The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods t...The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods that enable remote monitoring and patient care.This study aimed to determine the success and factors affecting telemonitoring in CAPD patient care.This study is a scoping review(ScR)using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR method.Article searches were carried out on ProQuest,PubMed,and ScienceDirect with a time range of 2018-2023.Data extraction was performed regarding knowledge level,quality of life,clinical outcomes(peritonitis),and risk of hospitalization.Of the 12 articles and studies included,6 articles were related to the effect of telemonitoring on CAPD patient outcomes,and 6 articles were associated with the effect of education on CAPD patient outcomes.Education provided to patients can improve patient understanding of therapeutic modalities for renal disorders,reduce the potential for peritonitis and dialysis complications,and improve the quality of life of patients with CAPD.CAPD patients who received telemonitoring had a better quality of life,good clinical outcomes,and a lower risk of hospitalization than those who did not receive telemonitoring and had fewer health-care visits.In summary,the implementation of telemonitoring and education in chronic kidney disease patients with CAPD modality therapy has been proven effective in improving quality of life and reducing dialysis-related risks.展开更多
Objective:To study the prevalence of anemia,the proportion of hemoglobin(Hb)levels,the treatment methods,and the influencing factors of Hb levels in maintenance hemodialysis(MHD)and peritoneal dialysis patients.Method...Objective:To study the prevalence of anemia,the proportion of hemoglobin(Hb)levels,the treatment methods,and the influencing factors of Hb levels in maintenance hemodialysis(MHD)and peritoneal dialysis patients.Methods:In this study,602 patients with maintenance hemodialysis and continuous ambulatory peritoneal dialysis were enrolled from December 2020 to December 2022 in our hospital,and their medical records were collected and summarized.The main contents included the patient’s gender,age,primary disease,dialysis duration,dialysis method,the use of erythropoietic stimulating agents(ESA),intravenous iron,and laboratory tests.A Hb index exceeding 110 g/L was set as the standard for the prevalence of anemia.Results:The rate of anemia in patients undergoing blood purification was 83%.The proportion of ESA use was 84.1%,and the proportion of iron use was 76.7%,of which the proportion of intravenous iron used was 17.0%,and the proportion of folic acid used was 28.3%.Conclusion:The incidence of anemia in MHD patients was relatively high,with a low proportion of patients reaching the standard Hb levels.Risk factors include albumin(ALB)levels,iron storage,white blood cells,C-reactive protein,cholesterol,etc.Nutritional support,iron supplementation,and prevention of micro-inflammatory reactions can effectively promote the improvement of Hb indicators in dialysis patients to prevent anemia.展开更多
BACKGROUND Neisseria mucosa is a gram negative diplococcus belonging to the genus Neisseria found commonly in the upper respiratory tract.It is typically a commensal organism when it is parasitic on oral and nasal muc...BACKGROUND Neisseria mucosa is a gram negative diplococcus belonging to the genus Neisseria found commonly in the upper respiratory tract.It is typically a commensal organism when it is parasitic on oral and nasal mucosa.To our knowledge,it does not cause disease in healthy individuals with normal immunity,but can be pathogenic in those with impaired immune function or change in bacterial colonization site.Neisseria mucosa has been reported to cause bacterial meningitis,conjunctivitis,pneumonia,endocarditis,peritonitis and urethritis.However,peritoneal dialysis-related peritonitis caused by Neisseria mucosa is extremely rare in clinical practice,which has not previously been reported in China.CASE SUMMARY A 55-year-old female presented to the nephrology clinic with upper abdominal pain without apparent cause,accompanied by nausea,vomiting and diarrhea for two days.The patient had a history of Stage 5 chronic kidney disease for five years,combined with renal hypertension and renal anemia,and was treated with peritoneal dialysis for renal replacement therapy.The patient was subsequently diagnosed with peritoneal dialysis-related peritonitis.Routine examination of peritoneal dialysis fluid showed abdominal infection,and the results of microbial culture of the peritoneal dialysis fluid confirmed Neisseria mucosa.Imi-penem/cilastatin 1.0 g q12h was added to peritoneal dialysis fluid for anti-infection treatment.After 24 d,the patient underwent upper extremity arteriovenous fistulation.One month later,the patient was discharged home in a clinically stable state.CONCLUSION Peritonitis caused by Neisseria mucosa is rare.Patients with home-based self-dialysis cannot guarantee good medical and health conditions,and require education on self-protection.展开更多
BACKGROUND According to the trend of global population aging,the proportion of elderly patients with chronic kidney disease(CKD)is expected to increase.However,there are more than 20 million people in China with decom...BACKGROUND According to the trend of global population aging,the proportion of elderly patients with chronic kidney disease(CKD)is expected to increase.However,there are more than 20 million people in China with decompensated kidney function,of which 19.25%are elderly people.Therefore,special attention should be paid to the education years,sleep quality,anxiety status,comorbidities with diabetes,cardiovascular disease(CVD),and anemia as independent risk factors for depression in elderly CKD patients.This study explores the clinical management of elderly CKD patients that should address these risk factors to prevent depression and improve their prognosis.AIM To investigate depression risk factors in older patients receiving peritoneal dialysis,aiding future prevention of depression in these patients.METHODS This retrospective study included a primary study population of 170 patients with CKD who received peritoneal dialysis from January 2020 to December 2022.We assessed the patients’mental status using the Beck Depression Inventory Score-II(BDI-II),Self-Rating Anxiety Scale(SAS),Anxiety Inventory Score,and the Pittsburgh Sleep Quality Index(PSQI).Logistic regression was employed to identify depression independent risk factors among these patients.RESULTS The non-depressed group had a significantly longer education period than the depressed group(P<0.05).The depressed group exhibited significantly higher mental status scores than the non-depressed group(P<0.001).Patients with diabetes mellitus(DM)or CVD had a higher probability of developing depression.Patients with depression had significantly lower hemoglobin and albumin levels than patients without depression(P<0.05).Spearman correlation analysis of BDI-II scale scores,measuring depression,indicated positive correlations with BDI-II and SAS scores as risk factors for depression in patients with CKD.In contrast,years of education,hemoglobin levels,and peritoneal Kt/V were negatively correlated,serving as protective factors against depression.An analysis of variance for influences with significant differences in the univariate analysis revealed that years of schooling,BDI-II,SAS,PSQI,DM,CVD,and hemoglobin levels independently influenced depression in older patients with CKD.CONCLUSION Education,BDI-II,SAS,PSQI,DM,and CVD are independent risk factors for depression in older patients with CKD;therefore,post-treatment psychological monitoring of high-risk patients is crucial to prevent depression.展开更多
Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysi...Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysis department of our hospital from March 2021-March 2023 were selected as research objects,divided into a research group and a reference group according to random number drawing method,with each group consisting of 35 cases.The patients in the research group were treated with roxadustat,and those in the reference group were treated with recombinant human erythropoietin.The total efficacy,anemia index,iron metabolism index,and occurrence of adverse reactions were compared between the two groups.Results:The total efficacy of the treatment received in the research group was significantly higher than that in the reference group(P<0.05).In terms of anemia indicators,there was no statistically significant difference between the hemoglobin(Hb),the red blood cell(RBC),and the hematocrit(HCT)of both groups(P>0.05)before treatment.After treatment,the anemia indicators of the patients in the research group were significantly better than those in the reference group,(P<0.05).In terms of iron metabolism,before treatment,there was no significant difference between the total iron-binding capacity(TIBC),the transferrin(TRF),the ferritin(FER),and iron(Fe)of both groups(P>0.05).After treatment,the research group’s iron metabolism indicators were significantly better than those of the reference group(P<0.05).The incidence of adverse reactions in the research group was significantly lower than that in the reference group(P<0.05).Conclusion:The short-term curative effect of roxadustat in the treatment of peritoneal dialysis patients was demonstrated through this study,making it a viable treatment option.展开更多
