A Cross-Sectional Study on The Prevalence of Anemia in Maintenance Hemodialysis and Peritoneal Dialysis Patients and Its Related Factors

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.

Gastrointestinal symptoms: A comparison between patients undergoing peritoneal dialysis and hemodialysis

AIM: To compare the prevalence and diversity of gastrointestinal (GI) symptoms in patients undergoing peritoneal dialysis (PD) and hemodialysis (HD).

Depression in End Stage Renal Disease： Comparison Between Patients Treated with Hemodialysis and Peritoneal Dialysis

Investigation of depression prevalence in end stage renal disease （ESRD） patients treated with two different methods, hemodialysis （HD） and continuous ambulatory peritoneal dialysis （CAPD） is conducted. We investigated whether the dialysis adequacy （Kt/v） and serum hemoglobin level had any correlation with depression severity. Psychiatric interview was performed on 30 HD and 30 CAPD patients. Hamilton depression rating scale （HAMD） was used to evaluate depression symptoms. Kt/v and serum hemoglobin level were detected. Half of HD patients were depressive, while depression wasn＇t found in any CAPD patient. Hemoglobin was in positive correlation with the HAMD, while Kt/v was in negative correlation with the HAMD. Patients on CAPD had less depressive symptoms. Good dialysis adequacy diminish depressive symptoms.

Application of Dorzagliatin in peritoneal dialysis patients with type 2 diabetes mellitus:A case report

BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.

Spontaneous dislodgment of a peritoneal dialysis catheter inserted using the Seldinger technique:A case report

BACKGROUND Peritoneal dialysis(PD)is an important renal replacement therapy in patients with end-stage renal disease.PD catheters remain the lifeline for patients undergoing PD.The catheter technique survival rate is considered a core PD outcome domain.CASE SUMMARY The PD catheter spontaneously dislodged in a patient undergoing PD during regular fluid exchange without pain.Abdominal computed tomography showed a tunnel infection.A double-cuff straight Tenckhoff catheter had been inserted using the Seldinger technique.Before this incident,the patient had a history of tunnel infections.We speculate that recurrent tunnel infections and catheter insertion using the Seldinger technique may have led to catheter dislodgement.CONCLUSION The present case suggests that clinicians should more rigorously assess the persistence of catheter-related infections concerning the potential complications arising from catheter dislodgement associated with the Seldinger technique.

Study on the occurrence and influencing factors of gastrointestinal symptoms in hemodialysis patients with uremia

BACKGROUND Gastrointestinal symptoms are common in patients with uremia undergoing hemodialysis,and these symptoms seriously affect patients'prognosis.AIM To assess the occurrence and factors influencing gastrointestinal symptoms in patients with uremia undergoing hemodialysis.METHODS We retrospectively selected 98 patients with uremia who underwent regular hemo-dialysis treatment in the blood purification center of our hospital from December 2022 to December 2023.The gastrointestinal symptoms and scores of each dimension were evaluated using the Gastrointestinal Symptom Grading Scale(GSRS).Patients were divided into gastrointestinal symptoms and no gastrointestinal symptom groups according to whether they had gastrointestinal symptoms.The factors that may affect gastrointestinal symptoms were identified by single-factor analysis.Multiple logistic regression analysis was performed to identify independent risk factors for gastrointestinal symptoms.RESULTS Gastrointestinal symptoms included indigestion,constipation,reflux,diarrhea,abdominal pain,and eating disorders,and the total average GSRS score was 1.35±0.47.This study showed that age,number of tablets,dialysis time,glucocorticoid,parathyroid hormone(PTH),combined diabetes mellitus and C-reactive protein(CRP)were independent risk factors for gastrointestinal symptoms in patients with uremia undergoing hemodialysis,whereas body mass index(BMI),hemoglobin(Hb),and urea clearance index were independent protective factors(P<0.05).CONCLUSION Gastrointestinal symptoms are mostly mild in patients with uremia undergoing hemodialysis,most commonly including dyspepsia,eating disorders,and gastroesophageal reflux.The independent influencing factors mainly include the BMI,age,number of pills taken,dialysis time,urea clearance index,Hb,use of glucocorticoids,and thyroid hormone level.PTH,CRP,and diabetes are clinically related factors influencing the occurrence of gastrointestinal symptoms,and targeted prevention can be performed.

