Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 （57.6±13.2） years. They were put on dialysis 3-98 （25.2±30.6） months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure，two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was （125.8±33.5）minutes, aortic clamp time was（77.2±25.5） minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.
ObjectiveTo investigate the influence of evidence-based nursing intervention on the treatment effect and quality of life in patients with peritoneal dialysis. MethodSixty-four patients who underwent peritoneal dialysis between January 2013 and December 2014 in our hospital were randomly divided into control group (n=32) and intervention group (n=32) . The control group received routine nursing and the intervention group received evidencebased nursing intervention. Urea clearance index (KT/V), serum albumin and hemoglobin levels were detected for both groups of patients before and after nursing intervention. Generic Quality of Life Inventory (GQOLI)-74 scale was used to assess patients' quality of life. ResultsAfter nursing intervention, KT/V, serum albumin and hemoglobin levels in the intervention group were significantly higher than those in the control group (P<0.05) . The scores of such items as physical function, psychological function, social function and overall evaluation in the GQOLI-74 scale in the intervention group were significantly higher than those in the control group (P<0.05) . ConclusionsEvidence-based nursing intervention can effectively improve the treatment effect and quality of life in patients with peritoneal dialysis, which is worthy of clinical popularization and application.
ObjectiveTo explore the practice effect of the combination management of tertiary hospital and community hospital for home peritoneal dialysis patients. MethodsA total of 50 patients of end-stage renal disease from December 2012 to May 2013 were involved in this study, including 26 males, and 24 females with the average age of 47.1±13.9. The patients were randomly divided into hospital group (30 patients) and combination group (20 patients). For the patients in the hospital group, the specialists take care of them with regular outpatient service and follow-up; for the patients in the combination group, they were taken care by doctors from both tertiary hospital and community hospital, while the community general practitioners were trained by the tertiary hospital regularly with peritoneal dialysis basic treatment and standardization management and communication. All the patients were managed for 9 months. ResultsAt the end of the observation,the dialysis adequacy success rate, hemoglobin, blood potassium, phosphorus, calcium, albumin, CO2CP, blood pressure success rate, the incidence of peritonitis, and average monthly medical treatment expense between the two groups were not statistically different (P>0.05); the difference in cost of transportation was statistically significant (P<0.05). ConclusionThe standardization manage of combination of tertiary hospital and community for patients with home peritoneal dialysis may reduces the patients' expense in transportation, and improve the community general practitioners' level of basic knowledge and indication of peritoneal dialysis.
ObjectiveTo investigate the prevalence of gallbladder stone in dialysis patients, determine whether it is higher than that in the general population, find out the difference of prevalence between hemodialysis and peritoneal dialysis patients, and analyzes the possible causes. MethodsWe analyzed the prevalence of gallbladder stone in 358 dialysis patients (126 cases of hemodialysis and 232 cases of peritoneal dialysis) followed up in our hospital from January 2009 to October 2012. And we compared it with 376 patients diagnosed with chronic kidney disease stage 5 (CKD5) and the general population. ResultsThe prevalence of gallbladder stone in dialysis patients followed up in our hospital was 23.5%, which was higher than CKD5 patients (P=0.002). The prevalence was significantly greater in dialysis patients than that in the general population (P<0.000 5). In the dialysis patients who were younger than sixty years old, the prevalence of gallbladder stone in peritoneal dialysis patients was obviously higher than that in the hemodialysis patients (P<0.05). The albumin level was significantly lower in peritoneal dialysis patients than in the hemodialysis patients. At the same time, cholesterol, low density lipoprotein, and the ratio of low density lipoprotein to high density lipoprotein were much higher with statistical significance. Logistic regression analysis showed that increasing age (OR=2.581, P=0.001), female (OR=2.554, P=0.000), the primary disease (diabetes mellitus) (OR=1.947, P=0.044) and dialysis period (OR=1.000, P=0.006) were risk factors for gallbladder stone in dialysis patients. ConclusionThe prevalence of gallbladder stone in dialysis patients is higher than that in the general population. Peritoneal dialysis patients have more risk factors to get gallbladder stone than hemodialysis patients. Risk factors for gallbladder stone in dialysis patients are increasing age, female, primary disease (diabetes mellitus), dyslipidemia, hypoalbuminemia, long dialysis period and so on.