Objective:Bayesian network meta-analysis was used to evaluate the effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home.Methods:Cochrane Library,PubMed,Embas...Objective:Bayesian network meta-analysis was used to evaluate the effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home.Methods:Cochrane Library,PubMed,Embase,Web of Science,China Biology Medicine disc,CNKI and Wanfang data were searched to identify randomized controlled trials(RCTs)investigating the effects of different nursing interventions or health education on peritonitis in home peritoneal dialysis patients from the establishment of each database to March 2022.After literature screening,the Cochrane 5.1 evaluation tool was used to assess quality,Review Manager 5.4 software was used to generate a literature quality evaluation chart and R4.1.2 software,JAGS package,and GEMTC package were used for statistical analysis.Results:A total of 9 RCTs involving 8 different nursing interventions and a total of 1011 patients were included in the meta-analysis.The incidence of peritonitis for the eight nursing interventions,ranked from highest to lowest,were:systematic nursing,Omaha system case management intervention,routine care+health promotion mode,PD specialist nurse-led multi-disciplinary network platform management mode,5E rehabilitation nursing mode,routine care+Omaha extended nursing service,one-on-one coordinated family support intervention,and routine care.Conclusions:Systematic nursing was found to be the most effective intervention in reducing the incidence of peritonitis in peritoneal dialysis patients at home.However,this conclusion needs to be further verified by more high-quality,multicenter and large sample RCTs.展开更多
Objective:Nowadays,the medical model is constantly changing,and the problem of how to improve the quality of life of peritoneal dialysis patients arises at a historic moment.This paper observes the publication and coo...Objective:Nowadays,the medical model is constantly changing,and the problem of how to improve the quality of life of peritoneal dialysis patients arises at a historic moment.This paper observes the publication and cooperation of research countries and institutions related to the quality of life of peritoneal dialysis patients,understands the research hotspots,explores the research trends,and provides a reference for further research by scholars.Methods:The search database was the Web of Science core collection,the search terms“peritoneal dialysis”and“quality of life”,the document type“Article or Review”,the language“English”and the period from 1985 to 2022.Results:A total of 1,597 literature were retrieved,and the number of documents showed an annual increase.The United States has the highest volume and centrality of publications and the most cooperation with other countries.The institution with the largest number of articles is the University of Toronto in Canada.The top three most highly cited documents were analyzed to derive the knowledge base of the research area.According to the analysis of keywords,there are high-frequency keywords such as“quality of life”and“peritoneal dialysis”and 11 keyword clusters.Understand the changing trends and frontiers in the research field through timeline maps and mutated words.Conclusion:The comparison of quality of life between peritoneal dialysis and haemodialysis and the study of factors influencing the quality of life is a hot research topic.With the gradual deepening of the research,it is suggested that future research should focus on the intervention research of influencing factors and clarify the intervention measures to improve patients’quality of life.展开更多
BACKGROUND Insertion of a catheter into the bladder is a rare complication of peritoneal dialysis(PD),and is mainly related to surgical injury.This paper reports a case of bladder perforation that was caused by percut...BACKGROUND Insertion of a catheter into the bladder is a rare complication of peritoneal dialysis(PD),and is mainly related to surgical injury.This paper reports a case of bladder perforation that was caused by percutaneous PD catheterization.CASE SUMMARY A 64-year-old man underwent percutaneous PD catheterization for end-stage renal disease.On the second day after the operation,urgent urination and gross hematuria occurred.Urinalysis showed the presence of red and white blood cells.Empirical anti-infective treatment was given.On the third day after the operation,urgent urination occurred during PD perfusion.Ultrasound showed that the PD catheter was located in the bladder,and subsequent computed tomography(CT)showed that the PD catheter moved through the anterior wall into the bladder.The PD catheter was withdrawn from the bladder and catheterization was retained.Repeat CT on the fourth day after the operation showed that the PD catheter was removed from the bladder,but there was poor catheter function.The PD catheter was removed and the patient was changed to hemodialysis.CT cystography showed that the bladder healed well and the patient was discharged 14 d after the operation.CONCLUSION Bladder perforation injury should be considered and treated timeously in case of bladder irritation during and after percutaneous PD catheterization.The use of Doppler ultrasound and other related technologies may reduce the incidence of such complications.展开更多
BACKGROUND The number of end-stage renal disease patients with diabetes mellitus(DM)who are undergoing peritoneal dialysis is increasing.Peritoneal dialysis-associated peritonitis(PDAP)is a serious complication of per...BACKGROUND The number of end-stage renal disease patients with diabetes mellitus(DM)who are undergoing peritoneal dialysis is increasing.Peritoneal dialysis-associated peritonitis(PDAP)is a serious complication of peritoneal dialysis leading to technical failure and increased mortality in patients undergoing peritoneal dialysis.The profile of clinical symptoms,distribution of pathogenic organisms,and response of PDAP to medical management in the subset of end-stage renal disease patients with DM have not been reported previously.Discrepant results have been found in long-term prognostic outcomes of PDAP in patients with DM.We inferred that DM is associated with bad outcomes in PDAP patients.AIM To compare the clinical features and outcomes of PDAP between patients with DM and those without.METHODS In this multicenter retrospective cohort study,we enrolled patients who had at least one episode of PDAP during the study period.The patients were followed for a median of 31.1 mo.They were divided into a DM group and a non-DM group.Clinical features,therapeutic outcomes,and long-term prognostic outcomes were compared between the two groups.Risk factors associated with therapeutic outcomes of PDAP were analyzed using multivariable logistic regression.A Cox proportional hazards model was constructed to examine the influence of DM on patient survival and incidence of technical failure.RESULTS Overall,373 episodes occurred in the DM group(n=214)and 692 episodes occurred in the non-DM group(n=395).The rates of abdominal pain and fever were similar in the two groups(P>0.05).The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli(E.coli)as compared to the non-DM group(P<0.05).Multivariate logistic regression analysis revealed no association between the presence of diabetes and rates of complete cure,catheter removal,PDAP-related death,or relapse of PDAP(P>0.05).Patients in the DM group were older and had a higher burden of cardiovascular disease,with lower level of serum albumin,but a higher estimated glomerular filtration rate(P<0.05).Cox proportional hazards model confirmed that the presence of diabetes was a significant predictor of all-cause mortality(hazard ratio=1.531,95%confidence interval:1.091-2.148,P<0.05),but did not predict the occurrence of technical failure(P>0.05).CONCLUSION PDAP patients with diabetes have similar symptomology and are predisposed to coagulase-negative Staphylococcus but not E.coli infection compared those without.Diabetes is associated with higher all-cause mortality but not therapeutic outcomes of PDAP.展开更多
AIM: To investigate gastrointestinal (GI) symptoms in peritoneal dialysis (PD) patients and to explore related factors contributing to GI symptoms. METHODS: One hundred and twelve patients undergoing PD participated i...AIM: To investigate gastrointestinal (GI) symptoms in peritoneal dialysis (PD) patients and to explore related factors contributing to GI symptoms. METHODS: One hundred and twelve patients undergoing PD participated in the study. The gastrointestinal symptom rating scale was used for measuring GI symptoms. Information on age, height, weight, body mass index, disease leading to chronic renal failure, history of corticosteroid therapy, presence of predialytic GI symptoms, daily dosage of pills, and duration, type and daily dialysate volume of PD was obtained by interviewing patients and/or reviewing the medical records. Hemoglobin, albumin and Kt/V data were obtained from follow-up database. We used multiple regression analysis with stepwise backward variable selection to test for factors predicting GSRS scores with significance level of selection entry at 0.05 and selection of stay at 0.10. RESULTS: The prevalence of eating dysfunction, reflux and indigestion in the PD patients was 44.2%, 32.7%,32.7%, respectively. A history of corticosteroid therapy (b = 8.93, P < 0.001) and all pills daily intake (b = 0.16, P = 0.007) were positively correlated to GI symptoms, while residual renal Kt/V (b =-3.47, P = 0.009) was negatively correlated to GI symptoms. Other factors were proven to be not associated with GI symptoms, with P > 0.05. CONCLUSION: Eating dysfunction, reflux and indigestion were common in PD patients. Daily dosage of pills and corticosteroid history predicted GI symptoms, while residual renal function prevented them.展开更多
