血液透析､腹膜透析和肾移植的成本-效果分析

目的 探讨我院行血液透析(HD)&#65380;腹膜透析(CAPD)和肾移植(KT)3种终末期肾脏病(ESRD)替代疗法第1&#65380;第2年的成本-效果比&#65377;方法 回顾性研究上述3种疗法患者开始治疗两年内的成本&#65380;对工作的影响&#65380;以及现阶段的生活质量(用SF-36量表),并进行有关分析&#65377;结果 KT组第1年的费用高于另外两组(P < 0.001);在第2年则明显低于另外两组(P=0.005),后两组间差异无统计学意义&#65377;KT组的睡眠质量&#65380;回返工作的比例均优于另外两组&#65377;在精神健康&#65380;生理职能和精力方面,KT组与CAPD组均优于HD组&#65377;在生理机能&#65380;一般健康状况&#65380;社会功能&#65380;情感职能上,KT组优于CAPD与HD组,后两组差异无统计学意义&#65377;结论 KT组从第2年开始体现其费用上的优势,而CAPD与HD两组之间在医疗成本上无显著差异&#65377;肾移植的治疗效果在整体上优于CAPD和HD,CAPD的治疗效果略优于HD&#65377;随着KT近期和远期存活率的提高,KT应是成本-效果比最好的ESRD替代治疗方法&#65377;     

低蛋白饮食对腹膜透析患者氮平衡的影响

目的 观察低蛋白饮食对腹膜透析（腹透）患者氮平衡及营养状况的影响,同时探寻保持腹透患者氮平衡的最低膳食蛋白摄入量（DPI）。 方法 将34例规律性腹透1个月以上、情况稳定的患者随机分为A、B、C 3组,DPI分别为1.2、0.9和0.6 g&#8226;kg－1&#8226;d－1。在研究第1、第7和第10天检测各组的氮平衡状况以及白蛋白、前白蛋白、钙、磷等指标。 结果 在第7、10天,A、B、C组平均DPI分别为（1.18±0.05）、（0.87±0.02）、（0.66±0.03） g&#8226;kg－1&#8226;d－1（P < 0.01）;平均能量摄入量（DEI）分别为129.29（117.57～133.89）、111.71（100.42～133.47）、146.8（128.03～163.18） kJ&#8226;kg－1&#8226;d－1;3组均呈正氮平衡,分别为2.99（2.15~4.72）、1.20（0.59~1.89）、0.24（－0.87~1.27） g。A组BUN和血磷有升高趋势,但差异无统计学意义。C组BUN在第7、10天显著下降（P < 0.01）。氮平衡与蛋白摄入量呈正相关（r = 0.712,P < 0.01）。 结论 在保证足够热量的基础上,规律腹透患者每天摄入0.65 g/kg的蛋白加上腹透液中丢失的蛋白量,既能保持氮平衡,又不增加透析的负荷。     

依贝沙坦对维持性腹膜透析患者残存肾功能的保护作用

目的 探讨血管紧张素Ⅱ受体拮抗剂（ARB）依贝沙坦能否延缓腹膜透析患者残存肾功能（RRF）的丢失。 方法 将入选的48例病情稳定的维持性腹膜透析患者随机分为依贝沙坦组和对照组。依贝沙坦组予安博维300 mg/d。所有患者每3个月行残存肾功能测定（eGFR），研究前后检测Kt/V、肌酐清除率（CCL）、血钾、血红蛋白，并记录血压和24 h尿量。 结果 研究结束时，依贝沙坦组和对照组的收缩压和舒张压、血红蛋白、血钾水平差异均无统计学意义；依贝沙坦组CCL[单位：L&#8226;周-1&#8226;(1.73 m2)-1] 高于对照组 （63.0±16.9 比 59.0±14.8，P < 0.05）；两组24 h尿量均减少，但对照组较依贝沙坦组减少明显 [(663±312) 比(885±276) ml/d，P < 0.05]。前6个月两组eGFR都明显下降，而依贝沙坦组更明显，6个月后依贝沙坦组下降变缓，研究结束时依贝沙坦组eGFR较对照组高[（1.68±1.01）比（1.04±0.76）ml/min，P < 0.05]。 结论 长期使用依贝沙坦可以延缓腹透患者的残存肾功能的丢失     

