| Background and objectives:Compared with hemodialysis,peritoneal dialysis(PD)as one of the most important renal replacement methods for end-stage renal disease(ESRD)has the advantages of better protection of residual kidney function(RRF)and better quality of life.Due to the long-term exposure of the peritoneum to the environment of high glucose and dialysate with high osmotic pressure,as well as the peritonitis,which cannot avoid the incidence of chronic progressive damage.The peritoneal damage leading to the Ultrafiltration failure(UFF)is an important reason for the patients withdraw the PD treatment.According to the literatures,the technical failure rate of PD is around12.7%-26.2% with one year PD treatment.There are 21% patients will have ultrafiltration failure with more than two year PD treatment.Peritoneal biopsy is the diagnosis of peritoneal damage.The major features of peritoneal damage are the deficiency of the extensive mesothelium accompanied by the thickening of the subcutaneous tissue,and the angiogenesis.It is difficult to extensive carry out the surgery and dynamic observation.There is lagging of Peritoneal equilibration test(PET)as a peritoneal functional index to indirectly reflect peritoneal damage.The peritoneal damage related biomarkers include cancer antigen-125(CA-125),transforming growth factor-β(TGF-β),and Interleukin-6(IL-6).The sensitivity and specificity of these biomarkers are uncertain and still need more studies.Previous studies have investigated the relationship between peritoneal morphology and functional parameters by using the ultrasound to evaluate the peritoneal thickness of PD patients.The advantage of ultrasound examination is non-invasive and good repeatability.The limitation of ultrasound examination is no omentum included as an indicator of the peritoneal damage analysis.Based on the anatomical structure,the omentum has a visceral peritoneal covering,which is even larger proportion of the entireperitoneum.Thus,the ultrasound examination cannot reflect the damage of the entire peritoneum.The clinical application of MRI is limited,because the examination is time-consuming and susceptible to metal substances.Therefore,there is no objective method at moment providing early,non-invasive,comprehensive dynamic observation of peritoneal damage and prognosis.Normal peritoneum is generally invisible or faintly visible on Computed tomography(CT).With the prolongation of dialysis time and the influence of peritonitis,CT scan found some patients have peritoneal thickening,omental structure change,etc.However,the underlying regularity of change still unknown at moment.Previous studies have used abdominal CT to analyze the imaging features of abdominal cavity in patients with Encapsulating peritoneal sclerosis(EPS).There is no report of the application of CT to evaluate the early peritonea damage.Thus,we aim to investigate the regularity of change and influencing factors of CT peritoneal imaging features in PD patients to explore a method for early diagnosis of peritoneal damage with non-invasive and dynamic monitoring.This method is expected to provide powerful gist for early intervention,reducing the withdrawal of PD treatment due to ultrafiltration failure and prolong the survival of patients,which have vital clinical significance.Methods:A 173 total routinely follow-up patients in our center on continuous ambulatory peritoneal dialysis(CAPD)are evaluated by the abdominal CT scans.Inclusion criteria:(1).Diagnosed as chronic renal failure with regular peritoneal dialysis more than six month;(2).Age between 18 to 80 years old,and without requirement of gender;(3).Agree to participate in this study.Exclusion criteria:(1).Patients with acute kidney injury and urgent start peritoneal dialysis;(2).Patients with abdominal adhesions due to abdominal tumors,abdominal surgery and trauma;(3).Peritoneal dialysis solution did not entirely empty before abdominal CT scan patients,which will affect the assessment;(4).Patients with incomplete clinical data.All patients need to sign the informed consent before participating in this study.This study has been reviewed and approved by the Centre’s Ethics Committee.A total of 109 patients were enrolled for analysis according to the inclusion criteria.Collectthe information of patients including gender,age,dialysis age,height,weight,primary disease,urine volume,and peritoneal ultrafiltration.Peritonitis indexes include the peritonitis occurrences,inflammatory indexes of each peritonitis(Routine blood tests:WBC,PCT,etc.),Ascitic fluid analysis WBC count,pathogens culture results,interval between the onset of peritonitis to formal treatment,the interval between the beginning of formal treatment to normal ascitic fluid,and treatment outcomes.The peritoneal injury severity of 109 patients who meet the criteria were evaluated by the semi-quantitative scoring system,including the thickness of the parietal peritoneum,the structure change of omentum,the calcification of parietal peritoneum and omentum,abdominal compartment and encapsulated effusion,bowel dilatation and intestinal obstruction,and the correlation between CT imaging evaluation index and age,dialysis age,primary disease,type of peritoneal