BACKGROUND There are no studies on the use of roxadustat in patients on regular peritoneal dialysis in China.AIM To observe the efficacy and safety of roxadustat in treating renal anaemia in peritoneal dialysis patien...BACKGROUND There are no studies on the use of roxadustat in patients on regular peritoneal dialysis in China.AIM To observe the efficacy and safety of roxadustat in treating renal anaemia in peritoneal dialysis patients.METHODS Patients with renal anaemia who were regularly followed at the Peritoneal Dialysis Center of the First Affiliated Hospital of China Medical University from November 1,2019 to June 30,2020 were selected.A before-and-after self-control design was performed to retrospectively analyse the treatment effects on anaemia in patients treated with recombinant human erythropoietin(EPO)and roxadustat.RESULTS A total of 31 patients with renal anaemia on long-term peritoneal dialysis treated with roxadustat were included.Haemoglobin(Hb)levels were maintained or increased in all patients(100%),and no patients had a decrease in Hb compared with the previous phase.Patients had a mean Hb of 86.2±14.8 g/L with Hb compliance(Hb≥110 g/L)of 16.1%during the EPO phase and a mean Hb of 112.4±18.5 g/L with Hb compliance of 67.7%during the roxadustat phase.No major adverse cardiovascular events occurred in any patient.CONCLUSION The application of roxadustat in peritoneal dialysis patients with renal anaemia can effectively improve the Hb compliance rate.展开更多
BACKGROUND Peritoneal dialysis(PD)catheter migration impedes the efficacy of dialysis.Therefore,several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelv...BACKGROUND Peritoneal dialysis(PD)catheter migration impedes the efficacy of dialysis.Therefore,several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelvis.AIM To evaluate the efficacy of creating a short musculofascial tunnel beneath the anterior sheath of the rectus abdominis during PD catheter implantation.METHODS Patients who underwent PD catheter implantation between 2015 and 2019 were included in this retrospective study.The patients were divided into two groups based on the procedure performed:Patients who underwent catheter implantation without a musculofascial tunnel before 2017 and those who underwent the procedure with a tunnel after 2017.We recorded patient character istics and catheter complications over a two-year follow-up period.In addition,postoperative plain abdominal radiographs were reviewed to determine the catheter angle in the event of migration.RESULTS The no-tunnel and tunnel groups included 115 and 107 patients,respectively.Compared to the no-tunnel group,the tunnel group showed lesser catheter angle deviation toward the pelvis(15.51±11.30 vs 25.00±23.08,P=0.0002)immediately after the operation,and a smaller range of migration within 2 years postoperatively(13.48±10.71 vs 44.34±41.29,P<0.0001).Four events of catheter dysfunction due to migration were observed in the no-tunnel group,and none occurred in the tunnel group.There was no difference in the two-year catheter function survival rate between the two groups(88.90%vs 84.79%,P=0.3799).CONCLUSION The musculofascial tunnel helps maintain catheter position in the pelvis and reduces migration,thus preventing catheter dysfunction.展开更多
BACKGROUND Abdominal hemorrhage is a complication of peritoneal dialysis catheter(PDC)insertion that cannot be neglected,and its causes are mainly related to surgical injury.This article reports a case of massive abdo...BACKGROUND Abdominal hemorrhage is a complication of peritoneal dialysis catheter(PDC)insertion that cannot be neglected,and its causes are mainly related to surgical injury.This article reports a case of massive abdominal hemorrhage that was caused by a rare rupture of corpus luteum shortly after PDC during the initiation of peritoneal dialysis(PD)insertion.CASE SUMMARY A 37-year-old woman was surgically placed a Tenckhoff catheter because of endstage renal disease.On the third postoperative day,the color of the abdominal drainage fluid was pink,and deepened gradually.It turned pale after initiating conservative treatment.On the tenth postoperative day,the color of the abdominal drainage fluid suddenly turned dark red,and the color progressively deepened.The patient’s hemoglobin dropped from 88 g/L to 57 g/L.Abdominal computed tomography(CT)indicated abdominal effusion and a high-density shadow in the abdominal cavity.The surgeon performed a laparotomy and found that the corpus luteum had ruptured on the right side and a left ovarian blood body had formed.The gynecologist repaired the ovary and performed a bilateral oophoroplasty.After the operation,the patient stopped bleeding and hemodialysis was temporarily stopped.PD was resumed after half a month.The patient’s condition improved,and she was discharged 14 d after the laparotomy.CONCLUSION If abdominal hemorrhage occurs in women of childbearing age after PDC insertion,luteal rupture should be considered as the cause.展开更多
BACKGROUND Hema-Plus,a recombinant human erythropoietin(rHuEPO)or epoetin alfa has shown effectiveness in correction of anemia in Thai population in clinical practice.This study was aimed to demonstrate efficacy and s...BACKGROUND Hema-Plus,a recombinant human erythropoietin(rHuEPO)or epoetin alfa has shown effectiveness in correction of anemia in Thai population in clinical practice.This study was aimed to demonstrate efficacy and safety under the evidencebased approach.AIM To evaluate the efficacy and safety of rHuEPO(Hema-Plus)for treatment of anemia over 12 wk in Thai patients with Stage V chronic kidney disease(CKD)on peritoneal dialysis(PD).METHODS This study was an open-label,multi-center study to enroll 30 CKD patients identified to start PD with hemoglobin(Hb)less than 9.5 g/dL,serum ferritin more than 100 ng/mL,serum transferrin saturation more than or equal to 20%and who had not previously received epoetin.Patients with conditions that could increase the risk of adverse effects from study participation or interfere with study outcomes,were using concomitant androgens or had secondary hyperparathyroidism were excluded.All eligible patients started Hema-Plus by SC injection at 4000 IU once or twice weekly(week 0)and with follow-up at weeks 2,4,8,and 12.Dosage adjustment could be done to achieve Hb level of 11-12 g/dL.Primary end point was mean change in Hb level from baseline to end of treatment(week 12).Safety was assessed throughout the study.Quality of life(QoL)was assessed using KDQOL-36.RESULTS All 30 enrolled patients completed the study.Mean(standard deviation)Hb at baseline(week 0)to the end of 12 wk was significantly increased from 7.39(1.29)g/dL to 11.15(1.73)g/dL(paired t-test,P value<0.001).Overall change of Hb means from baseline over the other 4 visits was statistically significantly increased(repeated measure ANOVA,P value<0.001).Ten out of 39 adverse events(AEs)were serious.Two serious AEs were probably related to study medication by investigators’assessment.At week 12,the QoL scores in all domains were significantly increased from baseline.CONCLUSION Hema-Plus administered for 12 wk for treatment of anemia in patients on PD effectively increased Hb levels with acceptable safety profile.展开更多
Introduction: Peritonitis continues to be the main complication for patients on peritoneal dialysis (PD). Objective: To determine the frequency of peritonitis according to the disease-causing microorganism and its dis...Introduction: Peritonitis continues to be the main complication for patients on peritoneal dialysis (PD). Objective: To determine the frequency of peritonitis according to the disease-causing microorganism and its distribution throughout the year, linking to seasonality. Methods: A retrospective study conducted in the Dialysis Unit of the Hospital São Lucas, PUCRS (HSL-PUCRS). Patients undergoing PD between January 1984 and September 2013 were included. Descriptive statistics were used and Fisher’s exact test with Monte Carlo simulation for comparison between the categorical variables. Results: Of 415 evaluated patients, 66% had at least one episode of peritonitis with an incidence rate of 0.68 episode/year. There were 601 peritonitis episodes in total. The most common microorganism was coagulase-negative Staphylococcus (26.6%, n = 160), followed by Staphylococcus aureus (16.3%, n = 98), with 16.3% of the sample being negative culture. Most episodes occurred in the months of January (10.3%, n = 62) and May (10.1%, n = 61), while June had the lowest occurrence (5.2%, n = 31). The number of episodes observed in January and May were significantly higher when compared to June展开更多
