Serum albumin is a key biomarker of nutrition in patients receiving peritoneal dialysis (PD). However, prior studies have largely relied on single or averaged measurements, which fail to capture long-term dynamic changes. This study aimed to identify five-year serum albumin trajectories in PD patients and evaluate their associations with mortality. We conducted a retrospective cohort study of adult PD patients in a tertiary hospital in Beijing, China, with at least one annual albumin measurement during the first five years of PD. Group-based trajectory modeling (GBTM) identified latent albumin trajectory patterns. Multinomial logistic regression was used to examine baseline factors associated with trajectory membership, and Cox proportional hazards models were used to assess associations with all-cause mortality. Among 153 patients, three distinct albumin trajectories were identified: high-stable (HS, n = 56; 36.6

INTRODUCTION:Renal anemia is one of the most common complications in dialysis patients. The shortened red blood cell (RBC) lifespan is an important mechanism of renal anemia. This study aims to investigate the RBC lifespan and its influencing factors in anemic dialysis patients. METHOD:Prevalent patients on maintenance hemodialysis or peritoneal dialysis, treated with anti-anemia therapy including recombinant human erythropoietin (rHuEPO) or roxadustat for more than 4 months were enrolled. RBC lifespan was measured by the RBC lifespan analyzer RBCS-01A depended on Levitt's carbon monoxide (CO) breath test. Participants were primarily divided into low and high RBC lifespan groups by the average value. RESULT:A total of 187 patients were included in this study. The average RBC lifespan was 65.2 ± 28.55 days. The logistic regression analysis indicated treating with roxadustat rather than rHuEPO [OR 2.94, 95% CI (1.46, 5.95), p < 0.01], male [OR 2.15, 95% CI (1.08, 4.29), p = 0.03], higher body mass index (BMI) [OR 1.17, 95% CI (1.07, 1.27), p < 0.01], and higher total iron-binding capacity (TIBC) [OR 1.04, 95% CI (1.01, 1.06), p = 0.01] were independent risk factors for the shorten of RBC lifespan. While higher adjusted calcium [OR 0.14, 95% CI (0.03, 0.70), p = 0.02] and older age [OR 0.96, 95% CI (0.94, 0.99), p = 0.01] were independent protective factors. CONCLUSION:This study demonstrated that independent risk factors contributing to this reduction in RBC lifespan include male, elevated BMI, increased TIBC, and decreased adjusted calcium levels. Additionally, the type of anti-anemia therapy administered appears to have an impact on RBC lifespan.

OBJECTIVE:Peritoneal dialysis(PD)-associated peritonitis is a common and major complication of PD and the most common cause of technical failure of PD. The presence of bacterial biofilm may be an important factor leading to refractory or recurrence of peritonitis. To investigate the formation and characteristics of bacterial biofilms on PD catheters after peritonitis-associated catheter removal. METHODS:The patients with maintenance PD who were regularly followed up in the Peking University People' s Hospital from June 2007 to January 2022 were retrospectively analyzed. The patients who withdrew from PD because of peritonitis and removed the PD catheter in our hospital and underwent the scanning electron microscope examination of the catheter were selected. The general information of the patients, the electron microscope results of the PD catheter and the bacterial culture results of the PD fluid were summarized. RESULTS:(1) A total of 18 patients were included, 11 were female (accounting for 61.1%). The average age of the patients was (59.1±11.5) years, and the average duration of dialysis was (80.1±47.4) months. Primary kidney diseases were predominantly chronic glomerulonephritis (55.6%), followed by diabetic nephropathy (27.8%), and others (16.6%). The reasons for catheters removal in 18 patients were refractory peritonitis in 11 cases, recurrent peritonitis in 5 cases, and fungal peritonitis in 2 cases. (2) 16 of the 18 patients (88.9%) had catheter bacterial biofilm, and the bacterial biofilm forms were all cocci. Some were arranged in grape-like shapes, and their diameters ranged from about 500 nm to 1 000 nm. The bacterial culture results of peritoneal dialysis fluid showed that the three most common pathogens were Escherichia coli, methicillin-sensitive Staphylococcus aureus (MSSA), and Staphylococcus epidermidis. (3) Among the 18 patients enrolled, 13 patients (72.2%) had peritonitis in the past. The causative bacteria of peritonitis in 9 patients were cocci, including coagulase-negative Staphylococci (Staphylococcus suis, Staphylococcus surface, Staphylococcus xylosus, Staphylococcus warneri), Staphylococcus aureus, Streptococcus (Streptococcus salivarius and Aerococus viridans). CONCLUSION:Bacterial biofilm formation on the inner surface of PD catheter is common in peritonitis-associated catheter removal patients. Not all PD catheters removed due to peritonitis have bacterial biofilms. Bacterial biofilms and peritonitis pathogens may not be consistent.

