We report a rare case of peritoneal dialysis (PD)-associated peritonitis caused by Coxiella burnetii, an intracellular pathogen typically associated with Q fever. A 28-year-old female with lupus nephritis and end-stage kidney disease on PD presented with cloudy effluent and abdominal pain after consuming undercooked lamb. Despite initial empirical broad-spectrum antibiotic therapy (cefazolin/ceftazidime protocol), clinical symptoms persisted. Conventional bacterial, fungal, and mycobacterial cultures were negative. Metagenomic next-generation sequencing (mNGS) of the peritoneal effluent identified C. burnetii DNA. The treatment was transitioned to doxycycline and hydroxychloroquine resulted in clinical improvement and normalization of inflammatory markers. This case underscores the diagnostic value of mNGS in culture-negative peritonitis and emphasizes C. burnetii as an emerging pathogen in immunocompromised PD patients, particularly with zoonotic exposure histories.

Peritoneal dialysis-associated peritonitis is the primary cause of technical failure and infection-related mortality in PD patients. Culture-negative peritonitis poses unique management challenges. The reported incidence of culture-negative peritonitis varies substantially across regions and centers, likely reflecting differences in patient characteristics, microbiological practices, and treatment protocols. In this study, we aimed to investigate the risk factors, treatment strategies, and clinical outcomes of culture-negative peritonitis in a large peritoneal dialysis center in northern China. In this single-center retrospective cohort study, we included consecutive peritonitis episodes from January 2013 to December 2023. We assessed patient demographics, medical history, peritonitis presentation, antibiotic use, and treatment pathways. The primary outcomes were culture-negativity and outcomes of medical cure. Logistic regression was used to identify independent risk factors for culture negativity and failure to achieve a medical cure. The overall incidence of peritonitis during the study period was 0.15 episodes per patient-year and the culture-negative peritonitis rate was 25.5

Peritonitis is the leading cause of technical failure in peritoneal dialysis (PD), often resulting in the cessation of home dialysis. Culture-negative peritonitis poses unique management challenges with limited evidence on optimal strategies. This retrospective cohort study included consecutive cases of PD-associated peritonitis from 2013 to 2023 in the PD center of Peking Union Medical College Hospital. The clinical data were extracted from electronic health records. The diagnosis, classification, and outcomes of peritonitis were consistent with ISPD guidelines. Depending on the characteristics of the data, comparisons between groups were conducted using t-tests, Mann–Whitney tests, or Fisher’s exact test. Logistic regression was used to analyze the correlation between various factors and outcomes. Culture-negative (CN) peritonitis accounted for 25.5% (63/247) of all peritonitis. Compared with culture-positive (CP) peritonitis, patients with CN peritonitis were more likely to have smoked (P = 0.031) and had significantly higher rates of antibiotic use before culture collection (47.6% vs. 9.2%, P < 0.0001). Baseline characteristics, including age, diabetes status, BMI, PD modality, and pre-peritonitis bloodwork, were comparable. In multivariate logistic regression, only smoking history (OR = 2.01, 95% CI: [1.024, 3.945], P = 0.042) and the use of antibiotics before culture collection (OR = 58.59, 95% CI: [3.942, 19.54], P < 0.0001) were independently associated with negative culture peritonitis. The patients initially presented to the emergency room (ER) experienced higher rates of antibiotic use (27.55% vs. 9.85%, P = 0.0007) and delays in effluent culture collection (average 12.7 hours vs. 1.2 hours, P < 0.0001) than those presented to the PD unit. Multivariate logistic regression analysis indicated that CP peritonitis, automated peritoneal dialysis (APD), and non-first episodes of peritonitis independently predicted the poor prognosis of not being medically cured. CN peritonitis generally had better outcomes with higher medically cured rates and fewer refractory cases. However, a subgroup of patients with comorbidities requiring antibiotics (N = 9) use before culture had the worst prognosis: 4 of them died during peritonitis treatment, and the survivors had a catheter removal rate of 60%. Cultural negativity is influenced by the initial presentation’s location and sample collection delays. CN peritonitis generally has favorable outcomes. Special attention is needed for CN peritonitis patients with comorbid infections, as their prognoses are significantly worse. These findings highlight the importance of tailored management strategies for patients with peritonitis, particularly for those with a history of antibiotic use or recurrent episodes.