Objective:To analyze and study the effect of continuous nursing mode for continuous peritoneal dialysis nursing.Methods:40 patients with continuous peritoneal dialysis received in our hospital were randomly selected a...Objective:To analyze and study the effect of continuous nursing mode for continuous peritoneal dialysis nursing.Methods:40 patients with continuous peritoneal dialysis received in our hospital were randomly selected as the research object.The research time was from June 2018 to June 2020.The patients were divided into two groups by random number table method.The patients with routine nursing mode were named as the control group and the patients with continuous nursing mode were named as the observation group(20 cases in each group).The clinical nursing effects of different nursing modes are compared.Results:After nursing,the nursing compliance of the observation group was 95%,which was higher than 70% of the control group.There was significant difference between the two groups(P<0.05).Comparing the blood routine related indexes of the two groups,the blood potassium,hemoglobin,serum creatinine and carbon dioxide binding force of the observation group were better than those of the control group(P<0.05).The incidence of peritonitis and rehospitalization rate in half a year in the observation group were lower than those in the control group(P<0.05).Conclusion:The continuous nursing model for patients undergoing continuous peritoneal dialysis can improve the treatment effect of patients,significantly improve the compliance of patients,significantly improve the serological indexes,promote the health of patients,reduce the incidence of peritonitis,and significantly reduce the rehospitalization rate in half a year.It has a broad prospect of clinical promotion.展开更多
BACKGROUND Peritoneal dialysis (PD) is an important renal replacement therapy for patientswith end-stage renal disease. PD-related hydrothorax is a rare but seriouscomplication in PD patients, produced by the movement...BACKGROUND Peritoneal dialysis (PD) is an important renal replacement therapy for patientswith end-stage renal disease. PD-related hydrothorax is a rare but seriouscomplication in PD patients, produced by the movement of peritoneal dialysatethrough pleuroperitoneal fistulas. In previous reports, patients with hydrothoraxsecondary to PD were usually recommended to discontinue PD and transfer tohemodialysis (HD). Herein, we describe another method of managing thiscomplication—with an adjusted PD prescription and continuous drainage ofpleural effusion, patients could continue PD without recurrence of hydrothorax.CASE SUMMARY In this report, we present the medical records of 2 patients with hydrothoraxsecondary to PD. We recommended intermittent PD with continuous drainage ofpleural effusion. A type 18Ga soft catheter was placed to drain pleural effusion.Ultrasound-guided thoracentesis was performed, and the soft catheter was placedin the pleural cavity for a long period (3 mo and 2 mo, respectively). The pleuralcatheter was removed when no fluid was drained from the pleural cavity. Afterseveral months, pleuroperitoneal fistulas were closed in both patients and PD wascontinued. These patients did not transfer to HD, had no recurrence ofhydrothorax and were still treated with PD after 1 year.CONCLUSION These 2 case reports show that continuous drainage of pleural effusion with an18Ga soft catheter is a useful method for hydrothorax secondary to PD.展开更多
BACKGROUND In patients undergoing peritoneal dialysis(PD),catheter dysfunction is a common complication.A misplaced catheter is one of the reasons contributing to its dysfunction.The present study aimed to describe a ...BACKGROUND In patients undergoing peritoneal dialysis(PD),catheter dysfunction is a common complication.A misplaced catheter is one of the reasons contributing to its dysfunction.The present study aimed to describe a case of misplaced PD catheter with an unusual location of the catheter tip.CASE SUMMARY A 61-year-old man undergoing PD for 4 years was investigated for progressive nausea and fatigue of 3 mo.Dialysis adequacy studies indicated inefficient dialysis.Imaging discovered that the PD catheter tip was mispositioned in the pelvic cavity with its tip outside the peritoneal cavity.Despite the dialysate accumulating outside the peritoneal cavity,the patient had not developed perineal or scrotal edema.The patient had experienced a sustainable prolonged dialysis efficacy in this case until the renal function deteriorated further in view of the poor dialysis outcome and worsening health condition.The patient was subsequently transitioned to hemodialysis.CONCLUSION Proper placement of the catheter in the peritoneal cavity should always be confirmed and rechecked when necessary in patients undergoing PD to ensure dialytic adequacy.展开更多
BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortali...BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortality are unknown.AIM To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.METHODS This retrospective cohort study enrolled 568 patients with diabetes,aged≥18 years,who underwent USPD at one of five Chinese centers between 2013 and 2019.We divided the follow-up period into two survival phases:The first 6 mo of USPD therapy and the months thereafter.We compared demographic and baseline clinical data of living and deceased patients during each period.Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association(NYHA)classification.A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.RESULTS Forty-one patients died within the first 6 mo,accounting for the highest proportion of mortalities(26.62%)during the entire follow-up period.Cardiovascular disease was the leading cause of mortality within 6 mo(26.83%)and after 6 mo(31.86%).The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms.Independent risk factors for mortality within the first 6 mo were advanced age hazard ratio(HR:1.908;95%CI:1.400-2.600;P<0.001),lower baseline serum creatinine level(HR:0.727;95%CI:0.614-0.860;P<0.001),higher baseline serum phosphorus level(HR:3.162;95%CI:1.848-5.409;P<0.001),and baseline NYHA class III-IV(HR:2.148;95%CI:1.063-4.340;P=0.033).Independent risk factors for mortality after 6 mo were advanced age(HR:1.246;95%CI:1.033-1.504;P=0.022)and baseline NYHA class III-IV(HR:2.015;95%CI:1.298-3.130;P=0.002).CONCLUSION To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes,controlling the serum phosphorus level and improving cardiac function are recommended。展开更多
BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general population.To the best of our knowledge,this is the first report o...BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general population.To the best of our knowledge,this is the first report of persistent hiccups and non-ST elevation myocardial injury(NSTEMI)as an atypical presentation of COVID-19 in a peritoneal dialysis(PD)patient.CASE SUMMARY A 70-year old man,who had been on PD for 3 years with a history of ischemic heart failure and reduced ejection fraction,presented for a scheduled radionuclide myocardial scan.Upon arrival,he complained of anorexia,nausea for 5 d,and unremitting hiccups for the previous 48 h.Clinical and laboratory examinations revealed an NSTEMI plus a positive nasopharyngeal reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2.COVID-19 lung involvement was mild and was resolved without specific treatment.Myocardial injury was managed by coronary catheterization and stenting,while hiccups responded only to baclofen per os.CONCLUSION Persistent hiccups and NSTEMI can be atypical presentations of COVID-19 in peritoneal dialysis patients,which may be due to involvement of the central nervous system and myocardial injuries.展开更多
文摘The risk of peritonitis complications in continuous ambulatory peritoneal dialysis(CAPD)can be prevented or reduced by providing proper education and continuous monitoring.Telemedicine and telemonitoring are methods that enable remote monitoring and patient care.This study aimed to determine the success and factors affecting telemonitoring in CAPD patient care.This study is a scoping review(ScR)using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR method.Article searches were carried out on ProQuest,PubMed,and ScienceDirect with a time range of 2018-2023.Data extraction was performed regarding knowledge level,quality of life,clinical outcomes(peritonitis),and risk of hospitalization.Of the 12 articles and studies included,6 articles were related to the effect of telemonitoring on CAPD patient outcomes,and 6 articles were associated with the effect of education on CAPD patient outcomes.Education provided to patients can improve patient understanding of therapeutic modalities for renal disorders,reduce the potential for peritonitis and dialysis complications,and improve the quality of life of patients with CAPD.CAPD patients who received telemonitoring had a better quality of life,good clinical outcomes,and a lower risk of hospitalization than those who did not receive telemonitoring and had fewer health-care visits.In summary,the implementation of telemonitoring and education in chronic kidney disease patients with CAPD modality therapy has been proven effective in improving quality of life and reducing dialysis-related risks.