小剂量环孢素A联合小剂量泼尼松治疗特发性膜性肾病的初步观察

目的 非随机前瞻性观察小剂量环孢素A（CsA）联合小剂量泼尼松在我国特发性膜性肾病治疗中的疗效及不良反应,比较其与环磷酰胺（CTX）联合足量泼尼松的异同。 方法 31例经肾活检病理证实为特发性膜性肾病（Ⅰ~Ⅲ期）的肾功能正常的大量蛋白尿患者纳入本研究。CTX组20例,100 mg/d, 累积量约8 g;口服泼尼松0.6~1.0 mg&#8226;kg-1&#8226;d-1,2～3个月后逐渐减量。CsA 组19例（包括CTX组中治疗无效或复发的8例）,起始量1.0~1.5 mg&#8226;kg-1&#8226;d-1,2～3个月无效者,逐渐加量,最大剂量≤2.5 mg&#8226;kg-1&#8226;d-1;口服泼尼松0.15~0.50 mg&#8226;kg-1&#8226;d-1,3月个后逐渐减量。观察两组治疗前后的尿蛋白、血白蛋白和血肌酐等疗效指标及不良反应。 结果 CTX组随访（48±22）周,13例有效(65%,7例部分缓解,6例完全缓解),7例无效(35%)。CsA组随访（44±15）周,其中2例因不良反应而退出,余17例中,12例有效(70%,6例部分缓解,6例完全缓解),5例无效(30%)。两组缓解比例的差异无统计学意义。CTX组的不良反应有肝功能损伤等。CsA组的不良反应有血肌酐上升（3例）、高血压（12例）等,停药后或用药可控制。 结论 小剂量CsA联合小剂量泼尼松与CTX联合足量泼尼松治疗特发膜性肾病的缓解比例相近,对于CTX治疗无效或复发的患者,仍可能有效,虽然不良反应较多,但易于监测和控制。     

中晚期慢性肾脏病患者肾功能进展危险因素——单中心慢性肾脏病专业门诊队列研究

目的 探讨在慢性肾脏病（CKD）专业门诊管理下CKD 3~5期未透析患者肾功能进展相关危险因素。 方法 采取前瞻性队列研究设计,收集北京大学第一医院CKD专业门诊规律随访的CKD 3~5期未透析患者的血压、血红蛋白、钙磷代谢及蛋白尿等指标控制及肾功能的变化情况,进行肾功能进展的多因素分析。肾功能进展定义为每年估计的肾小球滤过率（eGFR）下降大于4 ml&#8226;min-1&#8226;(1.73 m2)-1、开始肾脏替代治疗和（或）肾脏病相关的死亡。 结果 共纳入138例患者,其中CKD 3期84例,4期36例,5期18例。进入队列时基线年龄为（56.5±16.7）岁,基线eGFR为（32.3±13.4） ml&#8226;min-1&#8226;(1.73 m2)-1,平均随访（27.1±12.1）个月。随访过程中患者平均血压（126.5±12.4）/（76.4±7.9） mm Hg;平均血红蛋白（123.4±17.6）g/L;平均钙磷乘积（45.2±7.7） mg2/dl2。分别有70例（50.7%）血压控制达标;102例（73.9%）血红蛋白控制达标;123例（89.1%）患者钙磷乘积控制达标;62例（44.9%）患者肾功能进展。多因素分析显示,随访过程中蛋白尿和血红蛋白水平与肾功能进展独立相关。 结论 通过CKD专业门诊的一体化治疗,能够有效控制中晚期CKD患者的各种并发症。控制蛋白尿和（或）改善贫血有利于延缓中晚期CKD患者肾功能进展。     

