| BackgroundVarious kinds of chronic kidney diseases(CKD)may eventually progress to end-stage renal disease(ESRD)and the patients may develop serious uremia poisoning symptoms,which brings serious threats to people's health.The etiology of ESRD is various and complex and ESRD often comes with serious complications needing relative inexperienced treatment.Since the 1950s,dialysis therapy has been applied in clinic and the lives of many ESRD patients have been saved,but there is still difficulties for medical professions to have a choice between hemodialysis(HD)or peritoneal dialysis(PD)at home and abroad due to the complex situation of patient and medical care system.Given the restriction of kidney donor,peritoneal dialysis and hemodialysis have been the major modes of renal replacement therapy(RRT).PD is gradually more and more acceptable for ESRD patients,based on its advantages of simple equipments,strong autonomy,hemodynamic stability and residual renal function protection,high early-stage survival rate,lower cost and lower cross infection risk.PD is widely used all over the world and has become the main RRT method in developed regions or countries like Hong Kong and Singapore over the past 30 years.At the same time,the concept that PD is good for the protection of residual renal function and the removal for middle molecules got common understanding.The number of PD patients continuously increased.Currently patients on CAPD and APD have accounted for about 15%of dialysis patients around the world.The proportion of PD patients accounted of all dialysis patients is 95%in Mexico,78%in Hong Kong,30%~45%in North America,25%~40%in Europe,and about 10%in mainland China.Many countries and regions have established a dialysis registration system,the annual report of registration system has become the most cited literature by literatures.The registration of dialysis in China began in 1999.Until 2006,it has greatly developed in Shanghai,Beijing,Guangzhou,Zhejiang and other major central cities.Annual increase rate of 20%for PD patients in our country is far more than the world average rate of 7%.But due to the influence of the economic and cultural background and the education level,compared with other developed countries and regions,uneven allocation of resources between different areas still exist in our country,and the registration system is not perfect,although the Chinese Society of Nephrology established the first national kidney disease data system in 2010,and collected 270000 patients with kidney disease information.So far there is no accurate statistical data and the single PD center data published is very small.Based on the above background and the big differences between the PD centers,this article studied ESRD patients taking PD therapy in our center during the 7 years from May 1,2008 to November 30,2014.In order to better promote the standardization of the peritoneal dialysis technology and provide basis for continuous quality improvement,the epidemiological characteristics and prognosis of patients with peritoneal dialysis and related risk factors are carefully analyzed in details.The aim of the study is to realize current status of PD and to improve the treatment efficacy and management of PD in our hospital via the comparison of the data of the PD centers with others in developed countries and regions.Objectives:1.Taking peritoneal dialysis patient information as subject investigated,to analysize the epidemiologic feature and variation trend of the peritoneal dialysis patients and compare the data with that in developed countries and regions.2.Taking patients received peritoneal dialysis for over 2 years,to analyze the blood phosphorus levels in thoroughly,in patients with different sex,age,clinical characteristics and residual urine volumes before and after PD therapy,and other biochemical indicators,and explore the factors associated with elevated blood phosphorus.3.Taking patients received peritoneal dialysis for over 1 year,to analyze the hs-CRP levels in PD patients with different residual urine volume,nutritional status,clinical characteristics and other biochemical indicators,and explore the factors associated with elevated blood hs-CRP level.4.Taking patients received peritoneal dialysis for over 1 year,to analyze the cardiovascular adverse events occurred,and to investigate the risk