文摘Objective:To study the prevalence of anemia,the proportion of hemoglobin(Hb)levels,the treatment methods,and the influencing factors of Hb levels in maintenance hemodialysis(MHD)and peritoneal dialysis patients.Methods:In this study,602 patients with maintenance hemodialysis and continuous ambulatory peritoneal dialysis were enrolled from December 2020 to December 2022 in our hospital,and their medical records were collected and summarized.The main contents included the patient’s gender,age,primary disease,dialysis duration,dialysis method,the use of erythropoietic stimulating agents(ESA),intravenous iron,and laboratory tests.A Hb index exceeding 110 g/L was set as the standard for the prevalence of anemia.Results:The rate of anemia in patients undergoing blood purification was 83%.The proportion of ESA use was 84.1%,and the proportion of iron use was 76.7%,of which the proportion of intravenous iron used was 17.0%,and the proportion of folic acid used was 28.3%.Conclusion:The incidence of anemia in MHD patients was relatively high,with a low proportion of patients reaching the standard Hb levels.Risk factors include albumin(ALB)levels,iron storage,white blood cells,C-reactive protein,cholesterol,etc.Nutritional support,iron supplementation,and prevention of micro-inflammatory reactions can effectively promote the improvement of Hb indicators in dialysis patients to prevent anemia.
文摘BACKGROUND Neisseria mucosa is a gram negative diplococcus belonging to the genus Neisseria found commonly in the upper respiratory tract.It is typically a commensal organism when it is parasitic on oral and nasal mucosa.To our knowledge,it does not cause disease in healthy individuals with normal immunity,but can be pathogenic in those with impaired immune function or change in bacterial colonization site.Neisseria mucosa has been reported to cause bacterial meningitis,conjunctivitis,pneumonia,endocarditis,peritonitis and urethritis.However,peritoneal dialysis-related peritonitis caused by Neisseria mucosa is extremely rare in clinical practice,which has not previously been reported in China.CASE SUMMARY A 55-year-old female presented to the nephrology clinic with upper abdominal pain without apparent cause,accompanied by nausea,vomiting and diarrhea for two days.The patient had a history of Stage 5 chronic kidney disease for five years,combined with renal hypertension and renal anemia,and was treated with peritoneal dialysis for renal replacement therapy.The patient was subsequently diagnosed with peritoneal dialysis-related peritonitis.Routine examination of peritoneal dialysis fluid showed abdominal infection,and the results of microbial culture of the peritoneal dialysis fluid confirmed Neisseria mucosa.Imi-penem/cilastatin 1.0 g q12h was added to peritoneal dialysis fluid for anti-infection treatment.After 24 d,the patient underwent upper extremity arteriovenous fistulation.One month later,the patient was discharged home in a clinically stable state.CONCLUSION Peritonitis caused by Neisseria mucosa is rare.Patients with home-based self-dialysis cannot guarantee good medical and health conditions,and require education on self-protection.
文摘BACKGROUND According to the trend of global population aging,the proportion of elderly patients with chronic kidney disease(CKD)is expected to increase.However,there are more than 20 million people in China with decompensated kidney function,of which 19.25%are elderly people.Therefore,special attention should be paid to the education years,sleep quality,anxiety status,comorbidities with diabetes,cardiovascular disease(CVD),and anemia as independent risk factors for depression in elderly CKD patients.This study explores the clinical management of elderly CKD patients that should address these risk factors to prevent depression and improve their prognosis.AIM To investigate depression risk factors in older patients receiving peritoneal dialysis,aiding future prevention of depression in these patients.METHODS This retrospective study included a primary study population of 170 patients with CKD who received peritoneal dialysis from January 2020 to December 2022.We assessed the patients’mental status using the Beck Depression Inventory Score-II(BDI-II),Self-Rating Anxiety Scale(SAS),Anxiety Inventory Score,and the Pittsburgh Sleep Quality Index(PSQI).Logistic regression was employed to identify depression independent risk factors among these patients.RESULTS The non-depressed group had a significantly longer education period than the depressed group(P<0.05).The depressed group exhibited significantly higher mental status scores than the non-depressed group(P<0.001).Patients with diabetes mellitus(DM)or CVD had a higher probability of developing depression.Patients with depression had significantly lower hemoglobin and albumin levels than patients without depression(P<0.05).Spearman correlation analysis of BDI-II scale scores,measuring depression,indicated positive correlations with BDI-II and SAS scores as risk factors for depression in patients with CKD.In contrast,years of education,hemoglobin levels,and peritoneal Kt/V were negatively correlated,serving as protective factors against depression.An analysis of variance for influences with significant differences in the univariate analysis revealed that years of schooling,BDI-II,SAS,PSQI,DM,CVD,and hemoglobin levels independently influenced depression in older patients with CKD.CONCLUSION Education,BDI-II,SAS,PSQI,DM,and CVD are independent risk factors for depression in older patients with CKD;therefore,post-treatment psychological monitoring of high-risk patients is crucial to prevent depression.