吗替麦考酚酯联合低剂量激素治疗HBsAg阳性的成人微小病变性肾病综合征

目的 探讨吗替麦考酚酯（MMF）联合低剂量糖皮质激素方案治疗HBsAg阳性的成人微小病变性肾病综合征的疗效及安全性。 方法 前瞻性地选择HBsAg阳性、HBeAg 阴性及血清 HBV-DNA <1000 拷贝/ml的成人微小病变性肾病综合征患者30例,分成激素组（16例）及MMF组（14例）。激素组接受常规激素治疗方案（泼尼松片,1 mg&#8226;kg-1&#8226;d-1）;MMF组接受低剂量激素（泼尼松片,0.5 mg&#8226;kg-1&#8226;d-1）联合MMF 1.0~2.0 g/d。 结果 激素组和MMF组乙肝病毒激活发生比例分别为62.5%及35.7%,其中接受拉米呋定治疗分别为43.8%及21.4%;谷丙转氨酶升高发生比例分别为50.0%及28.6%。激素组及MMF组的完全缓解比例分别为11/14和10/12,两组复发比例分别为6/11和4/10。 结论 与常规激素治疗方案比较,MMF联合低剂量糖皮质激素方案能同样有效地治疗HBsAg阳性的成人微小病变性肾病综合征,并在减少乙肝病毒激活方面可能显示一定优势     

Gitelman综合征的表型特点及性别因素对表型的影响

目的 探讨中国人Gitelman 综合征（GS）的表型特点以及性别因素对GS表型的影响。 方法 分析了28例GS患者的临床表现以及血、尿电解质、血pH、血管紧张素、血醛固酮、血压等水平，比较男性、女性GS患者两组之间的差异。临床表现症状通过问卷调查获得，肾小球滤过率（GFR）通过简化MDRD公式（成人）、Schwartz公式（18岁以下青少年）或同位素法评估。 结果 男性患者中夜尿增多的比例显著高于女性患者（P < 0.05），但发病年龄、四肢乏力、软瘫、手足抽搐等症状的发生差异无统计学意义。男性患者血肌酐明显高于女性患者[（82.7±43.3） μmol/L比（58.7±12.7） μmol/L]，但经体表面积校正后的肾小球滤过率差异并无统计学意义[（143.0±48.4） ml&#8226;min-1&#8226;（1.73 m2）-1比（138.0±38.9） ml&#8226;min-1&#8226;（1.73 m2）-1]。男性GS患者尿钾排泄分数和尿氯排泄分数显著高于女性患者(33.0%±22.9%比17.0%±4.7%；2.30%±1.59%比1.23%±0.39%，均P < 0.05），但两组间血钾、血氯、血镁、血碳酸氢根离子、血管紧张素、血醛固酮、尿pH、24 h尿钾、尿氯离子排泄总量差异均无统计学意义。3例肾功能受损的患者均为男性。 结论 男性GS患者的夜尿发生要多于女性患者，男性GS患者的肾功能可能更易受损，性别因素对表型的影响可能与雌激素影响钠氯共转子在远端小管的密度有关。     

低分子右旋糖酐铁和蔗糖铁对慢性肾衰竭大鼠氧化应激的影响

目的 评价小剂量反复多次低分子右旋糖酐铁和蔗糖铁静脉用药后对慢性肾衰竭大鼠氧化应激的影响。 方法 以5/6肾大部切除术建立慢性肾衰竭大鼠模型。右肾切除术后第4周,将实验大鼠分为4组：低分子右旋糖酐铁（糖酐铁）组、蔗糖铁组、对照组、假手术组。观察6周,检测各组大鼠体内氧化应激、铁代谢等指标。 结果 糖酐铁组和蔗糖铁组大鼠血红蛋白明显高于对照组（P < 0.05）,而两铁剂组间差异无统计学意义。对照组大鼠的血清铁、血清铁蛋白、转铁蛋白饱和度显著低于假手术组（P < 0.05）;两铁剂组大鼠上述指标均显著高于对照组（P < 0.05）,而两铁剂组间差异无统计学意义。糖酐铁组和蔗糖铁组血浆晚期氧化蛋白产物（AOPP）显著高于对照组[（127.84±21.19） μmol/L、（134.21±29.38） μmol/L比 （81.83±19.93） μmol/L,P < 0.05],而两铁剂组间差异无统计学意义。两铁剂组大鼠血浆丙二醛（MDA）高于对照组,而蔗糖铁组高于糖酐铁组[（6.06±0.73） nmol/L比（4.99±0.80） nmol/L, P < 0.05]。糖酐铁组、蔗糖铁组和对照组大鼠血清超氧化物歧化酶（SOD）和总抗氧化能力（TAOC）差异无统计学意义。模型组大鼠血浆谷胱甘肽过氧化物酶（GSH-Px）水平显著低于假手术组（P < 0.05）,而蔗糖铁组显著低于糖酐铁组和对照组[（2123.11±74.78） nmol&#8226;ml-1&#8226;min-1比（2352.84±163.90） nmol&#8226;ml-1&#8226;min-1、（2310.23±125.99） nmol&#8226;ml-1&#8226;min-1,P < 0.05]。 结论 静脉补铁可部分纠正5/6肾大部切除肾衰竭大鼠的贫血,改善铁代谢指标。反复静脉小剂量补铁对慢性肾衰竭大鼠氧化应激状态有不良影响,而低分子右旋糖酐铁的不良影响低于蔗糖铁。     