factors of cardiovascular adverse events in peritoneal dialysis patients.Methods:1.A retrospective and prognostic analysis of the seven-year data of peritoneal dialysis patients in a single centerFrom January 1,2008 to November 30,2014,124 cases of PD patients with end-stage renal disease(ESRD)received CAPD treatment in our center for 6 years.Retrospectively collected patient information including name,gender,the age beginning PD treatment,the category of payment of medical expenses,primary disease causing ESRD,dialysis complications,exiting PD treatment,input them into the Microsoft Excel for data processing,and compared the data of peritoneal dialysis center with the data in developed countries or regions.2.Study of the serum levels of serum phosphorus and the factors affecting of its serum level in continuous ambulatory peritoneal dialysis patients.Patients recruited from The First Affiliated Hospital of Mongolia Medical University received CAPD from January 1,2008 to November 30,2014 for longer than 3 months.The data collected include the etiology of ESRD,sex,age,pre-and post-treatment blood Hb,SCr,BUN,ALB,ALP,Ca,P,iPTH of all patients.The fasting serum P levels of all the patients were measured.The level of serum P was compared between patients of different sex,age,residual urine volume,peritoneal transportation function,dialysis adequacy.All biochemical indicators were compared between the high P group and the low P group.Simple correlation analysis and stepwise regression analysis were used to explore the factor affecting the level of serum P.3.Investigation of nutrition and inflammation status in peritoneal dialysis patients.Patients recruited from First Affiliated Hospital of Mongolia Medical University received CAPD treatment from January 1,2008 to November 30,2014 for longer than 3 months.The data collected include etiology of ESRD,sex,age,pre-and post-treatment blood Hb,SCr,BUN,Alb,ALP,Ca,P,iPTH,hs-CRP levels.The fasting serum P levels of all the patients were measured.The level of P was compared between patients of different sex,age,residual urine volume,peritoneal transportation function,dialysis adequacy.Pre-and post-tratment biochemical indicators were compared between the high hs-CRP group and the low hs-CRP group.Simple correlation analysis and stepwise regression analysis were used to explore the factor affecting the level of hs-CRP.4.Analysis of the risk factors of cardiovascular adverse events in peritoneal dialysis patientsRandomly selected 113 cases of ESRD patients who accepted peritoneal dialysis in our hospital for over 1 year.The patients were divided into two groups according to with or without cardiovascular adverse events since 5 months ago.The cardiovascular adverse events include acute myocardial infarction,unstable angina,non-fatal heart failure.Data collected include age,gender,primary disease,dialysis period,dry weight,pre-and post-treatment systolic blood pressure,blood hemoglobin,total protein,triglyceride,cholesterol,low density lipoprotein,high density lipoprotein,blood urea nitrogen,serum creatinine and other biochemical indexes.The relationship of microinflanimation state and calcium phosphate metabolic disorder were analyzed in patients with different biochemical indexes.Results:1.Retrospective and prognostic analysis of the seven-year data of peritoneal dialysis patients in the single center1.1 The average age was 56.62± 13.02 years old.Male to female ratio was 1.1:1.The primary diseases were primary glomerulonephritis,hypertensive kidney damage,diabetic nehropathy.1.2 In 2010,18 new patients entered peritoneal dialysis.Until December 31,2010,there were 78 cases of maintenance peritoneal dialysis patients registered.In 201119 new patients entered peritoneal dialysis,with an 24%increase from the previous year.By December 31,2012,there were 105 cases of maintenance peritoneal dialysis patients registered.In 2013,18 new patients entered peritoneal dialysis,with a 14.6%increase from the previous year.By July 13,2014,there were 124 cases of maintenance peritoneal dialysis patients registered.1.3 In accordance with the age stratification,patients receiving peritoneal dialysis during 2008~2014 was mainly 51 to 60 years old,with the highest percentage of 32.2%of the total number of peritoneal dialysis patients.Followed by patients older than 60 years,with the