ObjectiveTo explore the practice effect of the combination management of tertiary hospital and community hospital for home peritoneal dialysis patients.
MethodsA total of 50 patients of end-stage renal disease from December 2012 to May 2013 were involved in this study, including 26 males, and 24 females with the average age of 47.1±13.9. The patients were randomly divided into hospital group (30 patients) and combination group (20 patients). For the patients in the hospital group, the specialists take care of them with regular outpatient service and follow-up; for the patients in the combination group, they were taken care by doctors from both tertiary hospital and community hospital, while the community general practitioners were trained by the tertiary hospital regularly with peritoneal dialysis basic treatment and standardization management and communication. All the patients were managed for 9 months.
ResultsAt the end of the observation,the dialysis adequacy success rate, hemoglobin, blood potassium, phosphorus, calcium, albumin, CO2CP, blood pressure success rate, the incidence of peritonitis, and average monthly medical treatment expense between the two groups were not statistically different (P>0.05); the difference in cost of transportation was statistically significant (P<0.05).
ConclusionThe standardization manage of combination of tertiary hospital and community for patients with home peritoneal dialysis may reduces the patients' expense in transportation, and improve the community general practitioners' level of basic knowledge and indication of peritoneal dialysis.
Peritoneal dialysis (PD) represents an essential renal replacement therapy for end-stage renal disease patients. However, conventional glucose-based dialysis solutions limit the clinical adoption of PD due to complications including peritoneal fibrosis and metabolic disturbances. This review systematically elaborates on advances in novel biocompatible osmotic agents: L-carnitine improves peritoneal metabolic homeostasis, while hyperbranched polyglycerol enables sustained ultrafiltration with dual peritoneal/renal protection. These innovations delineate the future direction for osmotic agent development: integrating multifunctional properties (anti-fibrotic, pro-repair, and metabolic regulation) beyond foundational osmotic efficacy.
Objective
To investigate the efficacy and safety of ultrasound-guided TAP block for the anesthesia in peritoneal dialysis (PD) catheter implantation.
Methods
Patients with end-stage renal disease who intended to receive PD catheter implantation in the West China Hospital of Sichuan University were enrolled from April 2015 to February 2016. Those who met the inclusion criteria were randomly divided into two groups: the local filtration anesthesia (LF) group and the TAP group. The two groups got the ultrasound guided TAP block (The LF group got a shame TAP block by making the skin wheal and just inserting the needle into the TAP with the guidance of ultrasound), then the LF group received local filtration anesthesia twenty minutes later, with the TAP group had sham LF anesthesia by injection of saline at the incision subcutaneously. The anesthetist generated the random allocation sequence and performed all TAP/sham blocks according to the allocation of each patient. The patients, investigators were all blind to the allocation. The follow-up time was 3 months. The primary outcomes were the rate of alteration to general anesthesia and the VAS score during and after the surgery. The dosages of sufentanil for analgesia during and after were recorded. The satisfaction to the effect anesthesia by the operation doctors, PD catheter related complications and adverse events related to TAP block or anesthetic agent were also recorded. Statistic analysis was conducted using SPSS 19.0 software.
Results
A total of 36 patients were included, 12 cases in the LF group and 24 cases in the TAP group. The rate of alteration to general anesthesia in the TAP group was 4.12% and was significantly lower than that in the LF group (33.3%) (P=0.034). The VAS scores at the time points of incision of skin, division of subcutaneous tissue and anterior rectus sheath, opening the peritoneum, insertion of PDC, suture of skin, 2 hours and 24 hours after operation were significantly lower in the TAP group compared to the LF group (P values=0.001, 0.037, 0.000, 0.001, 0.029, 0.035, and 0.000, respectively). The TAP group consumed less sufentanil during the operation and showed a higher satisfaction of the operation doctors. There were no significant differences in the PD catheter related complications and adverse events between the two groups.
Conclusion
The ultrasound-guided TAP block can be an effective and safe anesthesia method for PD catheter implantation. Because of the limitation of small sample size of this study, a multiple center study with larger sample size is suggested.
