不卧床维持性膜腹透析患者的饮食指导

不卧床维持性腹膜透析（ＣＡＰＤ），是治疗终末期慢性肾衰行之有效的方法之一。但ＣＡＰＤ可引起患者营养不良、高脂血症、肾性骨病等并发症，是影响患者治疗效果和愈合的重要因素。因此如何改善患者的营养状况，提高生活质量，延长存活时间，是ＣＡＰＤ面临的一个重要课...

双联系统腹膜透析临床效果观察

目前腹膜透析方法在不断改进、完善,双联系统腹膜透析更适合于病人家庭透析或外出旅游透析,其操作方便、简单,而腹膜炎发生率极低.作者应用双联系统腹膜透析方法治疗49例患者,其结果报道如下.1

百特双联系统腹膜透析在慢性肾功能衰竭中的应用

目的探讨百特（Baxter）双联系统腹膜透析在治疗慢性肾功能衰竭中的应用。方法收集2008年6月至2009年8月行Baxter腹膜透析的CRF患者7例，全部病例均采用解剖法植入Baxter腹透管行PD治疗。结果2例患者治疗失败，余5例均取得良好疗效，表现为尿毒症症状缓解，贫血改善，体力、精神较前好转。但血浆总蛋白、白蛋白水平有所下降。结论PD与血液透析相比，操作方便，价格低廉，具良好的残存肾功能保护作用等优点，已成为CRF治疗的首选治疗方式之一。

腹膜透析患者血性腹透液的原因及治疗

由于腹膜透析（PD）导管提供了一个观察腹腔内出血的窗口，血性腹透液在腹膜透析患者中并非罕见。妇产科相关疾病占其原因的大部分，其次为腹腔内器官如肾脏、肝脏、脾脏以及胃肠道。腹膜透析患者特有的原因为导管本身、尿毒症出血或腹膜炎等。治疗方式的选择在很大程度上取决于出血的病因。笔者就成人腹膜透析出现的血性腹透液的原因和治疗作一综述。

Peritoneal dialysis associated infections: An update on diagnosis and management

Peritoneal dialysis （PD） is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate 〈 0.67 episodes/patient/year on dialy-sis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% re-sulted in death. Improved diagnosis, increased aware-ness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD as-sociated infection. Gram-positive cocci such as Staphy-lococcus epidermidis , other coagulase negative staphy-lococcoci, and Staphylococcus aureus （S. aureus ） are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organ-isms. However, use of systemic vancomycin and cip-rofoxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis - success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodi-alysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupi-rocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms.

Targeting cannabinoid signaling for peritoneal dialysisinduced oxidative stress and fibrosis

Long-term exposure to bioincompatible peritoneal dialysis(PD) solutions frequently results in peritoneal fibrosis and ultrafiltration failure,which limits the life-long use of and leads to the cessation of PD therapy.Therefore,it is important to elucidate the pathogenesis of peritoneal fibrosis in order to design therapeutic strategies to prevent its occurrence.Peritoneal fibrosis is associated with a chronic inflammatory status as well as an elevated oxidative stress(OS) status.Beyond uremia per se,OS also results from chronic exposure to high glucose load,glucose degradation products,advanced glycation end products,and hypertonic stress.Therapy targeting the cannabinoid(CB) signaling pathway has been reported in several chronic inflammatory diseases with elevated OS.We recently reported that the intra-peritoneal administration of CB receptor ligands,including CB_1 receptor antagonistsand CB_2 receptor agonists,ameliorated dialysis-related peritoneal fibrosis.As targeting the CB signaling pathway has been reported to be beneficial in attenuating the processes of several chronic inflammatory diseases,we reviewed the interaction among the cannabinoid system,inflammation,and OS,through which clinicians ultimately aim to prolong the peritoneal survival of PD patients.

Is overhydration in peritoneal dialysis patients associated with cardiac mortality that might be reversible?