塞来昔布对Han：SPRD大鼠肾细胞外基质重塑的影响

目的 研究塞来昔布（CXB）对Han：SPRD大鼠肾细胞外基质（ECM）重塑的影响,探讨其抑制多囊肾肾间质纤维化的作用机制。 方法 选取杂合（cy/+）交配后第4代雄性、3周龄、体质量（68.5±16.6） g的Han：SPRD大鼠共57只,随机分成对照组（CXB：0 mg&#8226;kg-1&#8226;d-1）、CXB小剂量组（CBX：3 mg&#8226;kg-1&#8226;d-1）、CXB大剂量组（CBX：10 mg&#8226;kg-1&#8226;d-1）,每组19只。另选19只SD大鼠作为正常对照。饲料中加入CXB喂食13周后,处死动物。倒置显微镜下分析肾组织纤维化指数;实时荧光定量PCR检测肾组织胶原Ⅳ（COLⅣ）、基质金属蛋白酶（MMP）2、金属蛋白酶2组织抑制剂（TIMP）和转化生长因子（TGF）β1 mRNA的表达;免疫荧光共聚焦扫描法检测COLⅣ、MMP-2、TIMP-2、TGF-β1与PCNA共染的蛋白丰度;蛋白免疫印迹法检测TGF-β1的表达。 结果 与对照组相比,小剂量组和大剂量组均能显著减少肾囊肿指数（42.90±6.56和47.10±7.28比64.80±62.71,均P < 0.05）、纤维化指数（11.20±2.63和10.10±3.30比16.30±4.16,均P < 0.05）和间质炎性细胞的浸润（2.60±0.26和2.80±0.31比3.70±0.33,均P < 0.05）。小剂量组和大剂量组COLⅣ、TIMP-2和TGF-β1 mRNA的表达量显著低于对照组（均P < 0.05 ）,而MMP-2 mRNA的表达量显著高于对照组（均P < 0.05）。小剂量组和大剂量组COLⅣ荧光强度较对照组显著减弱,差异有统计学意义（20.30±5.11比61.40±4.51,P < 0.01;27.50±6.73比61.40±4.51,P < 0.05）。小剂量组和大剂量组MMP-2/TIMP-2比值较对照组增高,差异有统计学意义（4.88±1.52 和3.63±1.67比0.35±0.13,均P < 0.05）。小剂量组和大剂量组TGF-β1蛋白表达比对照组均显著减少。 结论 塞来昔布可能通过下调TGF-β1、增加MMP-2/TIMP-2比值、促进胶原Ⅳ的降解来抑制肾小管间质的纤维化。     

