Comprehensive Review:Diagnosis,Classification,and Risk Factors of Peritoneal Dialysis-Associated Peritonitis

Peritoneal dialysis(PD)is a predominant modality of renal replacement therapy(RRT)for individuals suffering from end-stage renal disease(ESRD).Peritoneal dialysis-associated peritonitis(PDAP)represents a frequent complication among patients undergoing PD,significantly contributing to adverse clinical outcomes.This review comprehensively examines the diagnosis,classification,and risk factors associated with PDAP,aiming to offer clinical practitioners essential guidance and a foundational framework for effective clinical management.

Comparison of clinical features and outcomes in peritoneal dialysisassociated peritonitis patients with and without diabetes:A multicenter retrospective cohort study

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.

频发腹膜透析相关性腹膜炎的临床分析

目的分析频发腹膜透析相关性腹膜炎(PDAP)的临床特征并探讨其影响因素。方法回顾性分析2012年1月2017年11月在吉林大学第二医院治疗的PDAP患者91例。其中,29例在1年内发生≥2次PDAP为频发组,62例仅发生过1次PDAP为偶发组,比较两组患者临床资料,分析影响频发PDAP的因素及预后。结果两组患者置管时血清白蛋白水平比较,差异有统计学意义(P<0.05)。两组患者感染时血清白蛋白水平比较,差异有统计学意义(P<0.05)。频发组G+菌感染率较偶发组高(P<0.05)。两组的G+菌均对青霉素、红霉素、苯唑西林的耐药率较高,对万古霉素、替加环素、利奈唑胺的敏感性较高。两组的G-菌均对氨苄西林、头孢唑啉、头孢呋辛钠、头孢呋新酯的耐药率较高,对美罗培南、亚胺培南、哌拉西林的敏感性较高。结论血清白蛋白水平可能是PDAP的影响因素。频发患者G+菌感染率较高。PDAP患者的G+菌对万古霉素、替加环素、利奈唑胺的敏感性较高,而G-菌对美罗培南、亚胺培南、哌拉西林的敏感性较高。

频发腹膜透析相关性腹膜炎的临床特征及危险因素的探讨

目的:分析频发腹膜透析相关性腹膜炎临床特征并探讨相关危险因素。方法:纳入93例腹膜透析治疗尿毒症患者,研究组(n=21)患者腹膜透析后腹膜炎发生率≥2次/年,参考组(n=72)1次/年。结果:Logistic回归分析结果显示血压、体质量指数、血白蛋白以及血红蛋白等均为频发性腹膜炎相关危险因素(P<0.05)。结论:频发腹膜透析相关性腹膜炎危险因素主要包括血压、体质量指数、血白蛋白、血红蛋白,应采取针对性措施以降低腹膜炎发生率。

频发性腹膜透析相关性腹膜炎的临床特征及危险因素分析

目的分析频发性腹膜透析相关性腹膜炎(F-PDAP)患者的临床特征并探讨其危险因素。方法回顾性分析2015年1月至2019年9月在安徽医科大学第二附属医院治疗并规律随访的101例腹膜炎患者资料,包括年龄、透析龄、性别、体质量指数(BMI)、文化程度、细菌培养结果、超敏C反应蛋白、血红蛋白、血白蛋白、淋巴细胞计数、血钙、血磷、血钾、总胆固醇、甘油三酯、尿酸、铁蛋白、全段甲状旁腺激素、末次透出液白细胞计数等指标。将1年内仅发生1次腹膜炎者定义为单发性腹膜透析相关性腹膜炎(S-PDAP)组,1年内发生腹膜炎≥2次者定义为频发性腹膜透析相关性腹膜炎(F-PDAP)组,并分析F-PDAP的临床特征及危险因素。结果(1)101例腹膜炎患者中,共发生腹膜炎133例次。其中F-PDAP组29例,发生61例次;S-PDAP组72例,发生腹膜炎72例次。F-PDAP组与S-PDAP组相比,患者透析龄更长、超敏C反应蛋白更高、铁蛋白更高(均P<0.005);但其血红蛋白、血白蛋白、淋巴细胞计数较S-PDAP组低(均P<0.001)。两组间年龄、性别、高血压患病率、糖尿病患病率、糖尿病肾病发生率、BMI、文化程度、腹透液细菌培养结果、校正钙、血磷、血钾、总胆固醇、甘油三酯、尿酸、全段甲状旁腺激素、末次透出液白细胞计数等指标比较差异均无统计学意义。(2)多因素Logistic回归分析显示高透析龄(OR=1.046,95%CI:1.002-1.091,P=0.039)、低血红蛋白(OR=0.909,95%CI:0.838-0.986,P=0.022)、低血白蛋白(OR=0.510,95%CI:0.328-0.793,P=0.003)、低淋巴细胞计数(OR=0.045,95%CI:0.001-0.864,P=0.045)为F-PDAP的危险因素。结论低血红蛋白、低血白蛋白、低淋巴细胞计数及较高的透析龄是频发性腹膜透析相关性腹膜炎危险因素,积极纠正贫血及低蛋白血症可能有助于降低腹膜透析相关性腹膜炎的发生率。

频发腹膜透析相关性腹膜炎患者病原菌及危险因素

目的探究频发腹膜透析(PD)相关性腹膜炎患者病原菌特点及危险因素。方法选择2018年7月-2020年7月四川省人民医院收治80例PD相关性腹膜炎患者作为研究对象,依据发生次数将单发以及频发感染患者分别纳入对照组与研究组,分别为53例与27例,分析患者病原菌感染特点,频发PD相关性腹膜炎危险因素。结果两组病原菌培养阳性率分别为60.38%和66.18%,阳性率比较无统计学差异;革兰阳性菌主要为表皮葡萄球菌、溶血葡萄球菌,革兰阴性菌主要为肺炎克雷伯菌,革兰阳性菌对红霉素、青霉素、苯唑西林、克林霉素耐药性较高,革兰阴性菌对氨苄西林、头孢唑林耐药性较高;两组患者白蛋白、血红蛋白、血肌酐、透析时间、无效拔管率等因素指标比较存在统计学意义(P<0.05),多元Logistic回归分析结果显示白蛋白水平低、血红蛋白水平低以及透析时间长是频发PD相关性腹膜炎危险因素(P<0.05)。结论白蛋白水平低、血红蛋白水平低以及透析时间长是频发PD相关性腹膜炎发生危险因素,临床需要重点关注。