AIMTo study the relationship between overhydration （OH） in peritoneal dialysis （PD） patients and cardiac mortality.METHODSOH, as measured by body composition monitor （BCM）, is associated with increased mortality in dialysis pa-tients. BCM has been used to guide treatment on the assumption that correcting OH will improve cardiac morbidity and mortality although data demonstrating causality that is reversible is limited. We wished to determine if OH in PD patients predicted cardiac mor-tality, and if there was a correlation between OH and cardiac troponin-T （cTnT） levels. Finally, we wished to determine if improving OH values would lead to a decrement in cTnT. All prevalent PD patients over the study period of 57 mo who had contemporaneous BCM and cTnT measurements were followed irrespective of transplantation or PD technique failure. We also studied a cohort of patients with who had severe OH （〉 ＋2L）.The Fresenius Body Composition Monitor was used to obtain hydration parameters. cTnT levels were done as part of routine clinical care. Data was analysed using SPSS version 20.0.RESULTSThere were 48 deaths in the 336 patients. The patients that died from cardiac or non-cardiac causes were similar with respect to their age, incidence of diabetes mellitus, gender, ethnicity and cause of renal failure. However, the patients with cardiac causes of death had significantly shorter dialysis vintage （10.3 mo vs 37.0 mo, P 〈 0.0001） and were significantly more overhydrated by BCM measurement （2.95 L vs 1.35 L, P 〈 0.05）. The mean （standard error of the means） hydration status of the 336 patients was ＋1.15 （0.12） L and the median [interquartile range （IQR）] cTnT level was 43.5 （20-90） ng/L. The cTnT results were not normally distributed and were therefore transformed logarithmically. There was a statistically significant correlation between Log （cTnT） with the OH value （Spearman r value 0.425, P 〈 0.0001）. We identifed a sub-group of patients that were severely overhydrated; median （IQR） hydration at baseline was ＋2.7 （2.3 to 3.7） L. They were followed up for a minimum of 6 mo. Reduction in OH values in these patients over 6 mo correlated with lowering of cTnT levels （Spearman r value 0.29, P 〈 0.02）. CONCLUSIONPatients that were overhydrated had higher cTnT, and had deaths that were more likely to be cardiac related. Reduction in OH correlated with lowering of cTnT.

TREATMENT OF COMPLICATIONS DUE TO PERITONEAL DIALYSIS FOR CHRONIC RENAL FAILURE WITH TRADITIONAL CHINESE MEDICINE

In this paper,the experience in the treatment of complications due to continuousambulatory peritoneal dialysis for chronic renal failure with traditional Chinese medicine(TCM)is reported.Modified Renshen Yangrong Tang(Ginseng Nutrition Decoction)wasused for anorexia and hypoproteinemia;modified Xiangsha Liujunzi Tang(Decoction ofCyperus and Amomum with Six Noble Ingredients)for abdominal pain and distension;modified Da Chaihu Tang(Major Bupleurum Decoction)for peritonitis;modifiedShenling Baizhu San(Powder of Ginseng,Poria and Atractylodes)for diarrhea due toinsufficiency of the spleen with abundance of dampness;Lizhong Tang(Decoction forRegulating the Function of Middle-jiao)and modified Sishen Wan(Pills of FourMiraculous Drugs)for insufficiency of both the spleen and the kidney;Siwu Tang(Decoction of Four Ingredients)added with other drugs for cutaneous pruritus,andGuishao Sijunzi Tang(Decoction of Four Noble Drugs added with Chinese Angelica Rootand white Peony Root)for renal anemia.The therapeutic principles of invigorating theliver and kidney,strengthening the bones and muscles,and promoting blood circulation toeliminate blood stasis were adopted in the treatment of renal osteopathy,and thetherapeutic principles of invigorating the liver and kidney,expelling phlegm and resolvingdampness,and promoting blood circulation to eliminate blood stasis in the treatment ofhyperlipemia.Shen Tekang capsules(capsules for improving the renal function)wasadministered to patients for strengthening the viability and improving the nutrition state,and the recipe for treating renal function failure(both formulated by the authors)forimproving the renal function so as to decrease the frequency and duration of dialysis.

Unplanned hospital readmissions after kidney transplantation among patients in Hefei,China:Incidence,causes and risk factors

Objectives:Unplanned readmissions severely affect a patient's physical and mental well-being after kidney transplantation(KT),which is also independently associated with morbidity.A retrospective study was conducted to identify the incidence,causes and risk factors for unplanned readmission after KT among Chinese patients.Methods:Patients who underwent KT were admitted to the organ transplant center of the Affiliated Hospital of University of Science and Technology of China(2017-2018).Medical records for these patients were obtained through the hospital information system(HIS).Results:In 518 patients,the incidence of unplanned readmissions within 30 days(n=9)was 1.74%,and 90 days(n=64)was 12.35%.The one-year unplanned readmission rate was 22.59%(n=122).Overall,122 patients were readmitted because of infection,renal events,metabolic disturbances,surgical complications,etc.Hemodialysis(OR=10.462,95%CI:1.355-80.748),peritoneal dialysis(OR=8.746,95%CI:1.074-71.238)and length of stay(OR=1.023,95%CI:1.006-1.040)were independent risk factors for unplanned readmissions.Conclusion:Unplanned readmission rates increased with time after KT.Certain risk factors related to unplanned readmissions should be deeply excavated.Targeted interventions for controllable factors to alleviate the rate of unplanned readmissions should be identified.