percentage of 25.9%of the total number of peritoneal dialysis patients.1.4 During 2008~2014,the age of the patients starting peritoneal dialysis treatment in our center was 56.62 ± 13.02,the average period of dialysis was 34.96 ± 19.22 months.The patients with dialysis period of 1~2 years had the highest percentage of 26.6%of all the maintenance peritoneal dialysis patients.1.5 The percentage of PD patients with a blood hemoglobin level?100 g/L increased year by year.The percentage of PD patients with a plasma albumin level?35g/L decreased year by year.The ratio of PD patients reaching the standard of dialysis adequacy(Kt/V?1.7 per week,total Ccr?50L/1.73 W/m2)basically remained stable.2.Study of the serum level of P and the factors affecting its serum level in continuous ambulatory peritoneal dialysis patients.2.1 The ratio reaching the standard of blood Ca in patients before or after 1 or 2 years of CAPD treatment was respectively 41.1%,54.9%,60.0%.The ratio reaching the standard of serum P in patients before or after 1 or 2 years of CAPD treatment was respectively 37.1%,50.4%,57.5%.The ratio reaching the standard of serum iPTH in patients before or after 1 or 2 years of CAPD treatment was respectively 23.4%,31.9%,48.8%.2.2 The serum phosphorus levels of the patients with either 1 or 2 years of CAPD treatment decreased when compared to pre-treatment levels,with statistically significant difference(P<0.05).2.3 There was no statistical significance between the serum level of either Ca,P,or iPTH of CAPD patients respectively with different gender,age,residual urine volume and dialysis adequacy(P>0.05).2.4 Given the treatment target of serum phosphorus as<1.78mmol/L.the PD patients were divided into normal phosphorus group and hyper-phosphorus group.There was statistical difference between the blood levels of the two groups for either Hb,Scr,UA,BUN,HDL,LDL,or TG(P<0.05).2.5 Putting serum P as the dependent variable,while blood Hb,Ca,iPTH,ALB,BUN,SCr,TC,TG,UA as independent variables,it is shown by correlation analysis that the level of serum P is negatively correlated to the level of either blood Hb(r = 0.359,P<0.05)or HDL(r = 0.296,P<0.05),while positively correlated to the level of BUN,SCr,UA,LDL and TC respectively(r = 0.453,0.530,0.453,0.242 and 0.333,P<0.05 respectively).3.Correlation analysis of the hs-CRP levels with residual urine volume and nutrition status in the single PD center3.1 Based on residual urine volume,the PD patients were divided into oliguria group(residual urine volume<400 ml)and non-oliguria group.There was no statistical difference between the hs-CRP levels of the two groups(P<0.05).3.2 Given the standard of dialysis adequacy as Kt/V>1.7,the PD patients were divided into adequate dialysis group and inadequate dialysis group,there was no statistical difference between the hs-CRP levels of the two groups(P>0.05)3.3 Based on the nutritional status evaluated with SGA scores,the PD patients were divided into good nutrition group and malnutrition group,there was significant difference between the hs-CRP levels of the two groups(P<0.05)3.4 Given the treatment target of the hs-CRP level as hs-CRP<3.0mg/L,the PD patients were divided into high hs-CRP group(hs-CRP>3.0 mg/L)and normal hs-CRP group(hs-CRP<3.0 mg/L).Comparing the levels of the two groups,there were statistical difference for systolic blood pressure(P<0.05)but no significant difference for blood Hb,ALB,iPTH,UA,BUN,HDL,LDL,TG,TC and GLU(P>0.05).3.5 Logistic regression analysis was performed based on the inspection level as a ?0.10,hs-CRP level as dependent variable while the levels of 13 indexes including systolic blood pressure,low density lipoprotein cholesterol,total cholesterol and parathyroid hormone as independent variables.It is shown by the results that either serum uric acid or plasma albumin is a risk factor for hs-CRP increase(P<0.05).4.Analysis for the risk factors of cardiovascular adverse events in the CAPD patients in a single center4.1 Among the patients,25 cases(22.1%)got cardiovascular adverse events and 88 cases(77.9%)did not.4.2 The average age of the patients in the group with cardiovascular adverse events was 48.72±14.14 years old,while the group without cardiovascular adverse events was 54.10±12.26 years old.There was no statistical difference between the two groups(P>0.05).4.3 The systolic blood pressure