文摘Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysis department of our hospital from March 2021-March 2023 were selected as research objects,divided into a research group and a reference group according to random number drawing method,with each group consisting of 35 cases.The patients in the research group were treated with roxadustat,and those in the reference group were treated with recombinant human erythropoietin.The total efficacy,anemia index,iron metabolism index,and occurrence of adverse reactions were compared between the two groups.Results:The total efficacy of the treatment received in the research group was significantly higher than that in the reference group(P<0.05).In terms of anemia indicators,there was no statistically significant difference between the hemoglobin(Hb),the red blood cell(RBC),and the hematocrit(HCT)of both groups(P>0.05)before treatment.After treatment,the anemia indicators of the patients in the research group were significantly better than those in the reference group,(P<0.05).In terms of iron metabolism,before treatment,there was no significant difference between the total iron-binding capacity(TIBC),the transferrin(TRF),the ferritin(FER),and iron(Fe)of both groups(P>0.05).After treatment,the research group’s iron metabolism indicators were significantly better than those of the reference group(P<0.05).The incidence of adverse reactions in the research group was significantly lower than that in the reference group(P<0.05).Conclusion:The short-term curative effect of roxadustat in the treatment of peritoneal dialysis patients was demonstrated through this study,making it a viable treatment option.
文摘Objective:Bayesian network meta-analysis was used to evaluate the effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home.Methods:Cochrane Library,PubMed,Embase,Web of Science,China Biology Medicine disc,CNKI and Wanfang data were searched to identify randomized controlled trials(RCTs)investigating the effects of different nursing interventions or health education on peritonitis in home peritoneal dialysis patients from the establishment of each database to March 2022.After literature screening,the Cochrane 5.1 evaluation tool was used to assess quality,Review Manager 5.4 software was used to generate a literature quality evaluation chart and R4.1.2 software,JAGS package,and GEMTC package were used for statistical analysis.Results:A total of 9 RCTs involving 8 different nursing interventions and a total of 1011 patients were included in the meta-analysis.The incidence of peritonitis for the eight nursing interventions,ranked from highest to lowest,were:systematic nursing,Omaha system case management intervention,routine care+health promotion mode,PD specialist nurse-led multi-disciplinary network platform management mode,5E rehabilitation nursing mode,routine care+Omaha extended nursing service,one-on-one coordinated family support intervention,and routine care.Conclusions:Systematic nursing was found to be the most effective intervention in reducing the incidence of peritonitis in peritoneal dialysis patients at home.However,this conclusion needs to be further verified by more high-quality,multicenter and large sample RCTs.
文摘Objective:Nowadays,the medical model is constantly changing,and the problem of how to improve the quality of life of peritoneal dialysis patients arises at a historic moment.This paper observes the publication and cooperation of research countries and institutions related to the quality of life of peritoneal dialysis patients,understands the research hotspots,explores the research trends,and provides a reference for further research by scholars.Methods:The search database was the Web of Science core collection,the search terms“peritoneal dialysis”and“quality of life”,the document type“Article or Review”,the language“English”and the period from 1985 to 2022.Results:A total of 1,597 literature were retrieved,and the number of documents showed an annual increase.The United States has the highest volume and centrality of publications and the most cooperation with other countries.The institution with the largest number of articles is the University of Toronto in Canada.The top three most highly cited documents were analyzed to derive the knowledge base of the research area.According to the analysis of keywords,there are high-frequency keywords such as“quality of life”and“peritoneal dialysis”and 11 keyword clusters.Understand the changing trends and frontiers in the research field through timeline maps and mutated words.Conclusion:The comparison of quality of life between peritoneal dialysis and haemodialysis and the study of factors influencing the quality of life is a hot research topic.With the gradual deepening of the research,it is suggested that future research should focus on the intervention research of influencing factors and clarify the intervention measures to improve patients’quality of life.
文摘BACKGROUND Insertion of a catheter into the bladder is a rare complication of peritoneal dialysis(PD),and is mainly related to surgical injury.This paper reports a case of bladder perforation that was caused by percutaneous PD catheterization.CASE SUMMARY A 64-year-old man underwent percutaneous PD catheterization for end-stage renal disease.On the second day after the operation,urgent urination and gross hematuria occurred.Urinalysis showed the presence of red and white blood cells.Empirical anti-infective treatment was given.On the third day after the operation,urgent urination occurred during PD perfusion.Ultrasound showed that the PD catheter was located in the bladder,and subsequent computed tomography(CT)showed that the PD catheter moved through the anterior wall into the bladder.The PD catheter was withdrawn from the bladder and catheterization was retained.Repeat CT on the fourth day after the operation showed that the PD catheter was removed from the bladder,but there was poor catheter function.The PD catheter was removed and the patient was changed to hemodialysis.CT cystography showed that the bladder healed well and the patient was discharged 14 d after the operation.CONCLUSION Bladder perforation injury should be considered and treated timeously in case of bladder irritation during and after percutaneous PD catheterization.The use of Doppler ultrasound and other related technologies may reduce the incidence of such complications.
文摘BACKGROUND The number of end-stage renal disease patients with diabetes mellitus(DM)who are undergoing peritoneal dialysis is increasing.Peritoneal dialysis-associated peritonitis(PDAP)is a serious complication of peritoneal dialysis leading to technical failure and increased mortality in patients undergoing peritoneal dialysis.The profile of clinical symptoms,distribution of pathogenic organisms,and response of PDAP to medical management in the subset of end-stage renal disease patients with DM have not been reported previously.Discrepant results have been found in long-term prognostic outcomes of PDAP in patients with DM.We inferred that DM is associated with bad outcomes in PDAP patients.AIM To compare the clinical features and outcomes of PDAP between patients with DM and those without.METHODS In this multicenter retrospective cohort study,we enrolled patients who had at least one episode of PDAP during the study period.The patients were followed for a median of 31.1 mo.They were divided into a DM group and a non-DM group.Clinical features,therapeutic outcomes,and long-term prognostic outcomes were compared between the two groups.Risk factors associated with therapeutic outcomes of PDAP were analyzed using multivariable logistic regression.A Cox proportional hazards model was constructed to examine the influence of DM on patient survival and incidence of technical failure.RESULTS Overall,373 episodes occurred in the DM group(n=214)and 692 episodes occurred in the non-DM group(n=395).The rates of abdominal pain and fever were similar in the two groups(P>0.05).The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli(E.coli)as compared to the non-DM group(P<0.05).Multivariate logistic regression analysis revealed no association between the presence of diabetes and rates of complete cure,catheter removal,PDAP-related death,or relapse of PDAP(P>0.05).Patients in the DM group were older and had a higher burden of cardiovascular disease,with lower level of serum albumin,but a higher estimated glomerular filtration rate(P<0.05).Cox proportional hazards model confirmed that the presence of diabetes was a significant predictor of all-cause mortality(hazard ratio=1.531,95%confidence interval:1.091-2.148,P<0.05),but did not predict the occurrence of technical failure(P>0.05).CONCLUSION PDAP patients with diabetes have similar symptomology and are predisposed to coagulase-negative Staphylococcus but not E.coli infection compared those without.Diabetes is associated with higher all-cause mortality but not therapeutic outcomes of PDAP.
文摘AIM: To investigate gastrointestinal (GI) symptoms in peritoneal dialysis (PD) patients and to explore related factors contributing to GI symptoms. METHODS: One hundred and twelve patients undergoing PD participated in the study. The gastrointestinal symptom rating scale was used for measuring GI symptoms. Information on age, height, weight, body mass index, disease leading to chronic renal failure, history of corticosteroid therapy, presence of predialytic GI symptoms, daily dosage of pills, and duration, type and daily dialysate volume of PD was obtained by interviewing patients and/or reviewing the medical records. Hemoglobin, albumin and Kt/V data were obtained from follow-up database. We used multiple regression analysis with stepwise backward variable selection to test for factors predicting GSRS scores with significance level of selection entry at 0.05 and selection of stay at 0.10. RESULTS: The prevalence of eating dysfunction, reflux and indigestion in the PD patients was 44.2%, 32.7%,32.7%, respectively. A history of corticosteroid therapy (b = 8.93, P < 0.001) and all pills daily intake (b = 0.16, P = 0.007) were positively correlated to GI symptoms, while residual renal Kt/V (b =-3.47, P = 0.009) was negatively correlated to GI symptoms. Other factors were proven to be not associated with GI symptoms, with P > 0.05. CONCLUSION: Eating dysfunction, reflux and indigestion were common in PD patients. Daily dosage of pills and corticosteroid history predicted GI symptoms, while residual renal function prevented them.
