者平均存活时间短,低蛋白血症影响患者预后（P〈0.01）。结论：血液透析转腹膜透析的主要原因是血管通路条件不佳;糖尿病肾病患者预后较非糖尿病患者差,低蛋白血症的患者提示预后不良。     

糖尿病肾病尿毒症患者血液透析与腹膜透析的疗效对比观察

目的：探讨治疗糖尿病肾病（DN）尿毒症较理想的透析方法，方法：对62例作血液透析（HD）和34例作持续性非卧床腹膜透析（CAPD）和DN尿毒症患进行比较，观察两组患透析前后的血液生化指标；生存率，死亡原因，透析后主要并发症。结果：透析前合并有高血压，心脏肥大，冠心病或年龄大于60岁，行CAPD治疗后出现并发症的机会较HD少（P＜0．05）。结论：透析前合并有高血压，心脏肥大，冠心病或年龄大于60岁的DN尿毒症患以选择CAPD治疗较佳。     

持续不卧床腹膜透析并发急性左心衰竭30例临床分析

目的:探讨持续不卧床腹膜透析(CAPD)并发急性左心衰竭的特点.方法:30例CAPD并发急性左心衰竭患者进行回顾性分析.结果:高血压、容量负荷过重是急性左心衰的主要原因,改为间歇性腹透(IPD)或临时改血液透析后,25例心衰竭得到纠正,5例死亡.结论:调整透析方案、增加超滤脱水是治疗CAPD并发急性左心衰的首选,抗心衰药物不作为常规方法.     

Efficacy and prognosis of peritoneal dialysis in patients with end-stage polycystic kidney disease

Objective To analyze the therapeutic effect and prognosis of peritoneal dialysis in patients with end-stage polycystic kidney disease. Methods A retrospective analysis was performed on patients with polycystic kidney disease who were treated with peritoneal dialysis for more than 3 months between July 2007 and September 2016 in the Second Hospital Affiliated to Soochow University. A total of 45 patients were enrolled in this study. Another 45 patients of non-diabetic nephropathy were selected as the control group matched by gender, age, and time of PD initiation. The information of the two groups such as general data, dialysis related complications, incidence of peritonitis, prognosis was recorded. Survival analysis was performed using the Kaplan-Meier method and Log-rank test．The risk factors affecting patients' survival were analyzed with Cox regression model. Results There were no significant difference in pre-dialysis age, sex ratio, blood pressure, urine volume, body weight, eGFR, biochemical data, and the proportion of hypertension and diabetes mellitus in the polycystic kidney group and control group. 24 h ultra-filtration volume, 4 h D/Pcr, Kt/V and Ccr between the two groups showed no significant difference (all P＞0.05). The incidence of peritonitis and the time of the first peritonitis in the two groups respectively as one episode per 82.4 months vs one episode per 81.5 months, (35.8±22.8) months vs (34.5±20.9) months had no statistical difference. The ratio of hernia (6.6% vs 2.2%), thoracic and abdominal leakage (4.4% vs 2.2%), dialysate leakage (0 vs 0), catheter dysfunction (4.4% vs 6.6%), exit-site infections (11.1% vs 6.6%), tunnel infections (4.4% vs 2.2%) and non PD related infections (11.1% vs 13.3%) had no significant difference. The 1-year, 3-year, 5-year patient survival of two groups respectively were 95.2% vs 93.3%, 78.9% vs 75.0%, 67.6% vs 64.9% (P=0.475), and 5-year technique survival was 78.7% vs 76.7% (P=0.623), demonstrating no obvious difference. Cox regression analysis showed that age and serum albumin were risk factors for the survival of patients. Conclusions The effect and prognosis of peritoneal dialysis in patients with polycystic kidney and non polycystic kidney were similar. Peritoneal dialysis is not the contraindication of polycystic kidney. Peritoneal dialysis can be used as a routine renal replacement therapy in patients with polycystic kidney disease.     

