Hemodialysis in elderly patients

International Urology and Nephrology -     

Natural changes in peritoneal equilibration test results in continuous ambulatory peritoneal dialysis patients: a retrospective, seven year cohort survey

We conducted a retrospective, 7 year cohort survey to examine the natural changes in peritoneal equilibration test (PET) results in patients with long-term uneventful continuous ambulatory peritoneal dialysis (CAPD). Thirty-two (17 males, 15 females) patients on CAPD with two or more standard PETs performed more than 6 months apart, in the absence of peritoneal insult, were included. Changes and pattern of PET results were evaluated by the dialysate to plasma ratio of creatinine (D:P-cre), the fourth h dialysate to instilled glucose ratio (D4:Do) and ultrafiltration volume (UF, ml). The subgroups included high (H), high-average (HA), low-average (LA), or low (L) transporters with the dividing ratios (D:P-cre) of >0.81, >0. 65 to 0.81, >0.5 to 0.65, and <0.5, respectively. The median D:P-cre significantly decreased (p = 0.04), but neither the D4:Do nor the final median UF significantly decreased. The change in D:P-cre was strongly and inversely correlated with the initial D:P-cre value (r = -0.68; p < 0.05). A similar relationship was found between the change in the final D4:Do and the initial D4:Do (r = -0.752; p < 0. 01) and between the change in the final UF and the initial UF (r = -0.875; p < 0.01). No correlation was found between the change in D:P-cre and the age of the patient, the time interval between PETs, monthly dialysate glucose exposure, or underlying diabetes/non-diabetes. The final peritoneal transport pattern was altered with 5 (15.6%) patients remaining in the extreme subgroups (H or L) and, by contrast, 84.4% (27/32) of the patients now in the averaged (HA or LA) groups (p < 0.01, chi2 test). We demonstrated a natural "centralization" migration of PET results after long-term uneventful CAPD, which may help to explain why patients with extreme PET characteristics, that is, H or L, continued to do well on CAPD.     

腹腔巨噬细胞产生一氧化氮对腹膜透析失超滤的作用

目的 研究腹腔巨噬细胞产生的一氧化氮（ＮＯ）对腹膜淋巴孔的作用,探讨腹膜淋巴孔的淋巴重吸收对长期腹膜透析失超滤的影响。方法 应用腹透液建立腹宁的小鼠模型,用全自动酶标仪动态测定怛,用扫描电镜观察不同时间点腹膜间皮超微病理变化,使用计算机与扫描电镜联机的图象处理系统,测定不同腹膜透析时间点腹膜淋巴孔的变化。结果 腹腹膜管析时程延长,透析组有大量巨噬细胞从腹膜淋巴孔游出,在腹膜表面形成许多乳斑。巨噬细     

Effect of peritoneal fluid from patients with mild and severe endometriosis on endometrial stromal cell proliferation

The aim of this study was to evaluate and compare the mitogenic effect of peritoneal fluid (PF) from women with mild and severe endometriosis on the endometrial stromal cell proliferation. Increasing concentrations of PF from women with and without mild or severe endometriosis were added to primary endometrial stromal cell cultures and³H-thymidine incorporation was used to assess DNA synthesis in these cultures. PF from women with mild endometriosis induced a statistically significant dose-dependent increase in stromal cell thymidine uptake ranged from 5.8 to 14.5 fold, whereas PF from women with severe endometriosis produced an average 51% inhibition of stromal cell proliferation of compared with cells exposed to non-endometriosis PF or exposed to nutrient medium supplemented with 2.5% calf serum alone. PF samples from patients with stage I endometriosis induced a statistically dose-dependent increase in stromal cell proliferation, whereas PF from patients with stage IV endometriosis caused a significant inhibition.     