三种肾小球滤过率评估方程对早期糖尿病肾病的诊断价值比较

目的 比较由血清胱抑素C（CysC）计算所得的肾小球滤过率（CysC-GFR）、Cockcroft-Gault公式（CG）-GFR和简化MDRD-GFR对早期糖尿病肾病的诊断价值。 方法 选取2008年1月至2009年4月我院内分泌科的2型糖尿病（DM）患者为对象。所有患者均进行99mTc-DTPA 清除率检查,并完成血CysC、Scr、血糖、血脂、肝功能、肾功能、糖化血红蛋白、血细胞分析、尿微量白蛋白排泄率、眼底检查及身高、体质量、血压等相关检查。排除以下患者：年龄>75岁,肝肾功异常,持续血尿,肝硬化,充血性心力衰竭,前列腺疾病,营养不良及感染。按照尿微量白蛋白排泄率（UAER）将患者分为正常白蛋白尿组（87例）、微量白蛋白尿组（34例）和大量白蛋白尿组（12例）。计算相应CG-GFR、MDRD-GFR及CysC-GFR。 结果 最终入选患者133例（男性 74例,女性 59例）,平均年龄（58.1±12.3）岁。以99mTc-DTPA 肾动态显像测定的GFR为金标准,分别以90 ml&#8226;min-1&#8226;（1.73 m2）-1和75 ml&#8226;min-1&#8226;（1.73 m2）-1为分割点时,CysC-GFR的诊断准确率为89%和92%,明显高于CG-GFR（79%～86%,P = 0.004,0.04）和MDRD-GFR（80%～86%,P = 0.02,0.04）;分割点在60 ml &#8226;min-1&#8226;（1.73 m2）-1时,CysC-GFR、CG-GFR和MDRD-GFR诊断的准确率分别为92%、90%和92%,差异无统计学意义。视网膜病变、HbA1c、CysC、糖尿病病程和CysC-GFR是微量白蛋白尿的主要危险因素。 结论 CysC-GFR可以敏感准确地反映早期糖尿病肾病GFR的下降,与CG-GFR和MDRD-GFR比较,此法快速简便,对早期糖尿病肾病患者GFR的评估有独特的优势,值得在临床推广应用。     

Patient survival and causes of death on hemodialysis and peritoneal dialysis – single-center study

Survival and causes of death in children dialyzed in a single center were analyzed. During the last 12 years a chronic dialysis program was introduced in 146 children in our center and 125 of them, eligible for observation, were included in this analysis; 58 patients were on hemodialysis (HD) and 67 on peritoneal dialysis [continuous ambulatory peritoneal dialysis/automated peritoneal dialysis (CAPD/APD)]. Mean age at the start of dialysis was 13.1 years in HD and 9.8 years in CAPD/APD patients. Overall, 16 patients died (12.5%); 6 (10.3%) on HD and 10 (14.9%) on CAPD/APD; 4 HD patients died of hemorrhagic stroke and 2 were killed in road traffic accidents. Of 10 CAPD/APD patients, 7 died of heart failure, ischemic stroke, and/or disseminated thromboembolic disease. Another was killed in a road traffic accident and 2 died during the course of severe infections. The 1-year patient survival rate was 96.6% in HD patients and 95% in CAPD/APD patients, 2-year survival 94% and 93% and 5-year survival 91% and 78%, respectively (P=0.2, NS). In conclusion, the survival rate for HD and CAPD patients is similar, although after 2 years of therapy, it is lower in CAPD patients. The main causes of death are cardiovascular. However, in CAPD/APD patients, heart failure with low cardiac output and thromboembolic complications are major causes of death, and in HD patients the main cause is hemorrhagic stroke. Received: 21 February 2001 / Revised: 31 July 2001 / Accepted: 2 August 2001     

Should CAPD be the first choice for dialysis in Romania? Audit of the Iasi 'C. I. Parhon' Dialysis Center: 1995-2000.