Validation of cystatin C-based equations for evaluation of residual renal function among patients undergoing continuous ambulatory peritoneal dialysis

Objective To validate cystatin (Cys C)-based equations for evaluation of residual renal function （RRF） in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods Fifty patients on CAPD from our department were enrolled in the study. Eight patients with residual urine volume ≤100 ml/d and 42 patients with residual urine volume ＞100 ml/d were enrolled into anuria group and non-anuric group respectively. The clinical and laboratory status of each group were compared and equations (Hoek’s, Yang’s and abbreviated MDRD equations) were validated in the non-anuric group by comparing with the arithmetic average of residual renal creatinine clearance rate and residual renal urea clearance rate which was considered as the golden standard for RRF. Results (1) Anuric group had significantly higher serum Cys C than the non-anuric group [(7.73±1.13) mg/L vs (6.46±1.15) mg/L, t＝2.39, P＝0.02)]. (2) RRF estimated by each equation was correlated well with measured RRF (r＝0.56, 0.56 and 0.39, all P＜0.05). (3) Yang’s equation [0.10 ml•min-1•(1.73 m2)-1] was least biased, followed by Hoek’s equation [-0.73 ml•min-1•(1.73 m2)-1] and abbreviated MDRD equation [3.15 ml•min-1•(1.73 m2)-1]. (4) The precision of Yang’s equation was equivalent to that of Hoek’s equation and both of them were better than abbreviated MDRD equation [6.2 and 6.1 vs 8.4 ml•min-1•(1.73 m2)-1]. (5) 50% accuracy according to Yang’s equation and Hoek’s equation revealed an elevated results in comparison to that according to abbreviated MDRD equation (59.5% and 54.8% vs 23.8%, respectively, all P＜0.01). Conclusions Serum Cys C-based prediction equations are better than the abbreviated MDRD equation in bias, precision and 50% accuracy. For patients undergoing CAPD, the use of Cys C-based equation to estimate RRF may be a clinically acceptable alternative.     

Pyridinium crosslinks in patients on haemodialysis and continuous ambulatory peritoneal dialysis

BACKGROUND: The urine excretion of the pyridinium crosslinks of collagen,pyridinoline (PYD) and deoxypyridinoline (DPD) closely reflectbone resorption and their assay has been used as specific markersof mature collagen turnover. The aims of this study were toevaluate the use of these markers to predict the severity ofosteodystrophy in patients with chronic renal failure. METHODS: Using an isocratic ion-paired reverse-phase high-performanceliquid chromatography, PYD and DPD were determined in the serum,urine and dialysate of 48 patients with chronic renal failureundergoing haemodialysis (n=28) or continuous ambulatory peritonealdialysis (n=20). Nineteen apparently healthy subjects were studiedas controls. RESULTS: In all groups, serum and urine crosslinks excretion showed poorcorrelation with age. In the patients urine PYD/creatinine andDPD/creatinine were significantly (P0.03 and 0.001 respectively)higher than normal; urine PYD and DPD levels were highly correlatedwith each other (r=0.98) and with serum PTH (r=0.84 and 0.83respectively). The mean (SD) predialysis serum PYD, 269 (334)nmol/l, was significantly (P0.003) elevated compared with normalpatients, 4.1 (0.6) and pre-dialysis serum DPD was 82.9 (93.7)nmol/l. DPD was below the detection limit of the assay in normalsera. In the patients postdialysis decreases in serum PYD andDPD were statistically significant (P<0.0002 and P<0.0007respectively). PYD and DPD were found in the dialysate of patientson haemodialysis as well as 24-h dialysate in patients on CAPD.Dialysate PYD and DPD were highly correlated with each other(r=0.80) and with dialysate creatinine (r=0.76 and r=0.62 respectively).In the patients, the mean serum, urine and dialysate PYD andDPD increased with the duration on dialysis. These findingsconfirm that metabolic bone disease increases in patients withduration of chronic renal failure. CONCLUSION: Estimation of serum crosslinks levels has potential as an additionaltool in the diagnosis and monitoring of renal osteodystrophy.The ability to determine crosslink levels in serum and dialysateshould be particularly useful in patients who are unable toproduce urine.     