ObjectiveTo explore the palliative care needs of peritoneal dialysis patients and their caregivers, providine a scientific basis for the targeted implementation of palliative care intervention programs.MethodsA semi-structured in-depth interview was conducted on 14 patients and 6 caregivers at a peritoneal dialysis center in a third-class hospital in Beijing. We used the Colaizzi seven-step data analysis method and the phenomenological method of qualitative research to analyze the data and refine the theme.ResultsThrough the analysis, 5 theme groups were summarized, including the need to alleviate physiological and psychological symptoms, the need for family support and help, the need for social help, the lack of understanding of palliative care, and the lack of scientific view of death.ConclusionsPeritoneal dialysis patients and their caregivers have a strong need for palliative care. Medical staff should fully respect the uniqueness of peritoneal dialysis patients and implement targeted palliative care interventions based on their needs and preferences, so as to effectively improve their quality of life.

Introduction: Currently, no consensus on optimal renal replacement modality has been reached for end -stage renal disease (ESRD) patients complicated with hemophilia. They may require infusion of coagu-lation factors during each hemodialysis session. In comparison, peritoneal dialysis (PD) might be preferred considering that coagulation replacement is only required for catheter placement. However, limited data on the safety and efficacy of PD for treating ESRD patients with hemophilia were reported.Methods: This is a single-center retrospective cohort study. ESRD patients diagnosed with hemophilia under PD in Peking Union Medical College Hospital from January 1, 1996 to December 31, 2021 were included and followed-up with every month. Their baseline clinical data, catheter insertion procedure, coagulation factor replacement, complications, and outcome were analyzed and compared with general PD patients.Results: In total, 8 patients diagnosed with hemophilia were included, all-male, with a mean age of 50.3 +/- 13.3 years old. Two were acquired hemophilia A, whereas the rest were hereditary hemophilia A (HHA). Seven patients experienced significant hemoglobin (Hgb) increment after PD. Peritoneal hemor-rhage only consisted of a small portion of all hemorrhage. Patients with hemophilia seemed to have lower small solute clearance despite higher baseline peritoneal permeability, and appeared to have increased peritonitis rate than other male PD patients, yet this study is not powered to prove this.Conclusion: PD is a safe and effective choice for patients with hemophilia and ESRD requiring dialysis. More studies are required to evaluate this certain rare group of patients.

Parvovirus B19 infection can cause chronic pure red cell aplasia in immunosuppressed hosts or acute and transient aplastic crisis in immunocompetent hosts. In dialysis patients, only transient aplastic crisis induced by parvovirus B19 infection has been reported. We herein report the first case of an adult dialysis patient who developed chronic pure red cell aplasia associated with parvovirus B19 infection. Repeated pneumonia and heart failure may contribute to an immunocompromised status, making the patient more vulnerable to parvovirus B19 infection. This case expands on the differential diagnosis of chronic anemia in patients undergoing dialysis.

Background: Lack of exercise may reduce the quality of life, physical capability, and functional capability of dialysis patients. Home-based exercise seems to be a desirable form of low-cost intervention. But the effectiveness of this intervention in the dialysis population is still unclear. The purpose of this meta-analysis is to provide effective evidence to determine the impact of home-based exercise on functional capacity, physical capacity, muscular strength, biochemical parameters, and health-related quality of life among dialysis patients with endstage renal disease (ESRD).Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to May 2023, to identify potential randomized controlled trials (RCTs) assessing the effectiveness of home-based exercise in dialysis patients with ESRD. Two independent reviewers selected studies, extracted data, and assessed the risk of bias using the Cochrane tool. Evidence summary using fixed or random effects for meta-analysis.Results: Twelve RCTs including 1008 dialysis patients met the inclusion criteria. The meta-analysis showed significant effects of home-based exercise on physical capacity. Seven studies reported the results of the 6-min walking test, compared with short-term (0-3 months) home-based exercise (P = 0.76), long-term (3-6 months) interventions (P < 0.001) can significantly improve the results of the 6-min walking test. The results showed that home-based exercise did significantly improve patients' VO2 peak (P = 0.007). Compared with center-based exercise or usual care, home exercise did not significantly improve handgrip strength, quality of life or CRP and other biochemical parameters (P > 0.05).Conclusion: The results showed that long-term home-based exercise can improve walking ability. In addition, home-based exercise had the benefit on the VO2 peak of ESRD patients receiving dialysis patients. However, there was no statistically significant difference in handgrip strength, health-related quality of life, CRP, and other biochemical parameters.