ObjectiveTo observe the changes of blood flow density and perfusion density in the macula of non-diabetic peritoneal dialysis (PD) patients, and their correlation with blood pressure, total protein, albumin, prealbumin, serum creatinine, urea, and high-sensitivity C-reactive protein were preliminarily analyzed.MethodsA single-center, cross-sectional, clinical observational study. From January to December 2018, 63 eyes of 63 non-diabetic patients (non-diabetic PD group) and 75 eyes of normal healthy people (the normal control group) who underwent PD treatment at the PD Center of Peking University First Hospital were included in the study. All were monocular into the group. Among the 63 patients in the non-diabetic PD group, 24 were males and 39 were females. The duration of PD was 7 to 185 months, with the average duration of 67.87±48.36 months. There were 75 healthy persons in the normal control group. There was no significant difference in age (t=－0.558), sex ratio (χ2=0.492), axial length (t=－1.197), and BCVA between the two groups (P＞0.05). OCT angiography was used to scan the macular area of 3 mm×3 mm and 6 mm×6 mm in the subject’s right eye. The blood flow density and perfusion density of superficial retinal capillaries in the macular area, as well as the area, circumference, and morphological index of the foveal avascular zone (FAZ) were measured. The blood flow density and perfusion density at different locations in the macular area of the two groups of eyes were compared by independent sample t test. The blood pressure, total protein, albumin, prealbumin, serum creatinine, urea, and high-sensitivity C-reactive protein was performed by Pearson correlation analysis.ResultsCompared with the healthy control group, the blood flow density and perfusion density of superficial retinal capillaries in the macular area of the non-diabetic PD group decreased in different scanning ranges with the macular vessel 3×3 center (t=－2.409), the macular vessel 3×3 macular (t=－2.423), macular vessel 3×3 intact (t=－2.759), macular vessel 6×6 intact (t=－1.882), macular vessel 6×6 outer layer (t=－2.188), macular perfusion 3×3 center (t=－1.990), macular perfusion 3×3 complete (t=－2.719), macular perfusion 6×6 complete (t=－2.113), and macular perfusion 6×6 outer layer (t=－2.205). The difference was statistically significant (P＜0.05). The comparison of the macular FAZ area of the two groups of eyes was statistically significant (t=1.985, P＜0.05). Correlation analysis showed that 3×3 macular blood vessels were intact and mean arterial pressure was positively correlated (r=0.256, P=0.043). The macular blood vessels were 3×3 intact, macular perfusion was 3×3 intact, and macular blood was 6×6 intact, which the pre-white protein was positively correlated with (r=0.468, 0.362, 0.333; P＜0.001, P=0.004, 0.008). The macular vessel 3×3 was intact, the macular perfusion 6×6 was intact, which the hypersensitive C-reactive protein was negatively correlated with (r=－0.370, －0.287, P=0.005, 0.030).ConclusionThe superficial retinal blood flow density and perfusion density in the macular area of non-diabetic PD patients are lower than those of normal healthy people.
ObjectiveTo investigate the status of exit-site care in patients undergoing peritoneal dialysis, and analyze the relationship between exit-site care practice and exit-site infection.MethodsThe patients undergoing peritoneal dialysis in Nanfang Hospital, Southern Medical University between January and October 2019 were recruited by convenience sampling method. The Exit-site Schaefer Scale was used to diagnose the occurrence of exit-site infection. According to the guidelines of the International Society of Peritoneal Dialysis and relevant research, a questionnaire was developed to investigate the status of exit-site care in all peritoneal dialysis patients. Logistic regression analysis was used to analyze the influence of care practice on exit-site infection.ResultsA total of 208 peritoneal dialysis patients were recruited. There were 39 patients with (totally 43 times of) exit-site infections, with an exit-site infection incidence of 0.06 episodes per patient-year. The main bacteria were Staphylococcus aureus (30.2%) and Pseudomonas aeruginosa (16.3%). Of the 39 infected patients, 8 (20.5%) had peritonitis and 3 (7.7%) had been infected more than once. The exit-site Schaefer score of the 208 patients was 3.14±2.75. Of the 208 patients, 204 (98.1%) had received training of exit-site care from nurses, 166 (79.8%) could wash their hands and wear masks as required, 196 (94.2%) covered dressings on the exit site, and 184 (88.5%) fixed catheters, but the application of antibiotic ointment did not follow the latest guidelines. The logistic regression analysis revealed that the history of redness and swelling at the exit site [odds ratio (OR)=7.926, 95% confidence interval (CI) (2.367, 26.535), P=0.001] and the history of traction-associated bleeding [OR=5.750, 95%CI (1.878, 17.610), P=0.002] were risk factors of exit-site infection.ConclusionsExit-site infection is common in peritonealdialysis patients. Most patients can perform the exit-site care as required, but the care content is yet to be updated. Nursing staff should improve the training content according to the latest guidelines, strengthen the exit-site assessment, follow-up, and retraining, treat the redness and swelling at the exit site timely, and tell the patients to pay attention to catheter fixation and avoiding excessive traction, to prevent the exit-site infection and the further development of peritonitis.