Skin disorders in peritoneal dialysis patients:An underdiagnosed subject

AIM： To examine all skin changes in peritoneal dialysis （PD） patients followed up in our unit.METHODS： Patients on PD program for at least three months without any known chronic skin disease were included in the study. Patients with already diagnosed skin disease, those who have systemic diseases that may cause skin lesions, patients with malignancies and those who did not give informed consent were excluded from the study. All patients were examined by the same predetermined dermatologist with all fndings recorded. The demographic, clinical and laboratory data including measures of dialysis adequacy of patients were recorded also. Statistical Package for Social Sciences （SPSS） for Windows 16.0 standard version was used for statistical analysis.RESULTS： Among the patients followed up in our PD unit, those without exclusion criteria who gave informed consent, 38 patients were included in the study with male/female ratio and mean age of 26/12 and 50.3 ± 13.7 years, respectively. The duration of CKD was 7.86 ± 4.16 years and the mean PD duration was 47.1 ± 29.6 mo. Primary kidney disease was diabetic nephropathy in 11, nephrosclerosis in six, uropathologies in four, chronic glomerulonephritis in three, chronic pyelonephritis in three, autosomal dominant polycystic kidney disease in three patients while cause was unknown in eight patients. All patients except for one patient had at least one skin lesion. Loss of lunula, onychomycosis and tinea pedis are the most frequent skin disorders recorded in the study group. Diabetic patients had tinea pedis more frequently （ P = 0.045）. No relationship of skin findings was detected with primary renal diseases, comorbidities and medications that the patients were using.CONCLUSION： Skin abnormalities are common in in PD patients. The most frequent skin pathologies are onychomycosis and tinea pedis which must not be overlooked.

Recurrent epiploic appendagitis and peritoneal dialysis: A case report and literature review

Epiploic appendagitis(EA)is rare cause of acute or subacute abdominal pain in patients on peritoneal dialysis(PD),where the diagnosis can be challenging as the clinical features,laboratory markers and imaging characteristics have not been described previously in this group of patients.Here,we present the management of a case of EA in a patient on PD and review published literature pertinent to the subject.The importance of establishing the diagnosis early by laparoscopy is emphasised.

NEUTROPHILIC TRANSIENT ACIDIFICATION AND SUPEROXIDE PRODUCTION IN PERITONEAL DIALYSATE

Aim. To elucidate whether an inhibited superoxide production(O 2 ) of neutrophils induced by commercial lactate based peritoneal dialysates(PDS) could be corrected after a transient intracellular acidosis. Methods. The intracellular pH([pHi]) of human neutrophils incubatd in PDS was monitored with a spectrofluorometer with a pH sensitive dye (BCECF AM). Neutrophilic O 2 stimulated by zymosan was determined in PDS with the superoxide dismutase inhibitable ferricytochrome c reduction, using a spectrophotometer. Results. The severe intracellular acidosis induced within 5 min by PDS at an extracellular pH of 5.2 could be promptly and completely recovered by a neutralization of the pH of media. However, O 2 by neutrophils exposed to the PDS for as little as 5 min was drastically and persistently inhibited, even the acidic [pHi] of cells had been fully returned for 1h. Conclusions. The intracellular acidification of cells in the initial phase could be transient and reversible, but impaired cell functions, at least in part including O 2 generating system, might be consistent and irreversible in the early stage of the cellular acidosis in the peritoneal cavity of CAPD patients. The findings above may be of particular importance in both clinic and cell biology.

PERITONEAL DIALYSIS AFTER REPAIR OF CONGENITAL HEART DISEASE IN CHILDREN

Objective. To investigate the effect of peritoneal dialysis on fluid balance and outcome in childrenwho receive cardiac operation.Methods. From July to Dec. 2000, 12(2.08%) patients of 576 consecutive children who underwentheart operation required peritoneal dialysis because of acute renal failure. The mean age of these 12 pa-tients was (2.9±2.0) years (range, 5 months～7 years) and the mean body weight was (12±3) kg (range,7.4～18.5 kg ).Results. The interval between the operation and the initiation of peritoneal dialysis was (21.2±11.4)hours (4.4～42 hours). The duration of peritoneal dialysis was (6.3±4.8) days (0.47～15 days). Mortality inthese 12 patients was 25%. Fluid removed by peritoneal dialysis was(34.7±17.8) ml@kg1@day-1@ Asymop-tomatic hypokalemia, thrombocytopenia and hyperglycemia were frequent complications, which were easilymanaged. Hemodynamics and pulmonary function improved during the study period.Conclusion. The early initiation of peritoneal dialysis is an effective and safe method totreat acute renal failure after cardiac operation in children.

