| Background: The number of patients with chronic kidney disease(CKD)in the world is increasing year by year,with a high prevalence rate and low awareness rate.It is often found that it has developed to end-stage renal disease(ESRD)and needs renal replacement therapy.At present,there are three commonly used renal replacement therapy: renal transplantation,hemodialysis,peritoneal dialysis(PD).Because peritoneal dialysis has the advantages of stable hemodynamics,more favorable for the protection of residual renal function,high social return rate of patients,and higher cost-effectiveness of medical care,the policy of "PD priority" is gradually carried out all over the world.Peritoneal dialysis-associated peritonitis(PDAP)is not only the most common complication of PD,but also the main cause of technical failure and withdrawal from PD in PD patients.However,the loss of peritoneal dialysate protein has been rarely studied and concerned.The purpose of this study was to explore the effect of protein level of peritoneal dialysate on peritoneal dialysis-related peritonitis and its predictive value.Cardiovascular events are the leading cause of death in peritoneal dialysis patients,accounting for 41.5% to 57.0% of the deaths in peritoneal dialysis patients.The purpose of this study is to observe the effect of peritoneal dialysis protein loss on cardiovascular events.Objective: To explore the effect of peritoneal dialysate protein level on peritoneal dialysis-related peritonitis and its predictive value,and to explore the effect of peritoneal dialysate protein level on cardiovascular events.Methods: The patients who regularly received continuous ambulatory peritoneal dialysis(CAPD)in our dialysis center from January 2021 to February 2023 were selected to record the medical history,demography and other information.The results of laboratory tests such as liver and kidney function,electrolytes and inflammation were recorded.The total amount and concentration of protein in the daily total peritoneal dialysate(that is,24-hour peritoneal dialysate protein)were observed and recorded.Prospective follow-up observation,the main end point: the occurrence of peritonitis.Secondary end point: cardiovascular events occurred.According to the occurrence of peritonitis at the main end point,the patients were divided into two groups: peritonitis group and non-peritonitis group.According to the median of 24-hour quantitative loss of peritoneal dialysate protein,the patients were divided into two groups: low loss group and high loss group.The general clinical data of patients with peritonitis and non-peritonitis were compared to screen the indicators with statistical differences that might affect the end events(focusing on the quantity of 24-hour peritoneal dialysate protein).COX multivariate regression analysis was used to determine whether the screening index was an independent risk factor for the end event.Kaplan-Meier survival curve was used to analyze the survival rate of independent risk factors under different exposure levels(low loss group,high loss group,etc.)to explore the impact of risk factors on end-point events.ROC curve was used to analyze the predictive value of risk factors to end events.Results:(1)67 CAPD patients were eventually included in the regular follow-up of our dialysis center,including 33 males(49%)and 34 females(51%).The follow-up date was as of February 28,2023,with a follow-up period of 1-20 months and an average follow-up time of 13.9 ± 0.21 months.There were 20 events of peritonitis for the primary endpoint and 18 events of cardiovascular origin for the secondary endpoint.(2)The median protein loss in peritoneal dialysate was 5.24 g,and the quartile interval was 0.93 g.COX multivariate analysis model showed that serum calcium level(Wald=5.591,P=0.015)and 24-hour peritoneal dialysate protein quantity(Wald=13.373,P < 0.01)were risk factors for peritonitis in PD patients,while 24-hour peritoneal dialysate protein quantification was not a risk factor for cardiovascular events(Wald=2.068,P=0.150 > 0.05).(3)The results of Kaplan-Meier survival curve showed that with peritonitis as the end point,there was significant difference in cumulative survival rate between low loss group and high loss group,and the risk of peritonitis was higher in high loss group than in low loss group(P < 0.05).There was a significant difference in cumulative survival rate between hypocalcemia group and hypercalcemia group,and the risk of peritonitis was higher in hypocalcemia group.The results of Kaplan-Meier survival curve showed that with cardiovascular events as the end point,there was a significant difference in cumulative survival rate between the low loss group and the high loss group,and the high loss group had a higher risk of cardiovascular events.(4)ROC curve showed that the area under the curve of 24-hour peritoneal dialysate protein quantitative prediction of peritonitis was 0.838,and the best cutoff point was 24-hour peritoneal dialysate protein quantitative = 5.61g/24h(sensitivity 80%,specificity 93.6%).The area under the curve of serum calcium to predict the occurrence of peritonitis was 0.290.Conclusion:(1)Protein loss in transperitoneal dialysate is a significant independent risk factor for the occurrence of PDAP.Patients with more protein loss in transperitoneal dialysate have a higher risk of peritonitis.(2)24-hour dialysate protein quantification can predict the occurrence of PDAP,and the best predictive value of 24-hour peritoneal dialysate protein quantification is 5.61g/24 h.(3)The level of serum calcium may be an independent risk factor for the occurrence of PDAP.The lower level of serum calcium may have a higher risk of PDAP.(4)The patients with more protein loss in transperitoneal dialysate had a higher risk of cardiovascular events. |
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