Peritoneal dialysis was first introduced in Romania in 1995.We are reporting data on patient and technique outcomes, basedon the 5-year experience of one of the first two Romanian continuousambulatory peritoneal dialysis (CAPD) centres. During this period,Romania had the highest rate of increase in renal replacementtherapy (RRT) and CAPD (28 times over baseline) in Europe: CAPDincrease in Romania vs Eastern Europe was 6.7 compared to asimilarly defined ratio of 5.6 for haemodialysis (HD). Between 1995 and 2000, at the ‘C. I. Parhon’ Hospitalin Iasi, 259 patients were started on HD and 102 on CAPD. The90 CAPD patients we followed were treated for a total of 1896months. 86.7% of the patients were alive on 31 July 2000—67.8%continuing on CAPD, 15.6% on HD and 3.3% transplanted. The 61patients still on PD on that date, represented 11.1% of theactual Romanian CAPD population and 31% of our RRT population(compared to 13.7% nationwide). The gross mortality rate was comparable to the mean calculatedfor the HD population nationwide. Mean survival of the CAPDpatients was 45.4±2.6 months (95% CI=40.4–50.4months). One-year and 5-year patient survival rates were 97.5%and 52.7% respectively, superior and similar to mean figuresnationwide. Mean technique survival was 36.6±0.6 months(95% CI=31.5–41.6 months). One- and 5-year technique survivalrates were 83.1% and 34.3% respectively. Technique failure wasmainly due to dialysis inefficiency: 50% of cases. Mean weeklyKt/V for the 5-year period was 1.92±0.21 while mean weeklycreatinine clearance was 61.2±12.4 ml/1.73 m²/week. Eighty-four episodes of peritonitis were recorded in 46 patients(0.25 episodes/patient/year); mean duration to peritonitis was23 months (95% CI=18.2–27.5). Malnutrition was noted (SGAscore) in 25.5% of the cases. Blood pressure (assessed by 24-hABPM) was adequately controlled in 83.3% of the patients. Leftventricular hypertrophy was ubiquitous (77.7%), but left ventriculardilatation and systolic dysfunction (fractioning shorteningindex <25%) were rare—4.4% and 3.3% respectively (similarin prevalence to the Iasi HD population). No statistically significantchanges in echocardiographic parameters were recorded betweenthe first and subsequent years on CAPD treatment. Peritoneal dialysis had a rapid increase in the last 5 yearsin Romania and particularly in the region of Moldova. Outcomesand complication rates are equal or superior to nationwide HDdata and comparable to distinguished centres of CAPD in economicallydeveloped countries. We conclude that, provided that optimalmedical practice is available, CAPD should be the RRT of choicein Romania, and that it represents the only solution to thecountry's limited dialysis resources.     

尿毒症透析患者糖化产物的测定及意义

目的：探讨蛋白质非酶糖化的早期产物Amadori及糖化终末产物AGEs在非糖尿病尿毒症透析患血清中的浓度变化及透析的清除效果。方法：用氯化硝基四氮唑蓝法分别测定20例血液秀析（HD）患，17例腹膜秀（CAPD）患和21例健康对照的果糖胺，用荧光分光光度计分别测定上述三组的糖化终末产物（AGEs)，对其结果进行统计学分析。结果：HD组与CAPD组的果糖胺水平比正常组增高，差异有显性（P＜0．01），而透析组之间无差异（P＜0．05），血清AGEs3组之间两两均有差异（P＜0．01），比较一次血透前后果糖胺透前透后无差异（P＜0．05），AGEs透前透后有显性差异（P＜0．01），但AGEs透只只降低了21．42％，结论：提示糖化产物在尿毒症患产生增多而排泌减少，透析治疗不能很好地清除。     

双涤纶套鹅颈管与Tenckhoff管在腹膜透析患者中的疗效比较

目的 比较双涤纶套鹅颈管与Tenckhoff管在持续性非卧床腹膜透析（CAPD）患者中的临床疗效。 方法 前瞻性入选首次植管并接受CAPD治疗的终末期肾脏病（ESRD）患者110例，随机分为鹅颈管组（A组）和Tenckhoff管组（B组），各55例。腹透管末端均为直型，以常规手术法植入，随访1年。记录并发症、生存时间、退出透析或死亡等结局。采用Kaplan-Meier法、Log-Rank检验进行生存分析。 结果 随访结束时，110例CAPD患者中17例死亡，3例转为肾移植，8例转为血液透析治疗，3例转至其他医院，79例（71.8％）继续在我院腹透治疗。两组患者共发生腹膜炎26例（35例次），总腹膜炎发生率为0.32次/病人年，A组为0.35次/病人年和B组为0.29次/病人年（P > 0.05）。植管距离首次腹膜炎时间分别为A组（30±29）周和B组（29±24）周（P > 0.05）。12个月时两组发生腹膜炎的风险同为26.97％。两组共发生隧道感染2次，出口感染9次，隧道及出口感染的发生率为0.1次/病人年。与A组比较，B组隧道感染（0.036次/病人年比0）和出口感染（0.11次/病人年比0.06次/病人年）发生率较高，但差异无统计学意义（P > 0.05）。两组间导管机械并发症（导管移位、大网膜包裹、腹透液渗漏、外涤纶套滑出）、腹股沟疝及腹痛的发生率差异均无统计学意义（P > 0.05）。两组各有4例拔管，12个月技术生存率两组同为92.73％。两组共17例死亡（15.45％），其中A组死亡7例，B组死亡10例（P > 0.05），死亡原因主要为心脑血管并发症（47.1％）和感染（23.5％）。患者12个月生存率A组为86.34％，B组为80.68％（P > 0.05）。 结论 鹅颈管与Tenckhoff管应用于CAPD患者，在感染并发症与机械并发症的发生率、12个月技术生存率及患者生存率等方面的差异均无统计学意义，两种腹透管的疗效相近。     