[This corrects the article DOI: 10.1016/j.ekir.2022.09.030.].

Renal replacement therapy and perioperative management have difficulties in hemophilia patients with end-stage renal disease. The paper summarized the diagnosis and treatment experience of six hemophilia patients complicated with end-stage renal disease from January 1, 2000 to March 31, 2023 in Peking Union Medical College Hospital. Among 6 patients treated with peritoneal dialysis, 3 were treated with hemodialysis or continuous venous-venous hemodialysis. Altogether 11 dialysis access procedures were conducted successfully, and no serious bleeding or thrombotic events. In further conjunction with literature review, the paper summarized the key points of dialysis access appliance relevant to such patients, to provide reference for renal replacement treatment paths.

目的:研究探讨Web of Science(WOS)科技文献数据库中人工智能(AI)在肾脏病学领域中相关的研究与应用,为临床相关研究提供提供参考.方法:通过系统检索WOS数据库建库至2022年5月8日关于AI在肾脏病学领域中应用的科技文献,获得1136篇相关研究数据,其中包括文献发表时间、期刊名称、研究机构、国别、引文和关键词信息,使用VOSviewer 1.6.17软件对AI在肾脏病学中的研究信息进行提取,并对国家、研究机构和作者生成合作网络聚类图,对关键词进行可视化聚类分析,建立共聚类图谱.结果:经过排除及筛选,共检索获得AI在肾脏病学领域中应用的科技文献1136篇,发文量呈逐年上升趋势.发文量排名前5的国家分别为美国、中国、意大利、韩国和日本,发文量较多的国家间形成4个合作团体.其中,发文量最多的期刊为《Journal of Endourology》(《内泌尿学杂志》),美国的Kaouk JH作者参与发文数量最多;参与10篇及以上的57名作者之间形成8个合作团体.参与合作机构数量>8个的18个研究机构形成了5个合作团体,其中机构中心性最高的是克利夫兰医学中心(Cleveland Clin).检索分析的关键词中,最终聚类为机器人辅助手术、癌症治疗以及机器学习在肾脏病风险预测和诊断中的应用共3类.结论:AI在肾脏病学领域中展现出了广阔的应用前景,以深度学习为代表的机器学习是当前的研究重点.

目的 基于Logistic回归和决策树探究终末期肾病患者发生轻度认知功能障碍的影响因素.方法 选取就诊于北京协和医院、北京朝阳医院及中国人民解放军总医院进行血液透析和腹膜透析的终末期肾病患者.基于多因素Logistic回归分析和决策树的CHAID算法分析终末期肾病患者发生轻度认知功能障碍的影响因素.结果 共纳入337例患者,轻度认知功能障碍发生率为44.2％.多因素Logistic回归分析结果显示:相比年龄≤44岁的患者,≥60岁发生轻度认知功能障碍的风险更高(OR=5.637,95％CI:2.843～11.175,P＜0.001);相比受教育时间6年及以下的患者,7～12年(OR=0.138,95％CI:0.023～0.827,P=0.030)和 12 年以上(OR=0.076,95％CI:0.013～0.454,P=0.005)发生轻度认知功能障碍的风险更低;伴有糖尿病(OR=2.009,95％CI:1.147～3.521,P=0.015)和有脑血管病史(OR=5.039,95％CI:2.281～11.129,P＜0.001)的患者发生轻度认知功能障碍的风险更高.共6个变量进入决策树模型,由上到下分别为年龄、脑血管病史、糖尿病、受教育时间、透析方式、肌酐.结论 决策树模型与传统Logistic模型的结合应用可以科学充分地探究终末期肾病患者发生轻度认知功能障碍的影响因素.其影响因素涉及患者一般情况、合并症、治疗方式及检查指标各个方面,临床中应给予关注和重视.