Objective: Biofilm formation significantly impacts infection risks in peritoneal dialysis (PD) patients. However, few studies focused on biofilms on PD catheters. This study aims to explore the formation and characteristics of bacterial biofilm on PD catheters. Methods: A retrospective study was conducted on maintenance PD patients from January 2007 to January 2024. We summarized the general characteristics of the patients, the reasons for catheter removal, scanning electron microscopy (SEM) results of the PD catheter, and bacterial culture results from the PD effluent. The selected patients were divided into two groups: catheter removal due to peritonitis group (20 cases) and catheter removal due to non-peritonitis group (8 cases). Results: (1) The average dialysis duration in catheter removal due to peritonitis group was 84.2 ± 46.6 months, significantly longer than that in catheter removal due to non-peritonitis group (21.8 ± 18.7 months). Thirteen patients (65.5%) in catheter removal due to peritonitis group had a history of peritonitis before the current episode, whereas none in catheter removal due to non-peritonitis group had experienced it previously ( p = 0.002). (2) Bacterial biofilm was detected in 20 (71.4%) out of 28 patients. Of these, bacterial biofilm was found in 18 patients (90.0%) in catheter removal due to peritonitis group, compared to only 2 patients (25.0%) in catheter removal due to non-peritonitis group ( p = 0.002). SEM revealed that the bacterial biofilm forms present on the PD catheters were exclusively cocci biofilms. The bacterial culture results from the PD fluid of patients in catheter removal due to peritonitis group indicated that the three most prevalent pathogens were Escherichia coli (7/20), methicillin-sensitive Staphylococcus aureus (3/20), and Staphylococcus epidermidis (3/20). Conclusion: Bacterial biofilm formation on PD catheters is common among long-term PD patients. It is important to note that not all PD catheters removed due to peritonitis exhibit bacterial biofilms, and such biofilms may also be present in patients without peritonitis.

Background. The peritoneal solute transport rate (PSTR) tends to increase over time in some patients undergoing peritoneal dialysis (PD), potentially leading to ultrafiltration (UF) failure. Previous case reports have shown a significant decrease in PSTR and subsequent recovery of UF after discontinuing PD for a while. Therefore, we conducted a randomized controlled crossover study to evaluate the impact of short-term peritoneal rest on PSTR. Methods. The study involved 14 continuous ambulatory peritoneal dialysis (CAPD) patients with high/high-average transport rate. Two groups were randomly assigned different treatment sequences: one group underwent daily intermittent peritoneal dialysis (IPD) for 4 weeks followed by CAPD, while the other group initially received CAPD treatment for 4 weeks and then switched to IPD. Peritoneal equilibration tests were performed before and after each treatment to evaluate PSTR and paired t-tests were used to compare the changes. Volume load, serum potassium and other clinical indicators were monitored at the same time. Results. Short-term peritoneal rest (daily IPD) significantly reduced PSTR, with a decrease in the dialysate:plasma creatinine ratio from 0.71 +/- 0.05 to 0.65 +/- 0.07 (P < .001). Additionally, ultrafiltration significantly increased from 210 +/- 165 ml to 407 +/- 209 ml (P = .001). But there were no significant changes in interleukin-6 and vascular endothelial growth factor of PD effluent. No serious adverse events such as hypotension or hyperkalaemia occurred. Conclusions. In PD patients with high and high-average transport, a 4-week period of short-term peritoneal rest by switching from CAPD to IPD (without long dwell) can lead to reductions in PSTR and increases in UF volumes, while maintaining clinical safety.