Gene expression of glucose transporters and its regulation by glucose in mesothelial cells

Objective To observe the influence of glucose on the expression of glucose transporters (GluTs) in peritoneal tissues.Methods Mesothelial cells (MsCs) from Sprague-Dawley (SD) rats were cultured in medium with glucose 214.4 mmol/L or 75.5 mmol/L. The normal medium with glucose 17.5 mmol/L was used as control. Total RNA was extracted from each sample after 24 hours incubation. Reverse transcript polymerase chain reaction (RT-PCR) was performed with primers corresponding to sodium-glucose transporter (SGIT1) and GluT1 -GluT4. mRNA expression of the above GluTs from each sample was measured with quantitative PCR.Results GluT1 and GluT2 mRNA can be detected in MsCs from SD rats, while no positive bands can be found specificaly for GluT3, GluT4 and SGIT1. Quantitating the amount of PCR products indicated that the levels of GluT1 mRNA in MsCs cultured 24 h in both 214.4 mmol/L glucose and 75.5 mmol/L glucose medium decreased dramatically compared with that in normal medium ( P≤0.01 ). While under the same conditions, the levels of GluT2 mRNA in MsCs cultured 24 h in 214.4 mmol/L and 75.5 mmol/L glucose medium both increased significantly ( P ＜ 0.01 ).Conclusions GluT1 is strongly expressed in MsCs under normal glucose levels and decreased dramatically under high glucose conditions, while GluT2 expressed at a low level in normal medium and increased greatly after incubation in high glucose conditions. This may play a great role in glucose absorportion during peritoneal dialysis and have some connection with ultrafiltration failure due to the alteration of glucose absorption after long-term dialysis.

Inhibition effect of small interfering RNA of connective tissue growth factor on the expression of vascular endothelial growth factor and connective tissue growth factor in cultured human peritoneal mesothelial cells

Background The peritoneum response to peritoneal dialysis can lead to fibrosis. The transforming growth factor β1 （TGF-β1 ） plays a key role in regulating tissue repair and remodelling after injury. Connective tissue growth factor （CTGF）, a downstream mediator of TGF-β1 inducing fibrosis, has been implicated in peritoneal fibrosis. Vascular endothelial growth factor （VEGF） plays a key role in angiogenesis that can hasten peritoneal fibrosis. In this study, we investigated the effect of small interfering RNA （siRNA） of CTGF by pRETRO-SUPER （PRS） retrovirus vector on the expression of CTGF and VEGF in human peritoneal mesothelial cells. Methods Retrovirus producing CTGF siRNA were constructed from the inverted oligonucleotides and transferred into packaging cell line PT67 with lipofectamine, and the virus supernatant was used to infect human peritoneal mesothelial cell （HPMC）. The cells were divided into seven groups： low glucose DMEM, low glucose DMEM ＋ TGF-β1 5 ng/ml, low glucose DMEM ＋ TGF-β1 5 ng/ml ＋ PRS-CTGF-siRNA1-4 and low glucose DMEM ＋ TGF-β1 5 ng/ml ＋ PRS. The expression of CTGF and VEGF were measured by semiquantitative RT-PCR and Western blot. Results Low levels of CTGF and VEGF were detected in confluent HPMCs. Following stimulation with TGF-β1 , the levels of CTGF and VEGF were significantly upregulated （P〈0.01）. Introduction of PRS-CTGF-siRNA1-4 resulted in the significant reduction of CTGF mRNA and protein, and VEGF mRNA （P〈0.01）, especially in groups PRS-CTGF-siRNA, and PRS-CTGF-siRNA4. The introduction of PRS void vector did not have these effects （P〉0.05）. Conclusions The expression of CTGF siRNA mediated by PRS retrovirus vector can effectively reduce the level of CTGF and VEGF induced by TGF-β1 in cultured HPMCs. This study may provide potential therapeutic strategies to prevent the peritoneal fibrosis.

Peritoneal dialysis for autosomal dominant polycystic kidney disease: a retrospective study

To describe the long-term clinical outcomes of patients with autosomal dominant polycystic kidney disease （ADPKD） who are on peritoneal dialysis （PD） therapy. We performed a retrospective matched-cohort analysis com- paring the clinical outcomes of 30 ADPKD patients with those of 30 non-diabetic patients who had bilateral small kidneys between July 1 2007 and July 31 2014. The patient groups were matched by age, gender, and time of PD initiation. There were no significant differences in the demographic or biochemical parameters, comorbid conditions, residual glomerular filtration rate, or Charison comorbidity score at the beginning of PD. The median renal volume was 1315 ml for the ADPKD group and 213 ml for the control group. Patients with ADPKD had similar 3-year patient survival （90.6% versus 86.3%, ,~=-0.807） and technique survival （89.2% versus 74.3%, P=0.506） compared with non-ADPKD patients. Also, there was no significant difference in the peritonitis-free survival between the ADPKD and control groups （P=0.22）, and rates of peritonitis were similar （0.19 versus 0.21 episodes per patient-year, P=-0.26）. No differences were observed in the incidence of PD-related complications, such as hernia and dialysate leak. ADPKD is not a con- traindication for PD, and a subgroup of ADPKD patients with relatively small kidney volume can be treated using PD.