Adverse Effect on Bacteria of Peritoneal Dialysis Solutions that Contain Acetate

Peritoneal dialysis solutions which contained 43 mEq per litre of acetate had a greater antibacterial effect than those containing lactate. Bacteria were isolated from 15 separate clinical infections, each caused by Escherichia coli, Pseudomonas sp., or Staphylo-coccus aureus. Incubation in the dialysate made with acetate substantially reduced the number of viable organisms from all but one of the 45 isolates. It is suggested that solutions made with acetate may provide greater protection from peritonitis.     

Plasma p-Cresol Lowering Effect of Sevelamer in Peritoneal Dialysis Patients: Evidence from a Cross-Sectional Observational Study

p-Cresol is a by-product of the metabolism of aromatic aminoacid operated by resident intestinal bacteria. In patients with chronic kidney disease, the accumulation of p-cresol and of its metabolite p-cresyl-sulphate causes endothelial dysfunction and ultimately increases the cardiovascular risk of these patients. Therapeutic strategies to reduce plasma p-cresol levels are highly demanded but not available yet. Because it has been reported that the phosphate binder sevelamer sequesters p-cresol in vitro we hypothesized that it could do so also in peritoneal dialysis patients. To explore this hypothesis we measured total cresol plasma concentrations in 57 patients with end-stage renal disease on peritoneal dialysis, 29 receiving sevelamer for the treatment of hyperphosphatemia and 28 patients not assuming this drug. Among the patients not assuming sevelamer, 16 were treated with lanthanum whereas the remaining 12 received no drug because they were not hyperphosphatemic. Patients receiving sevelamer had plasma p-cresol and serum high sensitivity C-reactive protein concentrations significantly lower than those receiving lanthanum or no drug. Conversely, no difference was observed among the different groups either in residual glomerular filtration rate, total weekly dialysis dose, total clearance, urine volume, protein catabolic rate, serum albumin or serum phosphate levels. Multiple linear regression analysis showed that none of these variables predicted plasma p-cresol concentrations that, instead, negatively correlated with the use of sevelamer. These results suggest that sevelamer could be an effective strategy to lower p-cresol circulating levels in peritoneal dialysis patients in which it could also favorably affect cardiovascular risk because of its anti-inflammatory effect.     

含蛋白转导域的SARA/SBD融合蛋白对腹膜透析大鼠

目的：探讨含蛋白转导域的SARA融合蛋白（PTD-SAR／SBD）对腹膜透析大鼠腹膜纤维化的抑制作用。方法：每日腹腔注射4．25％葡萄糖腹膜透析液（PDF）制备腹膜透析大鼠模型。28只Sprague-Dawley大鼠随机分为正常对照组（n=8）;腹膜透析模型组（n=10）;PTD-SARA／SBD蛋白干预组（n=10）。4周后行腹膜平衡试验,检测超滤量、葡萄糖吸收率;留取壁层腹膜组织行HE染色;免疫组织化学方法检测大鼠壁层腹膜间皮细胞转分化指标E-cadherin和Twist的表达;Westemblotting测定E-cadherin、twist,以及CollagenⅠ、TGF-β1、P-Smad3、t-Smad3的表达。结果：①与正常对照组比较,模型组大鼠壁层腹膜增厚,糖转运率增加,超滤量降低（P〈0．01）;免疫组织化学与westernblotting检测结果显示E-cadherin表达下调,Twist表达上调;CollagenⅠ、P-Smad3、TGF-β1表达增加。②与模型组比较,PTD-SARA／SBD蛋白干预组大鼠壁层腹膜糖转运率降低,超滤量增加（P〈0．05）;E-cadherin表达上调,Twist表达下调;CollagenⅠ、TGF-β1、P-Smad3表达减少,各组t-Smad3无明显变化。结论：PTD-SARA／SBD融合蛋白通过抑制TGF-WSmads信号通路部分逆转腹膜间皮细胞转分化从而改善腹膜结构和功能,为防治腹膜透析所致腹膜纤维化奠定基础。     