Key Clinical Message This case illustrates that under comprehensive management of individual and clinical needs, urgent‐start peritoneal dialysis can be performed safely without bleeding complications in patients with hemophilia A who developed end‐stage renal disease. Patients in these cases can benefit from synthetic strategy. Abstract Hemophilia A is a serious inherited bleeding disorder resulting from a deficiency of coagulation factor VIII (FVIII). Chronic kidney disease (CKD) involvement in hemophilia is relatively rare, but there has been an upward trend in the survival time of patients with prolonged hemophilia. Although peritoneal dialysis (PD) is often used as the first treatment modality for renal replacement treatment, limited data are available on comprehensive management in the hemophilia A population, especially for urgent‐start PD. A 56‐year‐old man who had hemophilia A, was diagnosed with CKD 3 years ago and developed end‐stage renal disease was admitted to our hospital after contracting pneumonia and undergoing subsequent Type I respiratory failure. Urgent‐start PD improved his condition and health outcomes, and protected his residual renal function. This case is the first study of a Chinese male patient with hemophilia A who developed end‐stage renal disease. We summarize the clinical treatment and nursing care strategies of urgent‐start PD in a hemophilia A patient with end‐stage renal disease. This case illustrates that under comprehensive management of individual and clinical needs, urgent‐start PD can be performed safely without bleeding complications in patients with hemophilia A.

背景 认知障碍（CI）在终末期肾病（ESRD）患者中发病率较高，且严重影响患者的预后。及早识别其发生的影响因素具有重要意义，但现有研究结论尚存争议，且国内尚无相关系统综述。目的 系统评价中国ESRD患者CI的影响因素。方法 计算机检索PubMed、Web of Science、EMBase、中国知网、万方数据知识服务平台、维普网和中国生物医学文献数据库，搜集有关我国ESRD患者CI影响因素的研究，检索时限均为建库至2021年10月。采用主题词与自由词相结合的方式进行检索，并根据各数据库特点进行调整。研究类型为横断面研究、队列研究或病例对照研究；研究对象为满足2002年肾脏病预后质量指南（K/DOQI）标准慢性肾脏疾病（CKD）5期的ESRD患者，或已经接受腹膜透析（PD）或者血液透析（HD）治疗的患者，且为中国人群。由2名研究者独立筛选文献，提取资料并评价纳入研究的质量后，使用 Stata 15.0软件进行Meta分析。结果 共纳入44篇文献，包括42 172例患者。纳入的队列研究和病例对照研究均为高质量研究，横断面研究质量均在中等及以上。Meta分析结果显示，年龄高〔OR=1.17，95%CI（1.13，1.22），P＜0.001〕、透析龄长〔OR=1.02，95%CI（1.00，1.03），P=0.008〕、高血压〔OR=2.02，95%CI（1.06，3.86），P=0.032〕、脑卒中〔OR=1.93，95%CI（1.33，2.80），P=0.001〕、糖尿病〔OR=1.99，95%CI（1.62，2.44），P＜0.001〕、Charlson合并症指数高〔OR=5.28，95%CI（1.48，18.82），P=0.010〕、抑郁〔OR=2.46，95%CI（1.61，3.77），P＜0.001〕、高甲状旁腺激素（PTH）〔OR=1.02，95%CI（1.00，1.04），P=0.034〕、高C反应蛋白（CRP）〔OR=1.20，95%CI（1.01，1.42），P=0.040〕、高同型半胱氨酸（Hcy）〔OR=3.34，95%CI（2.06，5.42），P＜0.001〕均是我国ESRD患者CI的危险因素。男性〔OR=0.55，95%CI（0.37，0.82），P=0.003〕、教育程度高〔OR=0.45，95%CI（0.37，0.55），P＜0.001〕、高血红蛋白（Hb）〔OR=0.91，95%CI（0.86，0.95），P＜0.001〕、高血清白蛋白（ALB）〔OR=0.77，95%CI（0.63，0.94），P=0.009〕、高血清肌酐（Cr）〔OR=0.997，95%CI（0.995，0.999），P=0.003〕均是我国ESRD患者CI的保护因素。结论 当前证据证明，年龄高、透析龄长、高血压、脑卒中、糖尿病、Charlson合并症指数高、抑郁、高PTH、高CRP、高Hcy是ESRD患者CI的危险因素，男性、教育程度高、高Hb、高ALB、高Cr是ESRD患者CI的保护因素。受纳入研究的数量和质量的限制，上述结论尚需要更多高质量研究予以验证。

