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.

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.

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.

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.

BCW理论下的精准随访模式在PD患者管理中的系统构建与应用研究

目的探讨行为改变轮模式(BCW)理论下的精准随访模式在腹膜透析(PD)患者管理中的系统构建与应用研究。方法选取2022年1-12月在该院行PD置管术的患者40例作为研究对象,在BCW理论指导下制定PD患者区域群体精准随访模式并采用应对效能量表(CEQ)、社会支持评定量表(SSRS)、患者满意度量表(CSQ-8)进行随访前后问卷调查。结果实施1、3、6个月随访后应对效能得分与实施前得分比较,差异均有统计学意义(P<0.05)。实施1、3、6个月随访后社会支持得分与实施前得分比较,差异有统计学意义(P<0.05)。实施6个月随访后患者满意度高于实施前,差异有统计学意义(P<0.05)。结论BCW理论下的精准随访模式在PD患者管理中效果理想,可在该地域推广使用。

基线腹膜转运特性对CAPD患者腹膜蛋白丢失、生存率及腹膜炎发生率的影响

目的:观察基线腹膜转运特性对持续不卧床腹膜透析(CAPD)患者腹膜蛋白丢失、腹膜炎发生率及生存率的影响。方法:回顾性分析2014年01月—2021年01月在我院行腹膜透析手术并规律CAPD治疗≥1年的91例患者作为研究对象,根据术后首次的腹膜平衡试验(PET)结果,将患者分为4组:高转运组(H)、高平均转运组(HA)、低平均转运组(LA)及低转运组(L),比较各组腹膜蛋白清除率(PrC)及腹膜炎发生率,分析终末期肾脏病(ESRD)不同原发病与其基线腹膜转运特性之间的关系。Kaplan-Meier生存曲线比较HT组(H和HA)和LT组(LA和L)患者的生存情况。结果:PrC水平在H、HA、LA及L四组间存在显著差异,H组的PrC水平显著高于HA、LA及L组,而其血清白蛋白水平显著低于其余三组(P<0.05)。不同ESRD原发病的患者,其基线腹膜转运特性也存在差异,糖尿病肾病患者的基线腹膜转运特性多为HA及H,而慢性肾小球肾炎患者的基线腹膜转运特性多为LA及HA。腹膜炎发生率及生存率在HT组和LT组差异无统计学意义(P>0.05)。结论:ESRD原发病不同可影响其基线腹膜转运特性的分布,不同基线腹膜转运特性PD患者间PrC水平存在显著差异,腹膜高转运特性的患者多伴有高的PrC水平和低的血白蛋白水平,而腹膜转运特性对CAPD患者的腹膜炎发生率及生存率无显著影响。

宏基因组二代测序和细胞因子在PD相关腹膜炎早期诊断中的应用

目的探究宏基因组二代测序(metagenomic second-generation sequencing,mNGS)技术在早期检测腹膜透析相关腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)患者细菌感染的病原学价值,了解不同细菌感染类型中细胞因子分布差异,构建相关风险预测模型。方法收集2020年4月─2023年4月就诊于安徽医科大学第一附属医院,符合国际腹膜透透协会(international society for peritoneal dialysis,ISPD)诊断标准的腹膜透析(peritoneal dialysis,PD)患者的临床资料,同时将其入院4小时内PD流出液送检mNGS检查及普通培养,并测定上清液中细胞因子水平,比较mNGS检测与实验室微生物培养病原学诊断结果,综合临床意义分为革兰氏阳性菌(G+菌)组、革兰氏阴性菌(G-菌)组和培养阴性(G0)组,比较2组细胞因子水平差异,确认危险因素并构建风险预测模型,同时进行效能检测。结果共50例PD相关腹膜炎患者纳入本研究,mNGS检测中41例患者检出病原体,检测阳性率高于微生物培养(χ^(2)=0.059,P=0.440),mNGS检测时间低于微生物培养(t=5.180,P<0.001)。多因素Logistics回归分析提示PD液中高白细胞介素(IL)10(OR=1.010,95%CI:1.000~1.020,P=0.024)、低IL-6(OR=0.620,95%CI:0.360~0.890,P=0.038)及高血清降钙素原(OR=1.200,95%CI:1.050~1.530,P=0.016)、低C反应蛋白水平(OR=1.014,95%CI:1.010~1.050,P=0.035)为PDAP预测G-菌感染的独立危险因素。ROC曲线及列线图结果显示上述炎症因子联合较单一因子对预测G-菌感染价值更大。结论mNGS在早期快速检测PDAP病原体方面显示了极大的诊断潜力,PD流出液中细胞因子IL-6、IL-10及血清降钙素原、C反应蛋白水平的整合提高了mNGS结果解释的精确度,依据细胞因子构建的风险预测模型可以较好区分不同种类细菌相关PDAP腹膜炎的患者。