尿毒症皮肤瘙痒患者采取腹膜透析与血液透析治疗的效果探究

目的：探究尿毒症皮肤瘙瘁患者采取腹膜透析与血液透析治疗的临床效果,并为该病的临床治疗提供经验积累。方法：选取我院肾内科于2005年1月-2012年12月收治的52例尿毒症皮肤瘙痒患者,利用随机数字表法进行分组,分别设为研究组和对照组。其中对照组实施血液透析治疗,而研究组开展腹膜透析治疗。记录两组在治疗前和治疗后第8周末血生化客观指标及皮肤瘙痒程度,并做好对比。结果：两组在治疗前的皮肤瘙痒评分、β2-MG、PTH、p3,BUN、SCr值差异无统计学意义（P〉0．05）;治疗后,研究组皮肤瘙瘁评分为（3．4±0．8）分,对照组为（5．8±0．9）分,差异有统计学意义（P〈0．05）。治疗后,研究组β2-MG、PTH及Ps．均低于对照组,差异有统计学意义（P〈0．05）。结论：尿毒症皮肤瘙痒患者的主要致敏因子为大中分子,采取腹膜透析能够有效清除大分子物质,进而达到瘙痒程度的有效改善。     

A Clinical Evaluation of Peritoneal Dialysis

A total of 18 peritoneal dialyses were performed on 14 patients at the Hamilton Civic Hospital over a period of 11 months. Nine of these patients were in uremia, four had non-nephrotoxic intoxication, and one had hepatic coma. Patients with chronic uremia may present with acute renal failure which may be treated by peritoneal dialysis with resultant significant prolongation of life. A decreased mortality rate might be expected in acute renal failure if dialysis is implemented before the classical picture of uremia develops. Many non-nephrotoxic intoxicating substances are readily dialysable. Considerable benefit to the patient and decreased time in hospital may result from the use of this procedure in cases of intoxication with such substances. Peritoneal dialysis may be of value in treatment of intractable congestive heart failure. This procedure may eventually provide another means of treating hepatic coma.     

Peritoneal Dialysis in Acute and Chronic Renal Failure

Clinical experience with peritoneal dialysis in eight cases of acute and four cases of chronic renal failure is presented. Seven of the acute cases survived but in some of these hemodialysis was also employed. The relatively simple technique of peritoneal dialysis was found to be effective, although slower than hemodialysis. In three of the cases it was selected in preference to hemodialysis. Its main advantages are that it does not require elaborate arrangements, or the use of blood or anticoagulants. The authors conclude that when the peritoneum is intact the method can be employed whenever the use of a temporary kidney substitute is indicated.     

Effect of Polysaccharides and Human Plasma Lipoproteins on the Secretion of Cystatin C by Peritoneal Macrophages from Normal and Tumor Bearing Mice

Intact peritoneal macrophages in vitro secreted the cysteine proteinase inhibitor cystatin C. Polysaccharides stimulated cystatin C secretion: lipopolysaccharide < carboxymethylated beta-D-glucan < sulfoethylated beta-D-glucan. Human plasma low-density- (LDL) and high-density lipoproteins (HDL) are still more potent inducers of cystatin C secretion by macrophages. Peritoneal macrophages from mice with experimental HA-1 hepatoma compared to those from intact mice secreted more cystatin C with maximum polysaccharide-stimulated secretion after 30 min of incubation. LDL and HDL induced cystatin C secretion by tumor macrophages also.     

腹膜透析病人的预后影响因素

在我国,终末期肾脏病的发病率逐年增加,相应地,腹膜透析病人的数量也在不断增长。明确腹膜透析病人预后的影响因素是临床医师亟待解决的重要课题。尿毒症毒素的积蓄可对腹膜透析病人的心血管系统产生不良作用,影响病人的生活质量。腹膜透析充分性的相关指标对于预测病人的生存率也有一定的指导意义。此外,腹膜炎的发生可使超滤量明显下降,增加病人的死亡率。合并症可能通过加重病人的营养不良状态、促进炎症水平,影响病人的预后。因此,重视病人的尿毒症毒素水平、透析充分性指标与合并症情况,积极防治腹膜炎,将有助于改善腹膜透析病人的预后。     

Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients.     