Background The chronic kidney disease-mineral and bone disorder(CKD-MBD) is known to be associated with increased mortality in dialysis patients, but whether current global guidelines for CKD-MBD, which were primarily developed from hemodialysis, are suitable for peritoneal dialysis (PD) patients practice require further investigation.Methods This is a single-center retrospective cohort study. In total 491 prevalent PD patients (median follow-ups: 34 months) from Peking Union Medical College Hospital (PUMCH) from January 2004 to December 2017 were included and followed until 30 June 2018. In the first dialysis year, the average levels of serum calcium, albumin-corrected calcium (CorCa), phosphorus, and parathyroid hormone (PTH) levels were the interested predictors in Cox proportional regression model.Results Of these PD patients (age 58 ± 17 years), 52% were male and 36% had diabetic nephropathy. In Cox regression over first-year mean parameters, PTH <100 pg/mL (HR = 1.97, 95% CI 1.32 to 2.94, p < 0.001) and ≥300 pg/mL (HR = 2.24, 95% CI 1.32 to 3.81, p = 0.003) were associated with increased all-cause mortality than that of PTH 100–200 pg/mL. Patients with albumin-corrected serum calcium level < 2.13 mmol/L also had higher risk of death than patients with level of 2.13 to 2.38 mmol/L (HR = 2.06, 95% CI 1.06 to 4.01, p = 0.02). Serum phosphorus ≥1.45 mmol/L were associated with increased all-cause mortality. However, lacking of data on 25-hydroxy vitamin D, alkaline phosphatase, and activated vitamin-D are limitations of our analysis.Conclusions As one of the largest PD cohort study focusing on CKD-MBD, we demonstrated that the level of CKD-MBD markers in the first PD year are independent predictors of all-cause mortality. PTH 100–300 pg/mL might be the best target for Chinese PD patients.

Since the outbreak of the coronavirus epidemic, the "virtual" telemedicine has become a critical substitute for patient-provider interactions. However, virtual encounters often face challenges in the care of patients in high-risk categories such as chronic kidney disease (CKD) patients. In this study, we explore the patient's satisfaction and the practical effects of a newly established telemedicine program on CKD patients' care during the COVID-19 pandemic. Based on a prior version of an online patient care platform established in 2017, we developed a customized and improved online telemedicine program designed to specifically address the challenges emerging from the pandemic. This included an online, smart phone-based strategy for triage and medical care delivery and psychological support. We invited a total of 278 CKD patients to join the new platform during the pandemic. The subjects in group A were patients utilizing our old online CKD system and were historical users registered at least 3 months before the pandemic. A pilot survey interrogating medical and psychological conditions was conducted. Feedback on the program as well as a psychological assessment were collected after 1 month. In total, 181 patients showed active responses to the program, with 289 person-time medical consultations occurring during the study. The virtual care program provided a rapid triage for 17% (30 out of 181) patients, with timely referral to in-patient medical encounters for their worsening medical conditions or severe psychological problems. Nearly all patients (97.4%) believed the program was helpful. The number of symptoms (OR 1.309, 95%CI 1.113-1.541; P = 0.001) and being enrolled during the pandemic (OR 3.939, 95% CI 1.174-13.221; P = 0.026) were associated with high stress. During the follow-up, the high-stress CKD group at baseline showed a significant decrease in avoidance score (6.9 ± 4.7 vs. 9.8 ± 1.9, P = 0.015). In conclusion, during the pandemic, we established an online telemedicine care program for CKD patients that provides a rapid triage function, effective CKD disease management, and potentially essential psychological support.