基金Liaoning Province Key R&D Guidance Program,No.2019JH8/10300016Liaoning Province Grassroots Health and Family Planning Appropriate Technology Promotion Project,No.LHATP-201801.
文摘BACKGROUND There are no studies on the use of roxadustat in patients on regular peritoneal dialysis in China.AIM To observe the efficacy and safety of roxadustat in treating renal anaemia in peritoneal dialysis patients.METHODS Patients with renal anaemia who were regularly followed at the Peritoneal Dialysis Center of the First Affiliated Hospital of China Medical University from November 1,2019 to June 30,2020 were selected.A before-and-after self-control design was performed to retrospectively analyse the treatment effects on anaemia in patients treated with recombinant human erythropoietin(EPO)and roxadustat.RESULTS A total of 31 patients with renal anaemia on long-term peritoneal dialysis treated with roxadustat were included.Haemoglobin(Hb)levels were maintained or increased in all patients(100%),and no patients had a decrease in Hb compared with the previous phase.Patients had a mean Hb of 86.2±14.8 g/L with Hb compliance(Hb≥110 g/L)of 16.1%during the EPO phase and a mean Hb of 112.4±18.5 g/L with Hb compliance of 67.7%during the roxadustat phase.No major adverse cardiovascular events occurred in any patient.CONCLUSION The application of roxadustat in peritoneal dialysis patients with renal anaemia can effectively improve the Hb compliance rate.
文摘BACKGROUND Peritoneal dialysis(PD)catheter migration impedes the efficacy of dialysis.Therefore,several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelvis.AIM To evaluate the efficacy of creating a short musculofascial tunnel beneath the anterior sheath of the rectus abdominis during PD catheter implantation.METHODS Patients who underwent PD catheter implantation between 2015 and 2019 were included in this retrospective study.The patients were divided into two groups based on the procedure performed:Patients who underwent catheter implantation without a musculofascial tunnel before 2017 and those who underwent the procedure with a tunnel after 2017.We recorded patient character istics and catheter complications over a two-year follow-up period.In addition,postoperative plain abdominal radiographs were reviewed to determine the catheter angle in the event of migration.RESULTS The no-tunnel and tunnel groups included 115 and 107 patients,respectively.Compared to the no-tunnel group,the tunnel group showed lesser catheter angle deviation toward the pelvis(15.51±11.30 vs 25.00±23.08,P=0.0002)immediately after the operation,and a smaller range of migration within 2 years postoperatively(13.48±10.71 vs 44.34±41.29,P<0.0001).Four events of catheter dysfunction due to migration were observed in the no-tunnel group,and none occurred in the tunnel group.There was no difference in the two-year catheter function survival rate between the two groups(88.90%vs 84.79%,P=0.3799).CONCLUSION The musculofascial tunnel helps maintain catheter position in the pelvis and reduces migration,thus preventing catheter dysfunction.
文摘BACKGROUND Abdominal hemorrhage is a complication of peritoneal dialysis catheter(PDC)insertion that cannot be neglected,and its causes are mainly related to surgical injury.This article reports a case of massive abdominal hemorrhage that was caused by a rare rupture of corpus luteum shortly after PDC during the initiation of peritoneal dialysis(PD)insertion.CASE SUMMARY A 37-year-old woman was surgically placed a Tenckhoff catheter because of endstage renal disease.On the third postoperative day,the color of the abdominal drainage fluid was pink,and deepened gradually.It turned pale after initiating conservative treatment.On the tenth postoperative day,the color of the abdominal drainage fluid suddenly turned dark red,and the color progressively deepened.The patient’s hemoglobin dropped from 88 g/L to 57 g/L.Abdominal computed tomography(CT)indicated abdominal effusion and a high-density shadow in the abdominal cavity.The surgeon performed a laparotomy and found that the corpus luteum had ruptured on the right side and a left ovarian blood body had formed.The gynecologist repaired the ovary and performed a bilateral oophoroplasty.After the operation,the patient stopped bleeding and hemodialysis was temporarily stopped.PD was resumed after half a month.The patient’s condition improved,and she was discharged 14 d after the laparotomy.CONCLUSION If abdominal hemorrhage occurs in women of childbearing age after PDC insertion,luteal rupture should be considered as the cause.
基金the Ethics Committee,Institute for the Development of Human Research Protections(IHRP),No.IHRP 2365/2556The Ethics Committee of Udon Thani Hospital,No.8/2559and Siriraj Institutional Review Board Faculty of Medicine Siriraj Hospital,Mahidol University,No.Si 588/2016.
文摘BACKGROUND Hema-Plus,a recombinant human erythropoietin(rHuEPO)or epoetin alfa has shown effectiveness in correction of anemia in Thai population in clinical practice.This study was aimed to demonstrate efficacy and safety under the evidencebased approach.AIM To evaluate the efficacy and safety of rHuEPO(Hema-Plus)for treatment of anemia over 12 wk in Thai patients with Stage V chronic kidney disease(CKD)on peritoneal dialysis(PD).METHODS This study was an open-label,multi-center study to enroll 30 CKD patients identified to start PD with hemoglobin(Hb)less than 9.5 g/dL,serum ferritin more than 100 ng/mL,serum transferrin saturation more than or equal to 20%and who had not previously received epoetin.Patients with conditions that could increase the risk of adverse effects from study participation or interfere with study outcomes,were using concomitant androgens or had secondary hyperparathyroidism were excluded.All eligible patients started Hema-Plus by SC injection at 4000 IU once or twice weekly(week 0)and with follow-up at weeks 2,4,8,and 12.Dosage adjustment could be done to achieve Hb level of 11-12 g/dL.Primary end point was mean change in Hb level from baseline to end of treatment(week 12).Safety was assessed throughout the study.Quality of life(QoL)was assessed using KDQOL-36.RESULTS All 30 enrolled patients completed the study.Mean(standard deviation)Hb at baseline(week 0)to the end of 12 wk was significantly increased from 7.39(1.29)g/dL to 11.15(1.73)g/dL(paired t-test,P value<0.001).Overall change of Hb means from baseline over the other 4 visits was statistically significantly increased(repeated measure ANOVA,P value<0.001).Ten out of 39 adverse events(AEs)were serious.Two serious AEs were probably related to study medication by investigators’assessment.At week 12,the QoL scores in all domains were significantly increased from baseline.CONCLUSION Hema-Plus administered for 12 wk for treatment of anemia in patients on PD effectively increased Hb levels with acceptable safety profile.