Abstract Background and Aims Globally, peritoneal dialysis (PD)-associated peritonitis (PDAP) is a common and severe complication in PD. Early identification of high risk PDAP helps to prevent adverse outcomes. Currently, there is no recognized predictive tool for treatment failure of PDAP. Therefore, this study aimed to develop and validate a prediction model for treatment failure in patients with PDAP. Method We retrospectively collected 313 PDAP episodes occurred between January 2007 and August 2023, from real-world clinical practice in a tertiary center in Beijing, North China. The candidate predictors including patient characteristics, latest laboratory tests before PDAP, laboratory tests at PDAP onset and the causative organisms in peritoneal effluent. The prognostic model was developed from a multivariable logistic regression model with predictors selected using the stepwise backward regression. The C-statistic and the calibration curve plot were used to assess the discrimination and calibration of the prediction model. A bootstrap with 100 resampling was also performed as internal validation to further determine the robustness of the model. Results Among 313 PDAP episodes, 63 was reported treatment failure. The final model included 7 variables and was termed BLEND35 (sex, PD duration, platelet-to-lymphocyte ratio before PDAP, Gram-negative peritonitis, blood white cell counts at PDAP onset, dialysate white blood cell counts on day 3 and day 5). The C-statistic of the model was 0.936 (95% CI 0.897–0.974), revealing great discrimination. Calibration plot indicated that the model-predicted probabilities correlated well with the actual observed frequencies (Hosmer-Lemeshow test, P = 0.1223; Brier score = 0.064). Decision-curve analysis also revealed a positive net benefit. Conclusion The BLEND35 model will help to identify those with most high risk of treatment failure of PDAP and contribute to personalize and precise treatment. However, external validation is required before future application.

ABSTRACT Background This study aimed to investigate the clinical characteristics and prognosis of refractory peritoneal dialysis (PD)‐associated peritonitis as well as the risk factors of its occurrence and treatment failure. Methods A single‐center retrospective cohort study was conducted among 519 patients undergoing PD from January 2007 to October 2021. According to the International Society for Peritoneal Dialysis guidelines, all episodes occurred in our center were divided into two groups: refractory and nonrefractory. Demographic, biochemical, and pathogenic bacteria and treatment outcome data were collected. Results During the 15‐year period, 282 episodes of peritonitis occurred in 166 patients undergoing PD. The refractory rate was 34.0% (96/282). Gram‐positive organisms were the leading cause of peritonitis (47.9%); however, gram‐negative organisms were predominant in refractory peritonitis (34.4%, p = 0.002). Multiple logistic regression revealed that gram‐negative organism‐based peritonitis, longer PD duration, and female sex were the significant independent predictors of refractory peritonitis. Among 96 refractory episodes, white blood cell (WBC) count, dialysate WBC on Day 3, and PD duration ≥5 years were the independent risk factors of treatment failure. Conclusions Gram‐negative organism‐based peritonitis, longer PD duration, and female sex were the independent risk factors of refractory peritonitis. Refractory peritonitis with higher WBC count, higher dialysate WBC on Day 3, and PD duration ≥5 years increased treatment failure risk and required immediate PD catheter removal. The timely identification of refractory peritonitis with high risk of treatment failure as well as timely PD catheter removal is important.

Abstract Background and Aims To analyse the clinical characteristics, pathogen distribution, and treatment outcomes of peritoneal dialysis associated peritonitis (PDAP) caused by gram-negative bacteria, and explore the risk factors for the occurrence and treatment failure of gram-negative bacterial peritonitis. Method We performed a single-center retrospective study included 544 PD patients who underwent regular follow-up between January 1, 2007, and December 31, 2022. After excluding culture-negative peritonitis, fungal peritonitis, and tuberculous peritonitis, based on the pathogens, all episodes were divided into the gram-negative peritonitis group (GNP) and the non-gram-negative peritonitis group (non-GNP). Demographic characteristics, laboratory examinations, pathogenic bacteria, and treatment outcomes were collected and compared between the two groups of peritonitis. Results Over the course of 16 years, 297 episodes of peritonitis occurred in 179 patients. Although the overall incidence of peritonitis is showing a year-on-year downward trend, the incidence of GNP has not changed significantly. However, the percentage of GNP cases among all peritonitis cases is on the rise. After excluding episodes of culture-negative peritonitis, fungal peritonitis, and tuberculous peritonitis, a total of 226 cases of peritonitis were included in the study. Among them, females accounted for 50.0%, with an average age of 63.04 ± 11.58 years and a median PD duration of 42 (21, 73) months. Escherichia coli was the main pathogen responsible for gram-negative bacterial peritonitis in our center (37/80, 46.3%), followed by Klebsiella pneumoniae (9/80, 11.3%). The GNP group had significantly higher white blood cell counts in peritoneal effluent on day 0, day 3, and day 5 after peritonitis onset compared to the non-GNP group (p < 0.001 for all). In terms of treatment outcomes, the GNP group had significantly higher rates of developing refractory peritonitis, treatment failure, and peritonitis-associated death compared to the non-GNP group (p < 0.001 for all). Multivariate logistic regression analysis revealed that enteric infection was an independent risk factor for GNP occurrence (OR = 6.315, 95% CI 3.364-11.854, p < 0.001). White blood cell counts on day 3 of peritoneal effluent (OR = 2.666, 95% CI 1.099-6.469, p = 0.030) and post-PDAP blood white blood cell counts (OR = 1.389, 95% CI 1.060-1.820, p = 0.017) were independent risk factors for treatment failure in GNP. Conclusion Over the past 16 years, the incidence rate of GNP in our center has shown no significant decrease, and the proportion of GNP cases has been increasing year by year. Escherichia coli is the main pathogen responsible for GNP in our center. GNP cases are more difficult to treat and have a poorer prognosis compared to non-GNP cases. Therefore, it is important to strengthen preventive measures for peritoneal dialysis patients, reduce the risk of enteric infection, and actively treat patients who have already developed gram-negative bacterial peritonitis to avoid adverse outcomes.