Continuous ambulatory peritoneal dialysis telemonitoring and education:A scoping review

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.

Hyperkalemia in Patients on Peritoneal Dialysis: Clinical Use Experience with New Potassium-Binders

Background: Patients with end-stage kidney disease (ESKD) on maintenance dialysis have a high risk of developing hyperkalemia. In addition to traditional approaches, a new option for the management of patients on dialysis includes the use of a potassium binder, sodium zirconium cyclosilicate (SZC). We evaluated the effect and safety of SZC in patients with chronic PD. Objective: To present a case series that illustrates the real-world use of new potassium-binders in hyperkalemic patients on peritoneal dialysis. Methods: This case series collected 9 patients on PD with baseline potassium values > 5.5 mmol/l and who were treated with SZC 5 g once a day. Data were collected at baseline and at 1, 2, and 3 months after initiation of treatment. Results: The median age of patients was 64.5 years and the median duration of observation was 90 ± 5 days. It was observed that median serum potassium decreased (5.8 mmol/l at baseline with a range of 5.8 mmol/L - 6.8 mmol/L versus 4.5 in the third month with a range of 3.6 mmol/L - 5.3 mmol/L) after SZC treatment. Adverse events were observed in 2 (22.2%). The unique adverse event was constipation and presented in 2 patients (22.2%). Constipation was mild and transient during the observation period. No adverse events of special interest were reported. Conclusion: Normokalemia was established and maintained in this series of patients treated with SZC. No episodes of hyper- or hypo-kalemia were observed. SCZ had a good safety profile and was well tolerated over 3 months.

Peritoneo-Vaginal Leaks in Peritoneal Dialysis: A Report of 3 Cases

Introduction: Peritoneal dialysis (PD) is an extra-renal purification technique indicated for patients with end-stage kidney disease (ESKD). Although it has many advantages, it also has a number of complications, such as peritoneo-vaginal leakage of dialysate. Cases Reports: Three male patients, aged 70, 50 and 77 respectively, with ESKD were placed on PD. All three patients presented with inadequate drainage and the progressive appearance of bilateral hydrocele, which occurred one year (late leakage), two and four days (early leakage) respectively after the initiation of exchanges. The etiological investigation led to the conclusion of a peritoneo-vaginal leak associated with an inguinal hernia in only one case. The two cases of early leakage were treated by temporary suspension of PD, with a good response in one case and failure in the second, leading to hisdefinitive transfer to hemodialysis (HD);however, the hernia repair enabled immediate resumption of PD in the third patient. Discussion and Conclusion: Peritoneo-vaginal leakage is a rare mechanical complication in PD. The clinical examination plays an essential role in confirming the diagnosis and in the therapeutic decision. If the diagnosis is uncertain, or if there is a clinical need to show the anatomy of the leak, an imaging approach becomes desirable. This complication should not prevent the progression of PD in the management of patients with ESKD.

Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Probiotic interventions in peritoneal dialysis:A review of underlying mechanisms and therapeutic potentials

Peritoneal dialysis(PD)is a commonly used modality for kidney replacement therapy for patients with end-stage kidney disease(ESKD).PD offers many benefits,including home-based care,greater flexibility,and preservation of residual kidney function compared to in-center hemodialysis.Nonetheless,patients undergoing PD often face significant challenges,including systemic inflammation,PD-related peritonitis,metabolic disorders,and cardiovascular issues that can negatively affect their quality of life and treatment outcomes.Recent studies have demonstrated the crucial role of the gut microbiome in overall health and treatment results,supporting the hypothesis that probiotics may bring potential benefits to the general population of ESKD patients.However,specific data on probiotic use in PD patients are limited.This opinion review aims to summarize the current knowledge on the relationship between PD and the gut microbiome and offers a novel perspective by specifically exploring how probiotic interventions could improve the outcomes of PD treatment.The review also outlines some clinical data supporting the effectiveness of probiotics in patients undergoing PD and considers the difficulties and restrictions in their application.Based on the current knowledge gaps,this study seeks to explore future research directions and their implications for clinical practice.

Bladder perforation injury after percutaneous peritoneal dialysis catheterization:A case report

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.