Adverse Effect of Ammonium Salts on the Antibacterial Activity of Paraformaldehyde Solutions

The antibacterial activity of aqueous solutions of paraformaldehyde in concentrations from 0.1 to 0.4% (w/v) is bacteriostatic rather than bactericidal in the presence or absence of ammonium chloride. The presence of ammonium chloride significantly lengthened the time of exposure to paraformaldehyde necessary for inhibition of growth of the test organism (Staphylococcus aureus FDA 209) when unbuffered solutions were used. Elevation of the pH of the reacting mixture of paraformaldehyde and ammonium chloride by partial buffering lengthened the time of exposure necessary for inhibition of growth of the test organism. Decrease of antibacterial activity was concomitant with the disappearance of paraformaldehyde from the reacting mixture. The reaction of paraformaldehyde with ammonium chloride was rapid at room temperature (25 C) and at pH levels near neutrality. The fate of the reacting paraformaldehyde, including the possibility of the formation of hexamethylenetetramine or methylenimine, is discussed with particular reference to loss of antibacterial activity.     

腹膜透析76例透析效能相关因素分析

目的以尿素清除指数和肌酐清除率为指标,探讨影响透析效能相关因素。方法评估76例透析患者的蛋白分解率及残余肾功能,研究其与尿素清除指数及肌酐清除率之间的关系。结果腹透患者营养状态和残肾功能分别与透析充分性呈正相关。结论加强患者营养状态,保护残余肾功能可提高透析充分性,改善患者生活质量。     

两种腹膜透析手术置管术的临床对比研究

目的:探讨腹腔镜下腹膜透析置管术与手术切开腹膜透析置管术的临床对比与应用价值.方法:选择2007年3月1日至2012年3月1日在新疆维吾尔自治区人民医院肾病科收治的慢性肾功能衰竭且自愿行腹膜透析的患者96例,其中45例在局麻下行常规手术切开置管术(A组),51例行腹腔镜置管术(B组),术后均使用百特双联系统装置进行腹膜透析.并对术后导管相关性并发症、住院天数、手术费用等方面进行回顾性分析和对比.结果:A组中:导管移位3例(6.7％),网膜包裹2例(4.4％),胸膜瘘1例(2.2％),腹膜炎1例(2.2％),短期透析引流时疼痛2例(4.4％),总体导管相关并发症发生率(19.9％),手术时间为25-40 min,人均手术费用1000元,住院时间7-15天.B组中:无一例发生漂管,阴囊水肿2例(3.9％％),透析管周围渗液2例(3.9％),胸膜瘘1例(2.0％),腹壁疝2例(3.9％),腹膜炎1例(2.0％),总体导管相关并发症发生率(15.7％),手术时间为15-25min,人均费用5500元,住院时间12-25天.结论:腹腔镜置管术与手术切开置管术各有利弊,选择哪种方法要根据患者经济、身体状况、患者意愿来选择.     

Clinical Significance of the Edema Index in Incident Peritoneal Dialysis Patients

Background

Proper monitoring for volume overload is important to improve prognosis in peritoneal dialysis (PD) patients. The association between volume status and residual renal function (RRF) remains an unresolved issue. The aim of the present study was to evaluate the association between the edema index and survival or RRF in incident PD patients.

Patients and Methods

We identified all adults who underwent PD. The edema index was defined as the ratio of extracellular fluid to total body fluid. Participants with available data regarding survivorship or non-survivorship during the first year after PD initiation were included in the area under the receiver operating characteristic curve analysis. The cutoff value of the edema index for 1-year mortality was >0.371 in men and >0.372 in women. Participants were divided into two groups according to the cutoff value of their baseline edema indices: High (>cutoff value) and Low (≤cutoff value). Survivors during the first year after PD initiation were divided into two groups according to the initial and 1-year edema index: Non-improvement (maintenance of criteria in the initial Low group during the year) and Other (all participants except those in the Non-improvement group).