Neisseria mucosa-A rare cause of peritoneal dialysis-related peritonitis:A case report

BACKGROUND Neisseria mucosa is a gram negative diplococcus belonging to the genus Neisseria found commonly in the upper respiratory tract.It is typically a commensal organism when it is parasitic on oral and nasal mucosa.To our knowledge,it does not cause disease in healthy individuals with normal immunity,but can be pathogenic in those with impaired immune function or change in bacterial colonization site.Neisseria mucosa has been reported to cause bacterial meningitis,conjunctivitis,pneumonia,endocarditis,peritonitis and urethritis.However,peritoneal dialysis-related peritonitis caused by Neisseria mucosa is extremely rare in clinical practice,which has not previously been reported in China.CASE SUMMARY A 55-year-old female presented to the nephrology clinic with upper abdominal pain without apparent cause,accompanied by nausea,vomiting and diarrhea for two days.The patient had a history of Stage 5 chronic kidney disease for five years,combined with renal hypertension and renal anemia,and was treated with peritoneal dialysis for renal replacement therapy.The patient was subsequently diagnosed with peritoneal dialysis-related peritonitis.Routine examination of peritoneal dialysis fluid showed abdominal infection,and the results of microbial culture of the peritoneal dialysis fluid confirmed Neisseria mucosa.Imi-penem/cilastatin 1.0 g q12h was added to peritoneal dialysis fluid for anti-infection treatment.After 24 d,the patient underwent upper extremity arteriovenous fistulation.One month later,the patient was discharged home in a clinically stable state.CONCLUSION Peritonitis caused by Neisseria mucosa is rare.Patients with home-based self-dialysis cannot guarantee good medical and health conditions,and require education on self-protection.

Evidence-based medicine: An update on treatments for peritoneal dialysis-related peritonitis

Peritonitis continues to be a major complication of peritoneal dialysis(PD), and adequate treatment is crucial for a favorable outcome. There is no consensus regarding the optimal therapeutic regimen, and few prospective controlled studies have been published. The objective of this manuscript is to review the results of PD peritonitis treatment reported in narrative reviews, systematic reviews, and proportional meta-analyses. Two narrative reviews, the only existing systematic review and its update published between 1991 and 2014 were included. In addition, we reported the results of a proportional metaanalysis published by our group. Results from systematic reviews of randomized control trials(RCT) and quasiRCT were not able to identify any optimal antimicrobial treatment, but glycopeptide regimens were more likely to achieve a complete cure than a first generation cephalosporin. Compared to urokinase, simultaneous catheter removal and replacement resulted in better outcomes. Continuous and intermittent IP antibiotic use had similar outcomes. Intraperitoneal antibiotics were superior to intravenous antibiotics in reducing treatment failure. In the proportional meta-analysis of RCTs and the case series, the resolution rate(86%) of ceftazidime plus glycopeptide as initial treatment was significantly higher than first generation cephalosporin plus aminoglycosides(66%) and glycopeptides plus aminoglycosides(75%). Other comparisons of regimens used for either initial treatment or treatment of gram-positive rods or gramnegative rods did not show statistically significant differences. The superiority of a combination of a glycopeptide and a third generation cephalosporin was also reported by a narrative review study published in 1991, which reported an 88% resolution rate.