Introduction: Disordered iron balance and abnormal parathyroid hormone (PTH) concentrations, both prevalent in hemodialysis patients, are risk factors of erythropoietin (EPO) resistance. Few studies have evaluated the correlation between iron indices and PTH and the potential role of iron markers on the association of PTH with EPO resistance in hemodialysis population. Methods: In this cross-sectional study of 71 maintenance hemodialysis patients, iron indices including hepcidin, ferritin, reticulocyte hemoglobin content (CHr), and transferrin saturation (TSAT) were examined. EPO responsiveness was measured as EPO resistance index (ERI). Lowess regression curves were performed to explore the correlations of iron indices, PTH, and ERI. The association between PTH and ERI was modeled using linear regressions. Potential role of iron indices on this association was examined using stratified analyses and mediation analyses. Results: The average ERI value was 10.3 ± 5.3 IU w−1 kg−1 (g/dL) −1. ERI was correlated to PTH, hepcidin, CHr, and TSAT (all p < 0.05). Hepcidin and PTH were closely correlated with each other (r = 0.28, p = 0.020). Analysis by PTH categories yielded a total association effect of 2.53 (95% CI: 0.27–4.85, p = 0.027) for high PTH subgroup versus the reference low subgroup. No clinically significant interaction between iron indexes and PTH was identified. Hepcidin appeared to mediate about one-third of the total association between PTH and ERI in hemodialysis population (33.6%, p = 0.025). Conclusion: Iron indices and PTH levels were related to ERI values. Hepcidin appeared to be closely correlated to PTH and partly mediate the association between PTH and ERI in hemodialysis population.

Background and hypothesis: Renal anemia is linked to a decreased lifespan of red blood cells. The factors influencing red blood cell lifespan (RBCLS) in peritoneal dialysis patients, particularly the connection between inflammation and RBCLS, are still not well understood. This cross-sectional study was conducted to investigate these relationships. Methods: Patients who had been undergoing peritoneal dialysis for more than 3 months were selected for this study. The carbon monoxide exhalation method was used to detect the life span of red blood cells. The patients were then divided into two groups based on whether the RBCLS was shorter than 75 days. General information, anemia-related indicators, and other laboratory indicators along with their treatment were compared between the two groups. The different indicators were then included in a logistic regression analysis to identify independent risk factors that influence the shortening of RBCLS. Results: A cohort of 59 peritoneal dialysis patients was examined, revealing a median RBCLS of 88 days. Of these patients, 39 exhibited a normal RBCLS, while 20 had a shortened lifespan. A comparison of the two groups indicated that patients with a shorter RBCLS exhibited lower levels of PD vintage (29.5 vs. 56.0, p = 0.031), albumin (34.62 ± 3.01 vs. 37.41 ± 3.60, p = 0.004), cholesterol (4.02 ± 0.54 vs. 4.55 ± 1.21, p = 0.026), and low-density cholesterol (2.19 ± 0.43 vs. 2.75 ± 0.87, p = 0.002), and a higher neutrophil-to-lymphocyte ratio (NLR) (3.05 vs. 2.61, p = 0.026) compared to those with a normal RBCLS. The logistic regression results indicated that PD vintage (OR 0.976, CI 0.958–0.999), albumin (OR 0.668, CI 0.514–0.867), low-density lipoprotein cholesterol (OR 0.046, CI 0.002–0.953), and NLR (OR 1.792, CI 1.016–3.162) were identified as independent risk factors influencing the shortening of RBCLS. Conclusion: Hypoalbuminemia, low LDL, and high NLR in peritoneal dialysis patients are identified as independent risk factors associated with a shortened RBCLS. Key learning points: RBCLS is reduced in both peritoneal dialysis and hemodialysis patients. The neutrophil-to-lymphocyte ratio (NLR) in peripheral blood, a simple and readily available laboratory indicator, can reflect the inflammatory status. This study adds: Nutritional status (albumin and LDL) and inflammatory status (NLR) are significant factors that impact the lifespan of red blood cells in peritoneal dialysis patients. Potential impact: This study presents novel findings on the relationship between chronic inflammation and RBCLS in patients with chronic kidney disease, highlighting the need for additional research in this area.