文摘Introduction: Peritonitis continues to be the main complication for patients on peritoneal dialysis (PD). Objective: To determine the frequency of peritonitis according to the disease-causing microorganism and its distribution throughout the year, linking to seasonality. Methods: A retrospective study conducted in the Dialysis Unit of the Hospital São Lucas, PUCRS (HSL-PUCRS). Patients undergoing PD between January 1984 and September 2013 were included. Descriptive statistics were used and Fisher’s exact test with Monte Carlo simulation for comparison between the categorical variables. Results: Of 415 evaluated patients, 66% had at least one episode of peritonitis with an incidence rate of 0.68 episode/year. There were 601 peritonitis episodes in total. The most common microorganism was coagulase-negative Staphylococcus (26.6%, n = 160), followed by Staphylococcus aureus (16.3%, n = 98), with 16.3% of the sample being negative culture. Most episodes occurred in the months of January (10.3%, n = 62) and May (10.1%, n = 61), while June had the lowest occurrence (5.2%, n = 31). The number of episodes observed in January and May were significantly higher when compared to June
文摘Objective:To analyze and study the effect of continuous nursing mode for continuous peritoneal dialysis nursing.Methods:40 patients with continuous peritoneal dialysis received in our hospital were randomly selected as the research object.The research time was from June 2018 to June 2020.The patients were divided into two groups by random number table method.The patients with routine nursing mode were named as the control group and the patients with continuous nursing mode were named as the observation group(20 cases in each group).The clinical nursing effects of different nursing modes are compared.Results:After nursing,the nursing compliance of the observation group was 95%,which was higher than 70% of the control group.There was significant difference between the two groups(P<0.05).Comparing the blood routine related indexes of the two groups,the blood potassium,hemoglobin,serum creatinine and carbon dioxide binding force of the observation group were better than those of the control group(P<0.05).The incidence of peritonitis and rehospitalization rate in half a year in the observation group were lower than those in the control group(P<0.05).Conclusion:The continuous nursing model for patients undergoing continuous peritoneal dialysis can improve the treatment effect of patients,significantly improve the compliance of patients,significantly improve the serological indexes,promote the health of patients,reduce the incidence of peritonitis,and significantly reduce the rehospitalization rate in half a year.It has a broad prospect of clinical promotion.
文摘BACKGROUND Peritoneal dialysis (PD) is an important renal replacement therapy for patientswith end-stage renal disease. PD-related hydrothorax is a rare but seriouscomplication in PD patients, produced by the movement of peritoneal dialysatethrough pleuroperitoneal fistulas. In previous reports, patients with hydrothoraxsecondary to PD were usually recommended to discontinue PD and transfer tohemodialysis (HD). Herein, we describe another method of managing thiscomplication—with an adjusted PD prescription and continuous drainage ofpleural effusion, patients could continue PD without recurrence of hydrothorax.CASE SUMMARY In this report, we present the medical records of 2 patients with hydrothoraxsecondary to PD. We recommended intermittent PD with continuous drainage ofpleural effusion. A type 18Ga soft catheter was placed to drain pleural effusion.Ultrasound-guided thoracentesis was performed, and the soft catheter was placedin the pleural cavity for a long period (3 mo and 2 mo, respectively). The pleuralcatheter was removed when no fluid was drained from the pleural cavity. Afterseveral months, pleuroperitoneal fistulas were closed in both patients and PD wascontinued. These patients did not transfer to HD, had no recurrence ofhydrothorax and were still treated with PD after 1 year.CONCLUSION These 2 case reports show that continuous drainage of pleural effusion with an18Ga soft catheter is a useful method for hydrothorax secondary to PD.
基金National Natural Science Foundation of China,No.81900692.
文摘BACKGROUND In patients undergoing peritoneal dialysis(PD),catheter dysfunction is a common complication.A misplaced catheter is one of the reasons contributing to its dysfunction.The present study aimed to describe a case of misplaced PD catheter with an unusual location of the catheter tip.CASE SUMMARY A 61-year-old man undergoing PD for 4 years was investigated for progressive nausea and fatigue of 3 mo.Dialysis adequacy studies indicated inefficient dialysis.Imaging discovered that the PD catheter tip was mispositioned in the pelvic cavity with its tip outside the peritoneal cavity.Despite the dialysate accumulating outside the peritoneal cavity,the patient had not developed perineal or scrotal edema.The patient had experienced a sustainable prolonged dialysis efficacy in this case until the renal function deteriorated further in view of the poor dialysis outcome and worsening health condition.The patient was subsequently transitioned to hemodialysis.CONCLUSION Proper placement of the catheter in the peritoneal cavity should always be confirmed and rechecked when necessary in patients undergoing PD to ensure dialytic adequacy.
基金Supported by Jilin Province Health and Technology Innovation Development Program Funded Project,No. 2018FP031
文摘BACKGROUND The risk of early mortality of patients who start dialysis urgently is high;however,in patients with diabetes undergoing urgent-start peritoneal dialysis(USPD),the risk of,and risk factors for,early mortality are unknown.AIM To identify risk factors for mortality during high-risk periods in patients with diabetes undergoing USPD.METHODS This retrospective cohort study enrolled 568 patients with diabetes,aged≥18 years,who underwent USPD at one of five Chinese centers between 2013 and 2019.We divided the follow-up period into two survival phases:The first 6 mo of USPD therapy and the months thereafter.We compared demographic and baseline clinical data of living and deceased patients during each period.Kaplan-Meier survival curves were generated for all-cause mortality according to the New York Heart Association(NYHA)classification.A multivariate Cox proportional hazard regression model was used to identify risk factors for mortality within the first 6 mo and after 6 mo of USPD.RESULTS Forty-one patients died within the first 6 mo,accounting for the highest proportion of mortalities(26.62%)during the entire follow-up period.Cardiovascular disease was the leading cause of mortality within 6 mo(26.83%)and after 6 mo(31.86%).The risk of mortality not only within the first 6 mo but also after the first 6 mo was higher for patients with obvious baseline heart failure symptoms than for those with mild or no heart failure symptoms.Independent risk factors for mortality within the first 6 mo were advanced age hazard ratio(HR:1.908;95%CI:1.400-2.600;P<0.001),lower baseline serum creatinine level(HR:0.727;95%CI:0.614-0.860;P<0.001),higher baseline serum phosphorus level(HR:3.162;95%CI:1.848-5.409;P<0.001),and baseline NYHA class III-IV(HR:2.148;95%CI:1.063-4.340;P=0.033).Independent risk factors for mortality after 6 mo were advanced age(HR:1.246;95%CI:1.033-1.504;P=0.022)and baseline NYHA class III-IV(HR:2.015;95%CI:1.298-3.130;P=0.002).CONCLUSION To reduce the risk of mortality within the first 6 mo of USPD in patients with diabetes,controlling the serum phosphorus level and improving cardiac function are recommended。
文摘BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general population.To the best of our knowledge,this is the first report of persistent hiccups and non-ST elevation myocardial injury(NSTEMI)as an atypical presentation of COVID-19 in a peritoneal dialysis(PD)patient.CASE SUMMARY A 70-year old man,who had been on PD for 3 years with a history of ischemic heart failure and reduced ejection fraction,presented for a scheduled radionuclide myocardial scan.Upon arrival,he complained of anorexia,nausea for 5 d,and unremitting hiccups for the previous 48 h.Clinical and laboratory examinations revealed an NSTEMI plus a positive nasopharyngeal reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2.COVID-19 lung involvement was mild and was resolved without specific treatment.Myocardial injury was managed by coronary catheterization and stenting,while hiccups responded only to baclofen per os.CONCLUSION Persistent hiccups and NSTEMI can be atypical presentations of COVID-19 in peritoneal dialysis patients,which may be due to involvement of the central nervous system and myocardial injuries.