Clinical outcomes of systemic lupus erythematosus patients undergoing continuous ambulatory peritoneal dialysis.

OBJECTIVES: The purpose of this study was to evaluate the outcome of systemic lupus erythematosus (SLE) patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS: Eighteen SLE patients who had been undergoing CAPD for at least 3 months in our unit were compared with 36 other age- and gender-matched non-diabetic CAPD patients with an underlying primary chronic glomerulonephritis (CGn). The clinical outcome, infective complications, lupus activities, biochemical parameters, haemoglobin level and the use of erythropoietin were reviewed. RESULTS: The duration of dialysis of the two studied groups was not different, with a mean of 35.4 months for the SLE group and 36.7 months for the CGn group. Before dialysis, SLE patients had a significantly lower albumin level (30.4+/-6.6 vs 35.4+/-5.59 g/dl, P<0.01), while the mean haemoglobin levels of the two groups were similar (8.5+/-1.8 g/dl for SLE vs 9.0+/-1.9 g/dl for the control group). However, the weekly dose of erythropoietin (EPO) used was significantly higher in the SLE group (6000 vs 3818 U/week, P<0.01) to maintain a similar haemoglobin level during dialysis. Regarding the infective complications, the SLE group had a higher peritonitis rate (5.7 episodes/100 patient-months vs 2.4 episodes/100 patient-months, P<0.05), and an increase in the non catheter related infection rate (6.67 episodes/100 patient-months vs 1.1 episodes/100 patient-months, P<0.001). However, no significant difference could be demonstrated in the Tenckhoff catheter exit site infection rate (2 episodes/100 vs 1.7 episode/100 patient-months). The number of patients who received a kidney transplant or required a change of mode to haemodialysis was similar among the two groups. Seven patients died during the follow-up period, and the overall mortality rate was much higher in the SLE group than in the control group (0.83/100 vs 0.15/100 patient-months, P<0.05). CONCLUSIONS: SLE patients on CAPD have a significantly lower pre-dialysis serum albumin level and use a higher dose of Epo to achieve a comparable haemoglobin level than other non-diabetic CGn CAPD patients. They also have a poorer prognosis in terms of infective complications and mortality rate.     

Swan neck presternal catheter for continuous ambulatory peritoneal dialysis in children

Since 15 December 1991 four swan neck presternal catheters (SNPC) have been implanted in four children aged 2–11 years. The observation period ranged from 4 to 10 months. The aim of this study was to evaluate the usefulness of a new peritoneal dialysis catheter implantation method in paediatric patients. The indications for insertion of the SNPC were: young age, use of nappies, obesity and recurrent exit site infection (ESI). The surgical technique of the SNPC implantation was similar to that used for adults. The chest location of the catheter exit site is advantageous for the following reasons: (1) easier care of a small child because of greater distance from nappies, (2) better healing and decreased risk of ESI in the area with less fat thickness and (3) less trauma. A larger number of children with a longer follow-up is necessary for better evaluation of the SNPC, as well as for estimation of frequency of ESI and peritonitis.     