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 dialysis, 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% resulted in death. Improved diagnosis, increased awareness 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 associated infection. Gram-positive cocci such as Staphylococcus epidermidis, other coagulase negative staphylococcoci, 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 organisms. However, use of systemic vancomycin and ciprofloxacin 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 hemodialysis. 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. Mupirocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms.

基于互联网的APD对腹膜透析患者透析质量及并发症影响的前瞻性对照研究

目的探讨基于互联网的管理模式下,自动化腹膜透析(automated peritoneal dialysis,APD)相对于持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)的效果及安全性。方法采用前瞻性对照研究方法,选取2020年11月~2021年11月中国人民解放军陆军军医大学第一附属医院收治的腹膜透析(peritoneal dialysis,PD)患者。根据透析方式分为APD组和CAPD组。在纳入APD患者后,再应用倾向性评分匹配法对患者进行1∶1匹配纳入PD对照组。两组进行为期1年的随访。最终纳入分析APD共52例,CAPD共58例。两组均采用互联网支持的远程医疗平台管理,对比两组的透析质量、腹膜炎发生率、不良心血管事件发生率,并采用肾脏病和生活质量问卷(Kidney Disease and Quality of Life Questionnaire,KDQOL-36)进行生活质量评分,对比两组的生活质量。结果APD组透析质量和生活质量评分高于CAPD组,腹膜炎和不良心血管事件发生率低于CAPD组,差异有统计学意义(P<0.05)。结论基于互联网的腹透管理模式下,进一步采用APD远程管理可更有效地提高透析质量和患者生活质量,降低患者腹膜炎及不良心血管事件发生率。

Independent risk factors for depression in older adult patients receiving peritoneal dialysis for chronic kidney disease

BACKGROUND According to the trend of global population aging,the proportion of elderly patients with chronic kidney disease(CKD)is expected to increase.However,there are more than 20 million people in China with decompensated kidney function,of which 19.25%are elderly people.Therefore,special attention should be paid to the education years,sleep quality,anxiety status,comorbidities with diabetes,cardiovascular disease(CVD),and anemia as independent risk factors for depression in elderly CKD patients.This study explores the clinical management of elderly CKD patients that should address these risk factors to prevent depression and improve their prognosis.AIM To investigate depression risk factors in older patients receiving peritoneal dialysis,aiding future prevention of depression in these patients.METHODS This retrospective study included a primary study population of 170 patients with CKD who received peritoneal dialysis from January 2020 to December 2022.We assessed the patients’mental status using the Beck Depression Inventory Score-II(BDI-II),Self-Rating Anxiety Scale(SAS),Anxiety Inventory Score,and the Pittsburgh Sleep Quality Index(PSQI).Logistic regression was employed to identify depression independent risk factors among these patients.RESULTS The non-depressed group had a significantly longer education period than the depressed group(P<0.05).The depressed group exhibited significantly higher mental status scores than the non-depressed group(P<0.001).Patients with diabetes mellitus(DM)or CVD had a higher probability of developing depression.Patients with depression had significantly lower hemoglobin and albumin levels than patients without depression(P<0.05).Spearman correlation analysis of BDI-II scale scores,measuring depression,indicated positive correlations with BDI-II and SAS scores as risk factors for depression in patients with CKD.In contrast,years of education,hemoglobin levels,and peritoneal Kt/V were negatively correlated,serving as protective factors against depression.An analysis of variance for influences with significant differences in the univariate analysis revealed that years of schooling,BDI-II,SAS,PSQI,DM,CVD,and hemoglobin levels independently influenced depression in older patients with CKD.CONCLUSION Education,BDI-II,SAS,PSQI,DM,and CVD are independent risk factors for depression in older patients with CKD;therefore,post-treatment psychological monitoring of high-risk patients is crucial to prevent depression.

Effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home: a network meta-analysis

Objective:Bayesian network meta-analysis was used to evaluate the effect of different nursing interventions on the incidence of peritonitis in peritoneal dialysis patients at home.Methods:Cochrane Library,PubMed,Embase,Web of Science,China Biology Medicine disc,CNKI and Wanfang data were searched to identify randomized controlled trials(RCTs)investigating the effects of different nursing interventions or health education on peritonitis in home peritoneal dialysis patients from the establishment of each database to March 2022.After literature screening,the Cochrane 5.1 evaluation tool was used to assess quality,Review Manager 5.4 software was used to generate a literature quality evaluation chart and R4.1.2 software,JAGS package,and GEMTC package were used for statistical analysis.Results:A total of 9 RCTs involving 8 different nursing interventions and a total of 1011 patients were included in the meta-analysis.The incidence of peritonitis for the eight nursing interventions,ranked from highest to lowest,were:systematic nursing,Omaha system case management intervention,routine care+health promotion mode,PD specialist nurse-led multi-disciplinary network platform management mode,5E rehabilitation nursing mode,routine care+Omaha extended nursing service,one-on-one coordinated family support intervention,and routine care.Conclusions:Systematic nursing was found to be the most effective intervention in reducing the incidence of peritonitis in peritoneal dialysis patients at home.However,this conclusion needs to be further verified by more high-quality,multicenter and large sample RCTs.

Analysis of the Short-Term Curative Effect of Roxadustat in Treating Renal Anemia in Patients with Peritoneal Dialysis

Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysis department of our hospital from March 2021-March 2023 were selected as research objects,divided into a research group and a reference group according to random number drawing method,with each group consisting of 35 cases.The patients in the research group were treated with roxadustat,and those in the reference group were treated with recombinant human erythropoietin.The total efficacy,anemia index,iron metabolism index,and occurrence of adverse reactions were compared between the two groups.Results:The total efficacy of the treatment received in the research group was significantly higher than that in the reference group(P<0.05).In terms of anemia indicators,there was no statistically significant difference between the hemoglobin(Hb),the red blood cell(RBC),and the hematocrit(HCT)of both groups(P>0.05)before treatment.After treatment,the anemia indicators of the patients in the research group were significantly better than those in the reference group,(P<0.05).In terms of iron metabolism,before treatment,there was no significant difference between the total iron-binding capacity(TIBC),the transferrin(TRF),the ferritin(FER),and iron(Fe)of both groups(P>0.05).After treatment,the research group’s iron metabolism indicators were significantly better than those of the reference group(P<0.05).The incidence of adverse reactions in the research group was significantly lower than that in the reference group(P<0.05).Conclusion:The short-term curative effect of roxadustat in the treatment of peritoneal dialysis patients was demonstrated through this study,making it a viable treatment option.

Bibliometric analysis of quality of life in peritoneal dialysis patients

Objective:Nowadays,the medical model is constantly changing,and the problem of how to improve the quality of life of peritoneal dialysis patients arises at a historic moment.This paper observes the publication and cooperation of research countries and institutions related to the quality of life of peritoneal dialysis patients,understands the research hotspots,explores the research trends,and provides a reference for further research by scholars.Methods:The search database was the Web of Science core collection,the search terms“peritoneal dialysis”and“quality of life”,the document type“Article or Review”,the language“English”and the period from 1985 to 2022.Results:A total of 1,597 literature were retrieved,and the number of documents showed an annual increase.The United States has the highest volume and centrality of publications and the most cooperation with other countries.The institution with the largest number of articles is the University of Toronto in Canada.The top three most highly cited documents were analyzed to derive the knowledge base of the research area.According to the analysis of keywords,there are high-frequency keywords such as“quality of life”and“peritoneal dialysis”and 11 keyword clusters.Understand the changing trends and frontiers in the research field through timeline maps and mutated words.Conclusion:The comparison of quality of life between peritoneal dialysis and haemodialysis and the study of factors influencing the quality of life is a hot research topic.With the gradual deepening of the research,it is suggested that future research should focus on the intervention research of influencing factors and clarify the intervention measures to improve patients’quality of life.