Background: Since the outbreak of the coronavirus epidemic, the 'virtual' telemedicine has become a critical substitute for patient-provider interactions However, virtual encounters often face challenges in care for high-risk patients such as chronic kidney disease (CKD) patients In this study, we explore the patient's satisfaction and practical effects of a newly established telemedicine program in CKD patients' care during the pandemic Methods: We established an online CKD patient care program, including triage strategy, medical care delivery, and psychological support, based on a smartphone application A total of 278 CKD patients were invited, at least 3 months before the pandemic or during the pandemic A pilot survey interrogating medical and psychologicalconditions was conducted The feedback to the program and the psychological assessment repeated after one month Results: Totally, 181 patients showed active responses to the program, with 289 person-time medical consultations occurred during the study The virtual care program provided a rapid triage, with 17% patients provided a timely referral to in-patient medical encounters Nearly all patients (97 4%) believed the program was helpful The number of symptoms (OR 1 309, 95%CI 1 113-1 541;P=0 001) and being enrolled during pandemic (OR 3 939, 95% CI 1 174-13 221;P=0 026) were associated with high stress After the follow-up, the high-stress CKD group at baseline showed a significant decrease in avoidance score (6 9±4 7 vs 9 8±1 9, P=0 015) Conclusions: During the pandemic, we established an online telemedicine care program for CKD patients that provides a rapid triage function, effective CKD disease management, and essential psychological support

Background Early-start peritoneal dialysis (PD) is an effective option for patients need unplanned dialysis. However, there are few studies on the long-term prognosis of early-start PD patients.Methods In this retrospective study, 635 eligible patients from 1 March 1996 to 30 September 2016 were included, and divided into three groups according to the duration of break-in period: 3 days or less, 4–13 days and more than 14 days. Patients started PD within 2 weeks and after 2 weeks were defined as early-start and conventional-start, respectively. The primary outcome was all-cause mortality, and the secondary outcome measures were peritonitis free survival and technical survival. Mechanical and infectious complications in the first 180 days were also analyzed.Results Early-start PD patients were more likely to have higher serum total carbon dioxide and creatinine levels and lower serum albumin, Kt/v, creatinine clearance (Ccr) and residual glomerular filtration rate (rGFR) levels at the start of PD. The median follow-up period was 30 months (interquartile range, 13-53 months). A worse survival was observed in the early-start group than that in the conventional-start group (p < 0.001), even adjustment for the covariates (HR 1.549, 95%CI 1.104–2.173, p = 0.011). In the subgroup analysis, in patients commencing PD after 2006 early-start and conventional-start PD patients had comparable survival. No differences were observed in the rate of infectious and mechanical complications, peritonitis-free survival and technique survival between early-start and conventional-start PD patients.Conclusions Early-start PD could be a safe and effective strategy for patients needing unplanned dialysis initiation with the progress of technology on PD.

Objective To investigate the effect of assisted peritoneal dialysis(PD)and self-care peritoneal dialysis on the prognosis of PD patients.Methods This retrospective study enrolled 637 adult patients started PD in Peking Union Medical College Hospital(PUMCH)from March 13,1996,to December 31,2016,and their clinical data were collected.Patients were divided into assisted and self-care PD groups according to the independence of manipulation of PD.In the assisted PD group patients were further divided into automated peritonealdialys(APD)and continuous ambulatory peritoneal dialysis(CAPD)groups according to different PD modes.Technique survival,peritonitis-free survival,and patient survival were compared between groups.Results Of the 637 patients,373 patients(35 with APD and 338 with CAPD)needed assistance.Assisted PD patients had older ages,a higher proportion of complications including diabetes,hypertension and cardiovascular diseases,higher levels of serum total carbon dioxide(TCO2)and estimated glomerular filtration rate(eGFR),but lower levels of serum albumin,potassium,phosphorus,creatinine,urea and parathyrin,and normalized protein catabolic rate(nPCR),compared to self-care PD patients.Assisted APD patients had a higher proportion of complications of cardiovascular diseases,a higher proportion of patient care need,and a higher residual kidney function at 3 months after PD initiation,compared to assisted CAPD patients.A worse survival was observed in the assisted PD patients than in the self-care PD ones;however,after multi-factor correction, assisted PD was not the independent risk factor for mortality(HR1.479,95%CI 0.978～2.236,P=0.064).Assisted PD and self-care PD patients had similar technique survival and peritonitis-free survival.Assisted APD and assisted CAPD patients had comparable patient survival,technique survival,and peritonitis-free survival.Conclusions Patient survival is worse in assisted PD patients,compared to self-care PD patients.There is no difference in technique survival and peritonitis-free survival between the two groups.APD patients have comparable patient survival,technique survival and peritonitis-free survival to assisted CAPD ones,and so assisted APD is a viable alternative for patients in need.