transport,glucose exposure,and the incidence of peritonitis were analyzed.Logistic regress was used to analyze the influence factors of peritoneal thickening and abnormal omental structure,and the relationship between the incidence of peritonitis,the cumulative score of peritonitis and the risk incidence of peritoneal thickening and abnormal omental structure.Results:There are 70 patients with parietal peritoneum thickness(64.22%),63 patients with abnormal omental structure(57.8%),4 patients with the calcification of parietal peritoneum and omentum(3.67%),11 patients with abdominal compartment and encapsulated effusion(10.09%),24 patients with bowel dilatation and intestinal obstruction(22.02%).According to the analysis of dialysis age,the proportion of peritoneal thickening and abnormal omental structure in patients with dialysis age > 5 years was significantly higher than that in patients with dialysis age < 1 year(p<0.05).The proportion of peritoneal thickening and abnormal omental structure in patients with peritonitis more than once was significantly higher than that in patients without peritonitis(p<0.05).The proportion of abnormal omental structure in patients with total glucose exposure > 165 kg was significantly higher than that in patients with total glucose exposure <60 kg(p<0.05).The proportion of abnormal omental structure in patients with high-average peritoneal transport was significantly higher than that in patients with low-average peritoneal transport(p<0.05).The univariate logistic regression analysis showed: the occurrence and the cumulative score of peritonitis are the risk factors for peritoneal thickening.The risk factors of abnormal omental structure including the dialysis age,the peritonitis occurrences,the cumulative score of peritonitis,the total glucose exposure,and the high-average peritoneal transport.Multivariate regression analysis revealed: the independent risk factors of peritoneal thickening and abnormal omental structure are the occurrence and the cumulative score of peritonitis.The risk prediction model suggested: the incidence risk of peritoneal thickening and abnormal omental structure will increase 4.364(95%CI 1.886 ~ 10.098)and 5.393(95%CI 2.204~13.197)times separately with the occurrence of peritonitis,the incidence risk of peritoneal thickening and abnormal omental structure will increase 2.191(1.536 ~3.124)and 2.072(1.498~2.866)times separately with the cumulative score of peritonitis increased by 1 point.Conclusions:The main imaging features of peritoneal dialysis patients with progressive peritoneal injury are thickness of the parietal peritoneum and the structure change of omentum.The major risk factor of progressive peritoneal injury is peritonitis.The abdominal CT scan can comprehensively investigate the characteristics and extent of peritoneal dialysis and injury,which is benefit for the early diagnosis of peritoneal injury.Background and objectives:Chronic Kidney Disease-Mineral and Bone Disorder(CKD-MBD)is a common complication of patients with uremia under dialysis treatment.Plenty of studies showed that blood biochemical profiles,especially serum calcium,phosphorus,and parathyroid hormone(PTH),are strongly correlated with the survival prognosis of dialysis patients.Severe vascular calcification often leads to fatal cardiovascular events.This study retrospectively analysed the serum calcium,phosphorus,intact parathyroid hormone(IPTH),and vascular calcification of patients with long-term continuous ambulatory peritoneal dialysis(CAPD),which aim to investigate the effect of different calcium concentration peritoneal dialysate on mineral and bone metabolism in patients with long-term CAPD.Methods:A retrospective analysis of our hospital peritoneal dialysis CAPD treatment for more than two years of 123 cases of patients with low calcium peritoneal dialysis group(LCD,calcium ion concentration 1.25 mmol / L)and standard calcium peritoneal dialysate group(SCD,calcium ion concentration 1.75 mmol / L)were observed in different calcium concentrations of peritoneal dialysis fluid on serum calcium,phosphorus and intact parathyroid hormone(i PTH),bone pain,pruritus,thickness of the carotid arteries and heart valve calcification situation influence according to the dialysate calcium concentration.Results:There were no differences in baseline level of demographic characteristics,peritoneal transport characteristics and calcium phosphorus metabolism between the two groups(p>0.05).Treatment after 2 years,serum calcium concentration and compliance rate of two groups compared with those before treatment weresignificantly increased(p<0.05);after treatment,the serum calcium,phosphorus and the average level of i PTH and compliance rate,carotid artery thickness,cardiac valve calcification proportion,bone pain,and skin itching cumulative incidence rate of the two groups showed no significant difference(p>0.05),and active vitamin D proportion in LCD group was significantly higher than that in the SCD group(P < 0.05).Conclusion:There were no significant differences in mineral and bone metabolism between low calcium peritoneal dialysis and standard calcium peritoneal dialysis for 2 years. |
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