of the patients in the group with cardiovascular adverse events was 175.28±19.89 mmHg while 131.86±19.03mmHg for patients in the group without cardiovascular adverse events.There was statistical difference between the levels of the two groups(P<0.05).4.4 The TC level in the group with cardiovascular adverse events was 7.25±1.55mmol/L which was statistically different with the 3.41±1.39mmol/L of the group without cardiovascular adverse events(P<0.05).The TG level of the group with cardiovascular adverse events was 8.90± 14.80mmol/L which was statistically different with the 1.05±1.54mmol/L of the group without cardiovascular adverse events(P<0.05).The HDL level in the group with cardiovascular adverse events was 6.00±8.16mmol/L which was statistically different with the of 1.22±2.28mmol/L of the group without cardiovascular adverse events(P<0.05).The LDL level of the group with cardiovascular adverse events was 4.39±0.90mmol/L which was statistically different with the 1.75±0.85mmol/L of the group without cardiovascular adverse events(P<0.05).4.5 The iPTH level of the group with cardiovascular adverse events was 623.58±186.75mmol/L which was statistically different with the 256.46±108.0lmmol/L of the group without cardiovascular adverse events(P<0.05).4.6 The BUN level of the group with cardiovascular adverse eventswas 23.25±7.26mmol/L which was statistically different with the 19.44±5.82mmol/L of the group without cardiovascular adverse events(P<0.05).4.7 The plasma Glucose level of the group with cardiovascular adverse events was 8.00±12.00mmol/L which was statistically different with the 4.6±6.0mmol/L of the group without cardiovascular adverse events(P<0.05).The SUA level of the group with cardiovascular adverse events was 625.96±153.96 mmol/L which was statistically different with the 355.94±81.98mmol/L of the group without cardiovascular adverse events(P<0.05).The blood Hb level of the group with cardiovascular adverse events was 96.32±12.68g/L which was statistically different with the 104.98± 19.83g/L of the group without cardiovascular adverse events(P<0.05).4.8 Logistic regression analysis was performed based on inspection level as a = 0.10,with or without cardiovascular adverse events as dependent variable while age,entering dialysis age,systolic blood pressure,serum uric acid and low density lipoprotein as independent variants.It is shown by the results that HUA and LDL are risk factors of cardiovascular adverse events in peritoneal dialysis patients.Conclusion:1.In the peritoneal dialysis center,the growth rate of peritoneal dialysis patients shown a decreasing trend which might be associated with the management.Different from developed countries in Europe,North America and other,regions,our patients started PD later.But when compared with Japan,our patients started even earlier.The primary diseases resulting in ESRD of our PD patients was primary glomerular disease mainly.Anemia,hypoalbuminemia,dialysis adequacy controlling were in improved year by year.2.From this data,the ratios reaching the treatment standard of calcium/phosphorus metabolism disorder and secondary hyperparathyroidism were very low,which suggested that it is necessary to emphasize the management peritoneal dialysis quality.It is shown by the analysis results of the data that elevated blood phosphorus often combined with lipid metabolic disorder,and that blood hemoglobin and urea nitrogen,serum creatinine,uric acid are associated with blood phosphorus.3.It is shown by the data of the center that micro inflammation is significantly associated with residual urine volume in the patients received CAPD for 1 year.It is suggested that micro inflammation might influence the nutritional status of CAPD patients.It is also shown by the data that elevated hs-CRP levels is more often complicated with lipid metabolic disorder in CAPD patients,and that blood uric acid and plasma albumin are risk factors for the increase of hs-CRP.4.It is shown by that data that elevated blood uric acid and low density lipoprotein were the independent risk factors of cardiovascular adverse events in peritoneal dialysis patients.It is suggested that controlling the blood pressure,blood lipid levels,calcium/phosphorus metabolism disorder is benefit fot preventing cardiovascular adverse events. |
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