RESEARCH ON A REAL-TIME CONTROL SYSTEM OF LOW POWER DISSIPATION FOR CONTINUOUS CYCLIC PERITONEAL DIALYSIS(CCPD) CYCLER

A low power dissipation control system for continuous cyclic peritoneal dialysis (CCPD) cycler and its characteristics are reported. Combined withhemodialysis and renal transplantation, peritoneal dialysis is used mainly for thetreatment of renal failure. CCPD has been developed during 1980＇s. It provided automatic dialysis procedures during the night to avoid interruptions in patients＇dailyroutine. Furthermore,there is a remarkable decrease in peritonitis occurance usingCCPD. The control system is a critical part for CCPD cycler. The system is approvedto be reliable and flexible in practical experiments. When AC power failure,the system can still ensure the completion of dialysis.

THE RESEARCH OF FLOW CONTROLLED SYSTEM FOR CONTINUOUS CYCLIC PERITONEAL DIALYSIS (CCPD)

Peritoneal dialysis is widely used in clinical practices.The flow controlled sys-tem we have developed is completely under computer control.In order to be as simpleas possible,we use only one valve to control the three stages of peritoneal dialysis,that is the infusion,dwell,and drainage of dialysate.In clinical application the wholetime during which the pipeline is shut is about 8-10 hours for every treatment.In or-der to avoid the phenomenon that the pipeline can’t open after it was closed for

金水宝片对CAPD患者营养状态、肾性贫血及心理状况的影响

目的:研究金水宝片对持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者营养状态、肾性贫血及心理状况的影响。方法:本研究为前瞻性队列研究。选取2021年4月—2022年3月赣州市人民医院收治的100例CAPD患者作为研究对象,根据随机数字表法分为观察组(n=50)和对照组(n=50)。对照组采用CAPD治疗,观察组采用金水宝片联合CAPD治疗。治疗前后检测白蛋白(ALB)、血清总蛋白(STP)、血红蛋白(Hb)及红细胞计数(RBC)水平,观察两组上述指标的变化。同时于治疗前后采用焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)分别对两组患者的心理状况进行调查分析。结果:与对照组比较,观察组治疗后ALB、STP、Hb及RBC水平均明显高于对照组,差异均有统计学意义(P<0.05)。治疗前,两组SAS与SDS评分比较,差异均无统计学意义(P>0.05);治疗后,观察组SAS与SDS评分均低于对照组,差异均有统计学意义(P<0.05)。结论:金水宝片在CAPD患者中的应用效果显著,能有效改善患者的营养状态、肾性贫血及焦虑抑郁状况。

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.

Peritoneal dialysis for chronic cardiorenal syndrome:Lessons learned from ultrafiltration trials

The current models of cardiorenal syndrome(CRS) are mainly based on a cardiocentric approach; they assume that worsening renal function is an adverse consequence of the decline in cardiac function rather than a separate and independent pathologic phenomenon. If this assumption were true,then mechanical extraction of fluid(i.e.,ultrafiltration therapy) would be expected to portend positive impact on renal hemodynamics and function through improvement in cardio-circulatory physiology and reduction in neurohormonal activation. However,currently available ultrafiltration trials,whether in acute heart failure(AHF) or in CRS,have so far failed to show any improvement in renal function; they have reported no impact or even observed adverse renal outcomes in this setting. Moreover,the presence or absence of renal dysfunction seems to affect the overall safety and efficacy of ultrafiltration therapy in AHF. This manuscript briefly reviews cardiorenal physiology in AHF and concludes that therapeutic options for CRS should not only target cardio-circulatory status of the patients,but they need to also have the ability of addressing the adverse homeostatic consequences of the associated decline in renal function. Peritoneal dialysis(PD) can be such an option for the chronic cases of CRS as it has been shown to provide efficient intracorporeal ultrafiltration and sodium extraction in volume overloaded patients while concurrently correcting the metabolic consequences of diminished renal function. Currently available trials on PD in heart failure have shown the safety and efficacy of this therapeutic modality for patients with chronic CRS and suggest that it could represent a pathophysiologically and conceptually relevant option in this setting.