Objective The purpose of this study was to explore the feasibility and the perioperative management of surgical treatment due to concomitant diseases in patients with maintenance peritoneal dialysis（MPD）. Methods All peritoneal dialysis patients treated in Peking University People’s Hospital from March2006 to May 2021 were enrolled in this study, and the surgical operation records were reviewed for retrospective study. General information of the operation, levels of hemoglobin, electrolyte, renal function, blood pressure and others before and after the operation for 1-3 days, and surgical complications were recruited. Perioperative management and dialysis program were then explored in the MPD patients. Results In the 513 MPD patients, 72（14.0%） patients required 96 operations for various concomitant diseases, and 71 operations involved in 11 departments were analyzed in this study. Hemoglobin（100.15±14.95 vs. 106.15±14.95 g/L, t=3.436, P=0.001）, serum albumin（32.45±5.14 vs. 34.99±5.14, t=3.362, P=0.002） and carbon dioxide binding capacity（25.30±3.66 vs. 27.04±2.76, t=4.205, P＜0.001） decreased but still within the target ranges after the operations as compared with those before the operations. Blood pressure and serum potassium had no changes after the operations. Patients used general anesthesia had a higher probability（58.3%） of switching to continuous renal replacement therapy（CRRT） or hemodialysis during perioperative period than those used local anesthesia and intra-spinal anesthesia. Antibiotics were routinely used in 18 operations, and iodine contrast agent was used in 25 operations. Postoperative peritonitis occurred in 2 cases. The prognosis was better in most cases except that one patient died within one week after the operation. Conclusion There are higher risks in MPD patients undertaking surgical operation. However, most patients tolerate the surgery if perioperative management is appropriately arranged. Management of perioperative period, especially the adjustment of dialysis program, must be emphasized to help patients safely go through the perioperative period.

目的 检索、总结并整合评价成人腹膜透析患者管理的相关证据,为临床医护人员提供循证证据.方法 检索加拿大安大略注册护士协会网站、英国国家卫生与临床优化研究所网站、苏格兰学院指南网、美国指南网、国际指南网、医脉通、BMJ最佳临床实践、UpToDate、Cochrane Library、乔安娜布里格斯研究所、PubMed、Embase、CINAHL、Web of Science、CNKI、万方数据库,同时补充检索英国肾脏协会和国际腹膜透析协会网站,检索时间为建库到2022年3月,收集有关成人腹膜透析患者管理的相关文献.采用采用澳大利亚JBI循证卫生保健中心对应的评价工具对纳入的文献进行质量评价和证据分级.结果 共纳入文献11篇,包括4篇指南,2篇专家共识,2篇证据总结,3篇随机对照试验.从饮食营养管理、运动管理、容量管理、并发症预防与管理和延续性护理方式5个方面总结了 24条证据.结论 该研究总结了成人腹膜透析患者管理的最佳证据,具有一定的实用价值和科学性,可为临床医护人员全面掌握和管理腹膜透析治疗患者提供循证依据.