ObjectiveTo observe the changes of blood flow density and perfusion density in the macula of non-diabetic peritoneal dialysis (PD) patients, and their correlation with blood pressure, total protein, albumin, prealbumin, serum creatinine, urea, and high-sensitivity C-reactive protein were preliminarily analyzed.MethodsA single-center, cross-sectional, clinical observational study. From January to December 2018, 63 eyes of 63 non-diabetic patients (non-diabetic PD group) and 75 eyes of normal healthy people (the normal control group) who underwent PD treatment at the PD Center of Peking University First Hospital were included in the study. All were monocular into the group. Among the 63 patients in the non-diabetic PD group, 24 were males and 39 were females. The duration of PD was 7 to 185 months, with the average duration of 67.87±48.36 months. There were 75 healthy persons in the normal control group. There was no significant difference in age (t=－0.558), sex ratio (χ2=0.492), axial length (t=－1.197), and BCVA between the two groups (P＞0.05). OCT angiography was used to scan the macular area of 3 mm×3 mm and 6 mm×6 mm in the subject’s right eye. The blood flow density and perfusion density of superficial retinal capillaries in the macular area, as well as the area, circumference, and morphological index of the foveal avascular zone (FAZ) were measured. The blood flow density and perfusion density at different locations in the macular area of the two groups of eyes were compared by independent sample t test. The blood pressure, total protein, albumin, prealbumin, serum creatinine, urea, and high-sensitivity C-reactive protein was performed by Pearson correlation analysis.ResultsCompared with the healthy control group, the blood flow density and perfusion density of superficial retinal capillaries in the macular area of the non-diabetic PD group decreased in different scanning ranges with the macular vessel 3×3 center (t=－2.409), the macular vessel 3×3 macular (t=－2.423), macular vessel 3×3 intact (t=－2.759), macular vessel 6×6 intact (t=－1.882), macular vessel 6×6 outer layer (t=－2.188), macular perfusion 3×3 center (t=－1.990), macular perfusion 3×3 complete (t=－2.719), macular perfusion 6×6 complete (t=－2.113), and macular perfusion 6×6 outer layer (t=－2.205). The difference was statistically significant (P＜0.05). The comparison of the macular FAZ area of the two groups of eyes was statistically significant (t=1.985, P＜0.05). Correlation analysis showed that 3×3 macular blood vessels were intact and mean arterial pressure was positively correlated (r=0.256, P=0.043). The macular blood vessels were 3×3 intact, macular perfusion was 3×3 intact, and macular blood was 6×6 intact, which the pre-white protein was positively correlated with (r=0.468, 0.362, 0.333; P＜0.001, P=0.004, 0.008). The macular vessel 3×3 was intact, the macular perfusion 6×6 was intact, which the hypersensitive C-reactive protein was negatively correlated with (r=－0.370, －0.287, P=0.005, 0.030).ConclusionThe superficial retinal blood flow density and perfusion density in the macular area of non-diabetic PD patients are lower than those of normal healthy people.
ObjectiveTo systematically review the pharmacoeconomics of hemodialysis and peritoneal dialysis in patients with end-stage renal disease. MethodsCRD, NICE, CADTH, HITAP, NECA, IWIQG, ISPOR, PubMed, EMbase, CNKI, and WanFang Data databases were electronically searched to collect pharmacoeconomic studies on the hemodialysis and peritoneal dialysis in the treatment of end-stage renal disease from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, the conclusions of research models, pharmacoeconomic evaluation results, and sensitivity analysis were summarized. ResultsA total of 15 pharmacoeconomic studies were included, among which 9 studies used the Markov state transition model, and 6 were observational studies. From the perspective of health outcomes, peritoneal dialysis had cost-effectiveness advantages over hemodialysis in the treatment of end-stage renal disease under the condition of a clear threshold. ConclusionsCurrent evidence shows that compared with hemodialysis, peritoneal dialysis has certain cost-effectiveness advantages in the treatment of end-stage renal disease. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo compare the incidences of peritoneal dialysis (PD)-associated peritonitis among HIV and non-HIV patients, and to analyze the risk factors of PD-associated peritonitis. MethodsEnd-stage renal disease patients with HIV infection who newly started PD in West China Hospital of Sichuan University from 2012 to 2020 were retrospectively included, and non-HIV PD patients in the same period were included as controls at a ratio of 1 to 4. The risk factors of PD-associated peritonitis were analyzed by univariate analysis and multivariate logistic analysis. Kaplan-Meier survival analysis and COX regression analysis were used to compare the peritonitis-free survival between HIV group and non-HIV group. ResultsA total of 60 PD patients were included. The average follow-up time was 31.2±21.3 months. Peritonitis occurred in 7 HIV patients (58.33%) and 8 non-HIV patients (16.67%). Logistic regression analysis showed that HIV infection (P=0.018) and high platelet (>150×109/L) (P=0.032) were independent risk factors for PD-associated peritonitis. The incidence of PD-associated peritonitis in HIV patients significantly increased (HR=10.944, 95%CI 1.503 to 79.707). Kaplan-Meier survival analysis showed that the 5-year peritonitis-free survival of non-HIV group was significantly higher than that of HIV group (75.7% vs. 31.1%) (P=0.003). Multivariate COX survival analysis showed that the 5-year accumulative risk of peritonitis in HIV PD patients was 5.896 times (95%CI 1.508 to 23.043, P=0.01) higher than that of the non-HIV PD patients. ConclusionHIV infection is an independent risk factor for PD-associated peritonitis.