Results

In total, 631 patients were enrolled in the present study. The cutoff value of the edema index for 1-year mortality was >0.371 in men and >0.372 in women. The respective mean initial RRF values (mL·min^-1·1.73 m^-2) in the Low and High groups, respectively, were 4.88 ± 4.09 and 4.21 ± 3.28 in men (P = 0.108), and 3.19 ± 2.57 and 2.98 ± 2.70 in women (P = 0.531). There were no significant differences between groups in either sex. The respective mean RRF values at 1 year after PD initiation in the Low and High groups, respectively, were 3.56 ± 4.35 and 2.73 ± 2.53 in men, and 2.80 ± 2.36 and 1.85 ± 1.51 in women. RRF at 1 year after PD initiation was higher in the Low group than in the High group (men: P = 0.027; women: P = 0.001). In men, the cumulative 5-year survival rates were 78.7% and 46.2% in the Low and High groups, respectively, whereas in women, rates were 77.2% and 58.8% in the Low and High groups, respectively. For survivors during the first year after PD initiation, the Non-improvement group was associated with a poor survival rate compared with the Other group for both sexes.

Conclusion

A high edema index was associated with mortality in incident PD patients at baseline and follow-up. The edema index may be used as a new marker for predicting mortality in PD patients.     

The Associations between the Family Education and Mortality of Patients on Peritoneal Dialysis

Aims

To investigate whether education level of family members predicts all-cause and cardiovascular death and initial-episode peritonitis in patients on peritoneal dialysis (PD).

Methods

A total of 2264 patients on chronic PD were collected from seven centers affiliated with the Socioeconomic Status on the Outcome of Peritoneal Dialysis (SSOP) Study. All demographic, socioeconomic and laboratory data of patients and the education level of all family members were recorded at baseline. Multivariate Cox regression was used to calculate the hazard ratio (HR) of all-cause and cardiovascular mortality, and initial-episode peritonitis with adjustments for recognized traditional factors.

Results

There were no significant differences in baseline characteristics between patients with (n = 1752) and without (n = 512) complete education information. According to the highest education level of patients'' family, included 1752 patients were divided into four groups, i.e. elementary or lower (15%), middle (27%), high (24%) and more than high school (34%). The family highest education (using elementary school or lower group as reference, hazard ratio and 95% confidence interval of middle school group, high school group and more than high school group was 0.68[0.48–0.96], 0.64[0.45–0.91], 0.66[0.48–0.91], respectively) rather than their average education level or patients'' or spouse''s education was significantly associated with the higher mortality. Neither patients'' nor family education level did correlate to the risk for cardiovascular death or initial-episode peritonitis.

Conclusions

Family members'' education level was found to be a novel predictor of PD outcome. Family, as the main source of health care providers, should be paid more attention in our practice.     

Hyponatremia as a Predictor of Mortality in Peritoneal Dialysis Patients

Background and Aim

Hyponatremia is common in patients with chronic kidney disease and is associated with increased mortality in hemodialysis patients. However, few studies have addressed this issue in peritoneal dialysis (PD) patients.

Methods

This prospective observational study included a total of 441 incident patients who started PD between January 2000 and December 2005. Using time-averaged serum sodium (TA-Na) levels, we aimed to investigate whether hyponatremia can predict mortality in these patients.

Results

Among the baseline parameters, serum sodium level was positively associated with serum albumin (β = 0.145; p = 0.003) and residual renal function (RRF) (β = 0.130; p = 0.018) and inversely associated with PD ultrafiltration (β = −0.114; p = 0.024) in a multivariable linear regression analysis. During a median follow-up of 34.8 months, 149 deaths were recorded. All-cause death occurred in 81 (55.9%) patients in the lowest tertile compared to 37 (25.0%) and 31 (20.9%) patients in the middle and highest tertiles, respectively. After adjusting for multiple potentially confounding covariates, increased TA-Na level was associated with a significantly decreased risk of all-cause (HR per 1 mEq/L increase, 0.79; 95% CI, 0.73–0.86; p<0.001) and infection-related (HR per 1 mEq/L increase, 0.77; 95% CI, 0.70–0.85; p<0.001) deaths.

Conclusions

This study showed that hyponatremia is an independent predictor of mortality in PD patients. Nevertheless, whether correcting hyponatremia improves patient survival is unknown. Future interventional studies should address this question more appropriately.     