Perioperative management of continuous ambulatory peritoneal dialysis patients undergoing inguinal hernia surgery

Management of patients undergoing dialysis after inguinal hernia surgery has not been standardized. This report presents the results of 9 patients with inguinal hernias (11 hernias) who were undergoing continuous ambulatory peritoneal dialysis (CAPD). All patients treated in this hospital since 2007 have returned to CAPD within 3 days after surgery without switching to hemodialysis (HD). The mean durations for resuming CAPD after surgery were 7.6 days from 1998 through 2007 and 2.3 days since 2008. The surgical procedure was performed with a polypropylene mesh in all cases. Local anesthesia was utilized for one patient with low cardiac function. All patients recovered rapidly, with no uremia or dialysis-related complications. No leakage or hernia recurrence was observed over the subsequent observation period (56.2 months). This experience suggests the possibility that interim HD can therefore be skipped in patients undergoing CAPD if the hernia sacs are closed tightly. Local anesthesia seems to be safe for high-risk hernia patients undergoing CAPD.     

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。     

Effects of Different Dialysis Modalities on Cardiac Autonomic Dysfunctions in End‐Stage Renal Disease Patients: One Year Prospective Study

Cardiac autonomic dysfunction (CAD) is a common problem in patients with end‐stage renal disease (ESRD) and may contribute to the risk of cardiac mortality. Long‐term effects of dialysis modalities on CAD in ESRD patients are not clear. In this one‐year prospective study, we studied the effects of different dialysis modalities on CAD in ESRD patients. The study consisted of 20 ESRD patients who had the indications for initiating dialysis therapy (13 hemodialysis and 7 CAPD patients) and 15 healthy controls (M/F: 5/10; age 30 ± 4). In all the subjects, first at the beginning of study (in patient groups just before initiating dialysis therapy) and then after 12 months, we studied 24 hours ECG‐Holter monitoring and heart rate variability parameters (time and frequency domain analysis parameters; SDNN: standard deviations of nn intervals, rMSSD: square root of the median of standard deviation, HRVI: heart rate variability index, LF/HF: low frequency/high frequency). In ESRD patients, before dialysis therapy, all the parameters of time domain analysis were significantly lower compared to control group (p = 0.001). In patient groups, after dialysis therapy (on the 12th month), significant improvement was observed in time domain analysis parameters (p = 0.001). When dialysis modalities were compared, the increase in the time domain analysis parameters was significantly greater in the CAPD group compared to hemodialysis (HD) group. Our findings suggest that CAD is frequent in ESRD patients, a dialysis therapy of 12 months can cause significant improvement on CAD and the ameliorative effect of CAPD is better than HD.     

Attitudes of British Isles nephrologists towards dialysis modality selection: a questionnaire study.