艾考糊精腹透液单袋长时间留腹治疗连续性非卧床腹膜透析患者的安全性和有效性

Objective To evaluate the efficacy and safety of 7.5% icodextrin peritoneal dialysis solution for once-daily long dwell exchange in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods A prospective, multicenter, randomized, double blind, parallel controlled study was conducted for 5 weeks in 201 CAPD patients (96 male, 105 female) with mean age (56.1±13.7) years old. These patients were from 7 centers with 98 allocated to the icodextrin group and 103 to the dextrose group randomly. Patients in the icodextrin group were given 7.5% icodextrin and those in the dextrose group were given 2.5% Dianeal?誖PD-2 or PD-4 for the nocturnal long dwell exchange while the diurnal dialysis remained unchanged. During the 4- week treatment, patients were tested every other week for net ultrafiltration, peritoneal creatinine and urea nitrogen clearance after the long dwell. Other laboratory tests and adverse events were recorded. Results Compared to the dextrose group, the net ultrafiltration was up-regulated more significantly from the baseline in the icodextrin group [(342.53±25.79) ml vs (73.59±24.09) ml, P<0.01]. Episodes of net ultrafiltration less than 0 ml in the icodextrin group were much less than those in the dextrose group. Similarly, the mean difference between groups for change from baseline for peritoneal creatinine and urea nitrogen clearance was much higher[（428.02±53.14） ml/12 h vs （－99.79±50.19） ml/12 h， P<0.01； （306.43±53.31） ml/12 h vs (－116.02±51.05） ml/12 h， P<0.01， respectively] in the icodextrin group. In the icodextrin group, there was a decrease in serum sodium and chloride compared with baseline (P<0.01). Serum amylase activity decreased from (87.04±48.01) U/L to (21.59±13.58) U/L(P<0.01). Cholesterol in the icodextrin group was lower than baseline (P<0.05). There was no significant difference between two groups for the incidence and severity of adverse events. Conclusion 7.5% icodextrin is a safe and effective peritoneal dialysis solution for once-daily long dwell exchange in CAPD patients.     

Cytokines,adipocytokines and inflammatory markers in patients on continuous ambulatory peritoneal dialysis and hemodialysis

Background: Cytokines are essential mediators of immune response. Chronic renal failure patients suffer from chronic inflammation that results from factors such as impaired renal function, accumulation of uremic toxins and bio incompatibility of dialyzer membranes. These patients are also at increased risk of cardiovascular diseases. We have evaluated cytokines, adipocytokines and inflammatory markers in patients with chronic renal failure undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD).

Material and methods: We have determined serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP), leptin and ghrelin levels of chronic renal failure patients treated with either HD (n?=?20) or CAPD (n?=?20). TNF-α, IL-6, ghrelin and leptin measurements were performed by commercially available kits based on enzyme-linked immunosorbent assay (ELISA) method. hsCRP levels were determined by turbidimetric methods.

Results: Serum TNF-α and IL-6 levels of patients on HD were significantly higher than those of the ones on CAPD (p?<?0.05). Ghrelin, leptin and hsCRP concentrations were similar in both groups.

Conclusions: We can conclude that cytokine production is more obvious in HD process.     

Survival analysis in automated peritoneal dialysis patients

Objectives To compare the clinical characteristics, long-term survival and associated risk factors of automated peritoneal dialysis (APD) patients and continuous ambulatory peritoneal dialysis (CAPD) patients. Methods As a retrospectively study, adult patients started peritoneal dialysis in Peking Union Medical College Hospital (PUMCH) from September 1st, 2002 to September 30th, 2016 were enrolled. Baseline information and dialysis associated parameters were collected. The primary outcome was death and the secondary outcome was technical failure. The risk factors of death were analyzed in APD patients by Cox's regression model. Homochromous gender and age matched CAPD patients were analyzed as control. Results The baseline condition of 69 APD patients were similar to those of 138 CAPD patients. The survival rates of APD patients at 1-year、3-year and 5-year were 95.4%, 88.0% and 73.0% respectively, which were superior to CAPD patients. No significant difference in technical survival was found between APD and CAPD patients. Single-factor Cox's regression analysis showed that all-cause mortality of CAPD patients was 2.2 times higher than that of APD patients (95% CI 1.221-3.837). In the multi-factor Cox regression analysis model, adjusted by age, complications (including cardiovascular disease and diabetes), nPCR and serum creatinine, dialysis modality was not an independent risk factor of dialysis patients. Age (HR=1.077, 95%CI 1.016-1.142, P=0.013), diabetes (HR=3.608, 95%CI 1.117-11.660, P=0.032) and serum albumin (HR=0.890, 95%CI 0.808-0.982, P=0.020) were independently associated with all-cause death of APD patients. Conclusions Dialysis modality was not an independent risk factor for the all-cause mortality of peritoneal dialysis patients. Age, diabetic nephropathy and hypoalbuminemia were independently associated with the death of APD patients.