Background Peritoneal dialysis (PD)-associated peritonitis is a serious complication observed in peritoneal dialysis patients. Herein, we investigated the clinical characteristics and treatment outcomes of PD peritonitis in patients with different PD durations. Methods All peritonitis episodes from January 2007 to December 2020 at Peking University People's hospital PD center were retrospectively analyzed and divided into the long-dialysis duration (>= 60 months, LDD) and short-dialysis duration (<60 months, SDD) groups. Clinical characteristics and outcomes were compared between these groups. The risk factors for treatment failure were analyzed using a logistic regression model. Results During 14 years, 156 patients had 267 peritonitis episodes. There were 83 (31.1%) peritonitis episodes in the LDD group and 184 (68.9%) in the SDD group. No statistical difference was noted in peritonitis causes and the composition of causative pathogens between the two groups. The hospitalization, treatment failure, and transfer-to-hemodialysis rates, and peritonitis-related mortality were significantly higher in the LDD group than in the SDD group (all p < .05). Logistic regression analysis revealed that PD duration was an independent risk factor for PD-associated hospitalization, treatment failure and peritonitis-related death (p < .05). The receiver operating characteristic curve analysis results showed that when the cutoff value of PD duration was 5.5 years, the sensitivity of predicting PD peritonitis treatment failure was 51.1%, specificity was 78.8%, and the area under the curve was 0.679 (95% confidence interval: 0.594-0.765, p < .001). Conclusions PD duration is an independent risk factor for poor prognosis in PD peritonitis. Careful and active attention should be paid to the prevention of peritonitis in PD patients with long PD duration.

目的 探讨腹膜透析(peritoneal dialysis,PD)患者胸腹瘘的临床特征及诊治.方法 入选北京大学人民医院肾内科PD中心2006年1月1日～2021年9月30日确诊胸腹瘘的患者,收集一般资料、PD方案、胸腹瘘症状、体征、实验室检查、确诊方法、治疗及转归进行分析.结果 ①共纳入胸腹瘘患者5例,发生率0.96％.②5例胸腹瘘均在透析3～13周增加单次存腹剂量过程中发生,均为右侧,80％为女性,女性、老年高龄、低体表面积可能为危险因素.临床多表现为胸闷、呼吸困难、超滤减少等.③诊断方法:胸片提示右侧中到大量胸腔积液.可通过胸水葡萄糖高于血糖、亚甲蓝注入试验或CT腹腔造影确诊.④治疗方式:确诊后立即暂停PD转为血液透析(hemodialysis,HD),部分患者永久转至HD,或通过低剂量递增性PD逐渐恢复并长期PD治疗.结论 胸腹瘘为PD少见并发症,常在开始透析后增加单次存腹剂量的过程中发生,CT腹腔造影己成为最简便有效的确诊方式,治疗上需暂停PD,转为HD,或通过低剂量递增性恢复PD.如条件许可,手术治疗是解决胸腹瘘的有效措施.在透析液增量过程中应密切监测高危患者胸腹瘘相关症状体征、腹腔内压力变化,并减少目标存腹剂量,以预防胸腹瘘的发生.

目的 本研究通过对腹膜透析患者长期随访队列的生存分析,探讨腹膜炎发生频率对腹膜透析患者长期生存的影响.方法 研究对象为2006年1月～2014年4月新进入腹膜透析治疗的成人(年龄≥18岁)终末期肾病患者,随访截止时间为2020年12月.应用COX回归模型分析影响生存率的因素.按患者腹膜炎发生频次分为3组:A组(＜0.2次/年);B组(0.2～0.5次/年);C组(＞0.5次/年).应用Kaplan-Meier生存分析、COX回归模型分析比较3组患者的生存情况.结果 共221例腹膜透析患者入选.经过多因素COX回归,患者年龄(HR=1.058,95％CI:1.040～1.076,P＜0.001)、Charlson合并症指数(HR=1.274,95％CI:1.107～1.466,P=0.001)、时间平均全段甲状旁腺激素(iPTH)(HR=0.998,95％CI:0.996～0.999,P=0.001)和腹膜炎发生频率(HR=3.301,95％CI:2.098～5.196,P＜0.001)是预测死亡的独立危险因素.腹膜炎发生频率不同的3组间总体生存率存在差异(x2=99.473,P＜0.001),C组死亡风险高于 A 组(HR=2.022,95％CI:1.184～3.452,P=0.010);高于 B 组(HR=3.450,95％CI:1.723～6.906,P＜0.001);而A组、B组死亡风险无差别(HR=1.013,95％CI:0.621～1.652,P=0.958).结论 腹膜透析治疗中,腹膜炎发生频率可以影响患者生存.但其影响存在阈值,当腹膜炎发生频率超过0.5次/年时,患者死亡风险增加.