BACKGROUND: Dialysis demographics are changing around the world. Within the UK a striking decrease in the overall use of peritoneal dialysis (PD) has been noted. We set out to determine the opinions and attitudes of British Isles nephrologists about dialysis modality decisions and optimal dialysis system design. METHODS: A survey questionnaire was mailed to a random selection of members of the Renal Association of Great Britain and Ireland. RESULTS: A 63% response rate was achieved. Decisions about dialysis modality were based mostly on patient preference (mean score 4.4 on a scale of 1-5), quality of life data (mean score 3.8), and morbidity and mortality data (mean scores for both 3.6). The least important factors when choosing the modality of dialysis care were the treatment costs to either the patient or the health care system. Respondents felt that both PD and hospital-based haemodialysis (HD) were over-utilized in today's practice. They suggested that an 'ideal dialysis system' (based on patient survival, wellness, and quality of life) should have 27% of patients dialysed using hospital-based HD, 24% in a satellite unit, 11% dialysed using home HD, and 38% on some form of PD (19, 16, and 3% for CAPD, automated PD and intermittent PD, respectively). Few differences were identified between an ideal system which optimized patient survival, wellness, and quality of life, compared with one which optimized cost-effectiveness. CONCLUSION: This survey suggests that most nephrologists in the British Isles feel that hospital-based HD and CAPD are being currently overused, and that future dialysis planning should include a higher proportion of patients on satellite dialysis, home HD, and automated PD to optimize both dialysis cost-effectiveness and patient outcomes.     

CAPD and renal transplantation

Continuous ambulatory peritoneal dialysis (CAPD) is believed to improve the immune competence of end-stage renal failure patients and to increase the risk of graft rejection following subsequent renal transplantation. At this centre, 220 consecutive renal transplants have been studied in patients treated by either CAPD or haemodialysis (HD). Patient and graft survival was not significantly different for the two treatment groups over a five year follow-up. When only first cadaver recipients were considered (152 grafts) one-year graft survival (non-immunological failures excluded) was 77 per cent for CAPD and 79 per cent for HD patients (P greater than 0.05). Time on dialysis and number of pre-operative transfusions were significantly greater for the HD patients (P less than 0.05). A group of HD and CAPD patients were identified as being matched for age, sex, HLA, A, B, DR antigen matches, pre-operative transfusions and time-on dialysis. One-year graft survival of the CAPD patients was 82 per cent and for the HD patients 61 per cent. Studies of patient lymphocyte function and plasma suppressive activity in vitro revealed no differences between CAPD and HD treated patients. CAPD is not an immunological risk factor in renal transplantation and its continued use in the preparation of patients for transplantation is recommended.     

Increased incidence of gastrointestinal surgical complications in renal transplant recipients with polycystic kidney disease

BACKGROUND: We had the impression that, although our renal transplant recipients with polycystic kidney disease (PKD) had excellent long-term renal graft function, they had an increased incidence of postoperative gastrointestinal (GI) complications. METHODS: Over a 10-year period (1987 through 1996), 1467 renal transplants were performed in 1417 patients; 145 of these transplants involved PKD recipients. In the PKD group, 18 patients (12.4%) developed a posttransplant complication necessitating GI surgery (PKD-GI), an incidence twice that in the non-PKD recipients (73 patients or 6.2%, non-PKD-GI). RESULTS: PKD and non-PKD recipients displayed no significant difference in mortality. The PKD patients had better long-term renal graft survival than the non-PKD patients (P=0.08). There was no difference in mortality (P>0.6) or renal graft survival (P>0.6) between the PKD-GI and PKD-non-GI groups. The PKD-GI group had no increased mortality over the non-PKD-GI patients (P>0.6), despite a higher incidence of GI surgical complications in the PKD group versus the non-PKD group (overall: 12.4 vs. 6.2%, P<0.01; within 90 days of transplant: 7.6 vs. 3.3%, P<0.02) and a greater propensity for small and large bowel complications (overall: 9.0 vs. 2.6%; P< 0.001; less than 90 days: 6.9 vs. 2.0%, P<0.002). The PKD-GI recipients tended toward less long-term graft loss than their non-PKD-GI counterparts (11.1 vs. 27.4%; P=.22). The PKD-GI recipients suffered no acute rejection episodes within 90 days after their GI operation versus 11 of 73 non-PKD-GI recipients (O vs. 15.1%; P=0.075). CONCLUSIONS: PKD recipients of renal grafts should be watched closely early after transplant because of their increased risk of GI complications. These complications resulted in no increase in mortality or graft loss compared to non-PKD recipients with GI complications despite the PKD group's higher incidence of bowel perforation and increased age at time of transplant.