Objective To assess the possible causes of acute pancreatitis (AP) in long term peritoneal dialysis (PD) and hemodialysis (HD) patients, and to discuss the diagnosis and treatment of AP in this kind of patients. Methods The clinical data of 9 cases of AP in PD and HD patients who were admitted in the hospital during January 1993 and January 2000 were analysed retrospectively. Results The serum levels of amylase of all the 9 cases were over three and a half times of upper limit value of healthy subjects. B mode ultrasound and CT scan examinations were useful for diagnosis of AP. Eight patients recovered very well with conservative treatment, while one patient who was diagnosed as acute severe pancreatitis and complicated with shock died. Conclusion Long term PD and HD patients are predisposing to develop AP. Diagnosis of AP in these patients primarily depends on the detection of serum amylase. Dialysis treatment is indispensable for cure of AP.
Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 （57.6±13.2） years. They were put on dialysis 3-98 （25.2±30.6） months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure，two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was （125.8±33.5）minutes, aortic clamp time was（77.2±25.5） minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.
ObjectiveTo investigate the influence of evidence-based nursing intervention on the treatment effect and quality of life in patients with peritoneal dialysis.
MethodSixty-four patients who underwent peritoneal dialysis between January 2013 and December 2014 in our hospital were randomly divided into control group (n=32) and intervention group (n=32) . The control group received routine nursing and the intervention group received evidencebased nursing intervention. Urea clearance index (KT/V), serum albumin and hemoglobin levels were detected for both groups of patients before and after nursing intervention. Generic Quality of Life Inventory (GQOLI)-74 scale was used to assess patients' quality of life.
ResultsAfter nursing intervention, KT/V, serum albumin and hemoglobin levels in the intervention group were significantly higher than those in the control group (P<0.05) . The scores of such items as physical function, psychological function, social function and overall evaluation in the GQOLI-74 scale in the intervention group were significantly higher than those in the control group (P<0.05) .
ConclusionsEvidence-based nursing intervention can effectively improve the treatment effect and quality of life in patients with peritoneal dialysis, which is worthy of clinical popularization and application.
Objective
To investigate the change of cardiac structure and function in patients with uremia before and after peritoneal dialysis (PD).
Methods
Eighty three standard continuous ambulatory peritoneal dialysis (CAPD) patients treated between October 2009 and October 2014 were selected in this study. According to the ultrasound cardiogram before and 6 months after the PD, we analyzed the influence of age, diabetes mellitus, dialysis interval, hemoglobin, serum albumin, serum creatinine, serum calcium and phosphate and parathyroid hormone (PTH) on the cardiac structure and function.
Results
Hemoglobin increased significantly after PD (P <0.01), while albumin and PTH decreased significantly (P <0.01). The changes in creatinine, triglyceride and cholesterol were not statistically significant (P > 0.05). For CAPD patients, cardiac systolic function did no t obviously change before and after dialysis, while the diastolic function improved obviously after dialysis.
Conclusion
PD may improve cardiac diastolic function of CAPD patients.
ObjectiveTo compare the incidences of peritoneal dialysis (PD)-associated peritonitis among HIV and non-HIV patients, and to analyze the risk factors of PD-associated peritonitis. MethodsEnd-stage renal disease patients with HIV infection who newly started PD in West China Hospital of Sichuan University from 2012 to 2020 were retrospectively included, and non-HIV PD patients in the same period were included as controls at a ratio of 1 to 4. The risk factors of PD-associated peritonitis were analyzed by univariate analysis and multivariate logistic analysis. Kaplan-Meier survival analysis and COX regression analysis were used to compare the peritonitis-free survival between HIV group and non-HIV group. ResultsA total of 60 PD patients were included. The average follow-up time was 31.2±21.3 months. Peritonitis occurred in 7 HIV patients (58.33%) and 8 non-HIV patients (16.67%). Logistic regression analysis showed that HIV infection (P=0.018) and high platelet (>150×109/L) (P=0.032) were independent risk factors for PD-associated peritonitis. The incidence of PD-associated peritonitis in HIV patients significantly increased (HR=10.944, 95%CI 1.503 to 79.707). Kaplan-Meier survival analysis showed that the 5-year peritonitis-free survival of non-HIV group was significantly higher than that of HIV group (75.7% vs. 31.1%) (P=0.003). Multivariate COX survival analysis showed that the 5-year accumulative risk of peritonitis in HIV PD patients was 5.896 times (95%CI 1.508 to 23.043, P=0.01) higher than that of the non-HIV PD patients. ConclusionHIV infection is an independent risk factor for PD-associated peritonitis.