保肾乙丸对延缓腹膜透析患者残余肾功能的临床观察

本研究对行腹膜透析患者予口服中药保肾乙丸治疗,以观察其对残余肾功能的影响。将54例尿毒症行腹膜透析的患者随机分为两组,透析3个月后,对照组患者尿量(UV)、残余肾功能(RRF)、尿素KT/V、肌酐清除率(Ccr)均较治疗组有明显降低(P<0.01),而治疗组血尿素氮(BUN)、血肌酐(Cr)明显比对照组降低(P<0.01)。     

聚氯乙烯软袋对腹膜透析液中川芎嗪的吸附

 目的：考察聚氯乙烯（PVC）软袋装川芎嗪在腹膜透析液中的稳定性。方法：含川芎嗪0．04mg·ml^－1和0．20mg·ml^－1的腹膜透析液分别置于4℃，25℃和37℃，定时取样以HPLC测定含量，药物浓度降低≤5％为稳定性指标。结果：由于PVC软袋的吸附作用，各浓度在25℃ 6h后均有显著性降低，12h后降至95％以下；37℃ 4h即均有显著性降低，8h后降至95％以下。0．20mg·ml^－1（4℃）在24h后浓度明显下降，但10d后浓度下降未超过5％，0．04mg·ml^－1（4℃）在观察期间浓度略有升高。结论：PVC软袋可吸附川芎嗪，随温度的升高，吸附作用亦增强。川芎嗪溶于腹膜透析液后室温贮放不宜超过6h，温度升至37℃后尽快使用。     

尿毒症患者血清甲状腺功能测定分析

目的 探讨尿毒症患者体内血清甲状腺激素的变化以及血液透析对其的影响，为临床的诊治提供依据。方法 尿毒症患者分为非血液透析组(A组，30例)和血液透析组(B组，20例)，用化学发光的方法测定其血清甲状腺激素包括TT3、TT4、FT3、FT4、TSH；在血液透析组中有10例患者(C组)血液透析前后测定其血清甲状腺激素；并测定了20例年龄、性别相匹配的健康人群的血清甲状腺功能作为对照组(CG)。结果 尿毒症患者与对照组比较，TT4、FT3、FT4均下降，两组数据比较，差异有显著意义，其余差异无显著意义。血液透析前后比较甲状腺激素各项指标差异无显著意义。非血液透析组中BUN、Scr与FT3、FT4呈负相关，与TSH无相关性。结论 在尿毒症患者有较高频率的甲状腺功能减退，在终末期肾脏疾病的患者中检测甲状腺功能应作为常规。     

腹膜透析与血液透析治疗肾功能衰竭分析

目的 探讨腹膜透析与血液透析在肾功能衰竭治疗中的应用价值.方法 应用腹膜透析治疗几种特殊类型的肾功能衰竭患者27例,并与同期血液透析患者的治疗效果进行比较.结果 腹膜透析的疗效与血液透析的疗效相同,差异无显著意义.结论 对几种特殊类型的肾功能衰竭患者,腹膜透析与血液透析选择性联合应用,可以提高患者长期存活质量.     

腹膜透析病人与营养师评估饮食状况的比较

腹膜透析病人中普遍存在营养不良，影响其预后欧美国家发生率为18％～56％，我国为30％～54．4％。饮食记录对及时发现营养不良非常重要，国际上多采用1d饮食回顾法或3～7d饮食日记法。但回顾询问法不够准确。本研究采用食物模具，在有经验的营养师指导下，采用回顾询问法对病人3d饮食日记自评与营养师评估进行比较，以了解腹透病人饮食记录的准确性。     

尼莫地平纳米脂质体包封率测定方法的研究

目的　建立尼莫地平纳米脂质体的包封率测定方法。方法　以高效液相色谱法为分析手段 ,采用反透析法测定尼莫地平纳米脂质体的包封率。结果　反透析法透析平衡时间为 6h ,游离药物回收率符合要求 ;此法测得自制尼莫地平纳米脂质体的平均包封率为 85 6 9%± 3 13% ,10h内无渗漏 ,方法重现性好。结论　反透析法便捷、准确 ,适用于脂溶性药物尼莫地平纳米脂质体的包封率测定。