目的 探讨腹膜透析(peritoneal dialysis,PD)患者骨量异常的影响因素及与远期预后的关系.方法 采用双能X线法测定PD患者骨密度,同时采集其临床、生化检验结果.记录患者骨折、死亡的时间及原因.分析PD患者骨密度的影响因素及其与全因死亡和心血管死亡的关系.结果 共74例PD患者纳入研究,女性38人,平均年龄(60.9±14.1)岁,中位随访时间59.5(27.8,98.0)个月,随访期间共52人死亡,其中26人为心血管死亡,5人骨折.腰椎与股骨骨量异常的诊断率存在统计学差异(x2=17.697,P＜0.001).低体质量指数(0R=0.666,95％CI:0.508～0.874,P=0.003)和高龄(0R=1.065,95％CI:1.007～1.126,P=0.027)是股骨骨量异常的独立危险因素.多因素COX回归分析显示:股骨骨量异常使PD患者心血管死亡风险增加2.58倍(HR=3.582,95％CI:1.193～10.760,P=0.023).结论 股骨骨量异常是PD患者心血管死亡风险的独立预测因素.

目的 了解维持性腹膜透析患者红细胞寿命的情况,探讨红细胞寿命的影响因素,为合理治疗提供依据.方法 选择2021年6月～8月期间在北京大学人民医院肾内科规律随访、病情稳定、透析3个月以上的腹膜透析患者,采用一氧化碳(CO)呼气法检测红细胞寿命.记录其一般资料、贫血相关指标及其治疗情况.应用SPSS 22.0进行统计分析,应用多元线性回归分析红细胞寿命的影响因素.结果 ①共纳入32例腹膜透析患者,其中男性17例(占53.12％),年龄(57.42±11.03)岁,透析龄34.00(20.25,104.25)月,原发病以慢性肾小球肾炎居首位,占46.87％.②腹膜透析患者的红细胞寿命44～132天,平均(79.45±24.98)天.③多元线性回归结果显示,血清白蛋白(β=3.269,P=0.010)、血肌酐(β=0.045,P=0.037)以及有无糖尿病(β=-19.702,P=0.041)是红细胞寿命的独立影响因素.结论 腹膜透析患者血清白蛋白低、血肌酐低以及合并糖尿病与红细胞寿命缩短独立相关,应针对性地予以治疗.

目的 探讨不同透析龄患者首次发生腹膜透析相关性腹膜炎(peritoneal dialysis-asso-ciated peritonitis,PDAP)的临床特征及治疗效果.方法 回顾分析2007年1月1日～2021年10月31日在北京大学人民医院肾内科规律随诊的腹膜透析患者发生首次腹膜炎的诊治情况.按透析龄3年、5年为界,将所有首次PDAP分为长透析龄组(≥60月)、中透析龄组(36～59月)以及短透析龄组(＜36月),对比不同透析龄患者首次PDAP的临床特征与治疗预后.结果 ①近15年期间,166名患者发生了首次PDAP,其中男性83例(占50％),发病时年龄(63.33±12.14)岁,中位透析龄30(13,57)月.主要原发病为糖尿病肾病59例(35.5％).②长透析龄组36例(占21.7％),发生首次腹膜炎时的中位透析龄79(68,102)月.随着透析龄延长,3组患者中合并糖尿病占比逐渐下降(62.1％、45.7％、30.6％,x2=11.068,P=0.004),首次PDAP的治疗失败率、腹膜炎相关死亡率逐渐升高(x2=10.095、11.171,P=0.005、0.003).多因素Lo-gistic回归分析结果显示:透析龄是首次PDAP治疗失败(OR=1.291,95％CI:1.048～1.591,P=0.016)和PDAP相关死亡(OR=1.675,95％CI:1.262～2.222,P＜0.001)的独立危险因素.透析龄每增加1年,PDAP治疗失败及死亡的风险增加1.291和1.675倍.结论 透析龄60月及以上的长透析龄患者发生首次PDAP时治疗失败率和PDAP相关死亡率更高,预后更差.透析龄是首次PDAP治疗失败及死亡的独立危险因素.应积极加强对长透析龄腹膜透析患者腹膜炎的相关预防.