Objective To assess the possible causes of acute pancreatitis (AP) in long term peritoneal dialysis (PD) and hemodialysis (HD) patients, and to discuss the diagnosis and treatment of AP in this kind of patients. Methods The clinical data of 9 cases of AP in PD and HD patients who were admitted in the hospital during January 1993 and January 2000 were analysed retrospectively. Results The serum levels of amylase of all the 9 cases were over three and a half times of upper limit value of healthy subjects. B mode ultrasound and CT scan examinations were useful for diagnosis of AP. Eight patients recovered very well with conservative treatment, while one patient who was diagnosed as acute severe pancreatitis and complicated with shock died. Conclusion Long term PD and HD patients are predisposing to develop AP. Diagnosis of AP in these patients primarily depends on the detection of serum amylase. Dialysis treatment is indispensable for cure of AP.
Objective To investigate the change of pathogenic distribution and drug resistance in peritoneal dialysis associated peritonitis (PDAP). Methods The clinical data of all the patients undergoing continuous ambulatory peritoneal dialysis and suffered from PDAP between January and December in 2014 was retrospectively collected, and the pathogens, drug resistance, outcomes and underlying causes were analyzed. Results A total of 64 patients had 72 cases of PDAP. Only 36 strains (50.0%) had positive culture results, among which 24 strains (66.7%) were Gram-positive bacteria strains, 7 strains (19.4%) were Gram-negative bacteria strains, and 5 strains (13.9%) were fungi. For Gram-positive bacteria strains, the resistance rates to vancomycin, linezolid and rifampicin were all 0%; the resistance rate to levofloxacin, gentamycin and cefazolin was 14.3%, 26.3% and 50.0%, respectively. For Gram-negative bacteria strains, the resistance rates to amikacin and imipenem were both 0%; the resistant rate to gentamycin, ceftazidime, levofloxacin and ampicillin was 28.6%, 28.6%, 42.9% and 100.0%, respectively. Conclusions The pathogenic spectrum and drug resistance in PDAP have been markedly changed. Selection of antibiotics should be chosen according to the characteristic of the pathogenic spectrum and drug resistance of each center. Great effort is still needed to improve the culture positive rate of the effluent dialysate and to improve the recovery rate of peritonitis.
ObjectivesTo systematically review the influence for catheter mechanical dysfunction of different peritoneal dialysis catheterization methods.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials (RCTs) and cohort studies on comparisons of different peritoneal dialysis catheterization from inception to March 31st, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed by using ADDIS 1.16.6 software.ResultsA total of 33 studies (9 RCTs and 24 cohort studies) involving 3 301 patients were included. Network meta-analysis showed that the incidence of catheter mechanical dysfunctionwas the least and had statistically significant difference compared with that in percutaneous catheterization (OR=3.60; 95%CI, 1.64 and 15.38) and open surgery catheterization (OR=5.86; 95%CI, 2.68 and 14.53). Percutaneous catheterization was superior to open surgery catheterization, but there was no significant difference.ConclusionsLaparoscopic catheterization may be the best technique for catheter insertion in peritoneal dialysis considering catheter dysfunction. Each technology has its own advantages. Choice of insertion method should be based on the characteristics of both the patient and the insertion techniques.