Effectiveness of Ultrasound-Guided Arteriovenous Fistulas Cannulation in Difficult Hemodialysis Arteriovenous Access: A Meta-Analysis of Randomised Controlled Trials

Aim(s): Complex Arteriovenous fistula (AVF) poses challenges to cannulation. Ultrasound (US)-guided cannulation may promote successful cannulation and prevent AVF-related complications. Renal nurses performing US-guided cannulation may improve successful cannulation and reduce complications associated with unnecessary punctures. The study aims to conduct the meta-analyze to examine the effectiveness of renal nurse-performed US-guided cannulation to improve successful cannulation and reduce AVF-related complications in difficult AVF access. Design: A meta-analysis of randomised controlled trials. Methods: A systemic search was performed on electronic databases including CINAHL Plus, Web of Science, and PubMed from inception to October 2023. Risk ratios (RR) and standardized mean differences (SMD) were estimated using random-effect models for considerable homogeneity, and the Scottish Intercollegiate Guidelines Network (SIGN) methodology was adopted for critical appraisal. Results: Four RCTs were included. The results showed US-guided AVF cannulation had a significant effect in improving successful cannulation (RR: 0.19, 95% CI: 0.06 to 0.63, p = 0.007), and was favorable in reducing cannulation-associated complications (RR: 0.44, 95% CI: 0.10 to 1.93, p = 0.28), compared with blind needle cannulation. Conclusion: US-guided cannulation performed by renal nurses has the potential to improve successful cannulation, and fewer complications in hemodialysis patients with difficult arteriovenous access. Relevance to Clinical Practice: The results suggest the value of further training for renal nurses in US-guided cannulation, and broader implementation of US-guided cannulation to improve patient outcomes. Future studies could explore the optimal nursing training and longer-term benefits of US-guided cannulation by renal nurses in difficult AVF access. Patient or Public Contribution: No Patient or Public Contribution as this is a meta-analysis using the secondary data published in the RCTs.

Impact of a Nurse-Led Chronic Disease Management Intervention Model on Quality of Care and Satisfaction of Maintenance Hemodialysis Patients

Objective:To explore the impact of a nurse-led chronic disease management model on the quality of care and satisfaction of maintenance hemodialysis patients.Methods:72 patients who received maintenance hemodialysis(MHD)from June 2021 to March 2022 were selected to undergo the nurse-led chronic disease management model.The hemodialysis indexes,nutritional status,and the occurrence of adverse events were assessed after 24 weeks of the intervention,and patients’satisfaction was investigated and analyzed.Results:Comparing pre-intervention and after 24 weeks of intervention,urea reduction rate and urea clearance were improved but not statistically different(P>0.05),butβ2-microglobulin was significantly reduced compared with pre-intervention(P<0.05);after 24 weeks of intervention,the effect of decreasing blood calcium,parathyroid hormone,and potassium levels was not obvious(P>0.05),and the level of blood phosphorus decreased significantly compared with pre-intervention(P<0.01),albumin and hemoglobin levels were increased and better than before intervention(P<0.05);after 24 weeks of intervention,the incidence of intradialytic hypotension and hypertension was lower than before intervention(P<0.05),and the total incidence of complications was significantly lower than before intervention(P<0.01);there was no significant difference in the Self-Depression Scale scores after 24 weeks of intervention(P>0.05),and Self-Anxiety Scale scores were significantly lower and better than before intervention(P<0.01).Patient satisfaction was greatly improved,with a statistically significant difference(P<0.05).Conclusion:The chronic disease management intervention model led by specialized nurses is conducive to improving the psychological state and nutritional status of dialysis patients,enhancing the adequacy of dialysis for patients,reducing the incidence of related complications,and ultimately achieving the purpose of improving the quality of life of patients,which has significant clinical value.

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.

Development of Health Literacy for Regular Hemodialysis Patients in Menoufia Governorate: A Cross-Sectional Study

Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, p < 0.001), of increasing age (OR = 0.12 CI 95%: 0.07_0.19, p < 0.001), low education (OR = 1.08, CI 95%: 1.04_1.11, p < 0.001) and the patient did not undergo kidney transplant (OR = 4.19 CI 95%: 1.12_15.62, p = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.

Gastrointestinal symptoms in patients undergoing peritoneal dialysis: Multivariate analysis of correlated factors

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.

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.

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.