Serum Folate and Vitamine B12 Levels in Acute and Chronic Renal Disease. Effect of Peritoneal Dialysis

Serum folate and vitamin B₁₂ levels have been measured in 32 patients with renal failure. The initial mean serum folate level was raised above normal in seven patients with acute renal failure whereas the mean level in eight patients severely ill from chronic renal failure was significantly lower than normal. Serum folate levels fell during peritoneal dialysis and rose between dialyses in all these patients and also in one patient who was dialysed for acute pancreatitis.The mean serum B₁₂ level was raised in patients with both acute and chronic renal failure, but there was no consistent change in serum B₁₂ level during dialysis.Hypersegmented polymorphs were present in the peripheral blood film of most of the patients with acute or chronic renal failure. Their presence bore no relation to the clinical state, blood urea, serum folate, or serum B₁₂ level of the patients.     

Peritoneal Dialysis for the Treatment of Pericarditis in Patients on Chronic Hemodialysis

Three cases of pericarditis with effusion associated with infection and occurring in patients under good biochemical control on hemodialysis are reported. Continuation of hemodialysis, even with regional heparinization, allowed further accumulation of fluid. Peritoneal dialysis was instituted, with subsequent improvement in all three patients. This treatment is recommended in the belief that it hastens the resolution of the condition and may obviate the necessity of establishing permanent or semi-permanent artificial pericardial drainage.     

Diminished Selenium Levels in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients

In this cross-sectional study, selenium (Se) levels in the sera of 35 hemodialysis (HD) patients and 34 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for more than 3 months were compared with the serum Se levels of 34 healthy volunteers. The observed Se levels of 100.8 ± 51.9 μg/L in the sera of the HD patients and of 65.5 ± 32.1 μg/L in the sera of the CAPD patients were significantly lower than the 134.9 ± 81.2 μg/L of the controls, with p = 0.002 and 0.02, respectively. Furthermore, the Se levels were significantly higher in the HD rather than the CAPD patients (p = 0.01). In the spent dialysate effluent fluid of 32 of the CAPD patients Se was undetectable, in the remaining two CAPD patients the Se levels were 1.9 and 4.6μg/l, respectively. The low Se levels of HD and CAPD patients as compared to healthy persons are attributed to diminished Se retention due to chronic oxidative stress.     

腹透液相关浓度葡萄糖对人腹膜间皮细胞端粒长度的影响及葛根素的拮抗作用

目的:研究腹透液相关浓度葡萄糖(1.5%、2.5%)对人腹膜间皮细胞端粒长度的影响及葛根素的拮抗作用.方法:人腹膜间皮细胞在含糖(1.5%、2.5%)、含糖含葛根素(葛根素终浓度为100μg/ml)的无血清培养基培养24h后,收集细胞,提取DNA,采用Southerm杂交测定细胞端粒长度.结果:经含糖1.5%和2.5%培养基培养24h后腹膜间皮细胞大多出现肥大.高浓度葡萄糖组细胞端粒长度缩短,2.5%组和1.5%组无显著差别(P>0.05).葛根素加入后含糖组腹膜间皮细胞端粒长度延长(P<0.05).结论:高糖可使间皮细胞端粒缩短,且可能与高糖作用下细胞肥大有关,葛根素可拮抗高糖对间皮细胞端粒长度的影响.     

Preclinical Assessment of Adjunctive tPA and DNase for Peritoneal Dialysis Associated Peritonitis

A major complication of peritoneal dialysis is the development of peritonitis, which is associated with reduced technique and patient survival. The inflammatory response elicited by infection results in a fibrin and debris-rich environment within the peritoneal cavity, which may reduce the effectiveness of antimicrobial agents and predispose to recurrence or relapse of infection. Strategies to enhance responses to antimicrobial agents therefore have the potential to improve patient outcomes. This study presents pre-clinical data describing the compatibility of tPA and DNase in combination with antimicrobial agents used for the treatment of PD peritonitis. tPA and DNase were stable in standard dialysate solution and in the presence of antimicrobial agents, and were safe when given intraperitoneally in a mouse model with no evidence of local or systemic toxicity. Adjunctive tPA and DNase may have a role in the management of patients presenting with PD peritonitis.