| Objective:To analyze the clinical data of end-stage renal disease patients treated by peritoneal dialysis in blood purification center of our hospital,and to analyze the causes of death of peritoneal dialysis patients,so as to provide clinical basis for improving the prognosis of patients.Methods:832 patients who underwent peritoneal dialysis in our hospital from June 1,2009 to June 18,2019 were selected as subjects.Data of peritoneal dialysis patients who met the inclusion criteria of the study were collected in the medical record room of our hospital.Statistical information includes:hospitalization number,name,sex,age,type of medical insurance,indwelling time,prognosis,prognosis time,prognosis reasons,primary diseases and laboratory inspection indicators.For patients with peritonitis,the frequency of peritonitis and the results of bacterial culture for each peritonitis were collected.The patients were divided into death group(265 cases)and fluoroscopy group(358 cases).The survival rate,primary disease,cause of death,pathogenic bacteria and drug resistance of peritonitis patients were analyzed.Results:(1)The 1-year,3-year and 5-year survival rates of 832 peritoneal dialysis patients that included in the study are 94.5%,87.3%and 72.4%.(2)As of June 18,2019,358 of 832 peritoneal dialysis patients had continued peritoneal dialysis,265 patients died,57 patients had kidney transplantation,125 patients were converted to hemodialysis,9 patients had extubation,and 18 patients had the loss ratio of follow-up..(3)There were 265 patients in the death group and 358 in the dialysis group.There was no statistical difference in the sex ratio between the two groups(P>0.05).The average age of patients in the death group was significantly higher than that in the dialysis group,and the difference between the two groups has statistical significant(67.38±13.27 vs 58.04±14.68 P<0.05).The median dialysis time in the death group was significantly shorter than that in the dialysis group,and the difference between the two groups has statistical significant(P<0.05).(4)In this study,there are more than ten kinds of primary diseases in peritoneal dialysis dead patients and dialysis patients.The first primary disease in the death group was diabetes mellitus,followed by chronic glomerulonephritis and hypertension,with the proportions of 30.57%,28.68%and 24.15%respectively.The other primary diseases with relatively high proportions were polycystic kidney disease,gout and nephrotic syndrome,the proportions were 5.28%,2.64%and 1.89%,respectively.Chronic glomerulonephritis was the first primary disease in the dialysis group,followed by hypertension and diabetes mellitus,with the proportions of 51.40%,21.79%and 12.01%,respectively.In the dialysis group,polycystic kidney disease,nephrotic syndrome,systemic lupus erythematosus and gout accounted for 6.70%,3.07%,1.40%and 1.96%respectively.The first three primary diseases in death group were diabetes mellitus,chronic glomerulonephritis and hypertension,while the first three primary diseases in dialysis group were the same as those in death group,but the proportion was different,and the order was chronic glomerulonephritis,hypertension and diabetes.Chi-square test showed that the proportion of chronic glomerulonephritis in the death group was significantly lower than that in the dialysis group,and the difference was statistically significant(P<0.05).The proportion of diabetes mellitus in the death group was significantly higher than that in the thorough group,and the difference was statistically significant(P<0.05).There was no significant difference in the proportion of hypertension between death group and dialysis group(P>0.05).The death group was divided into 81 cases of diabetes mellitus and 184 cases of non-diabetes mellitus according to whether the primary disease was diabetes mellitus or not.The average dialysis time of diabetic patients was significantly lower than that of non-diabetic patients(P<0.05).(5)The leading causes of death in 265 peritoneal dialysis patients were cardiovascular events(25.66%),cerebrovascular events(14.72%),pulmonary infection(9.81%),peritonitis(6.79%),systemic failure,malignant tumors and malnutrition(6.42%,5.66%and 5.28%,respectively).The other causes of death were gastrointestinal bleeding,shock,respiratory failure,accidental death,suicide and so on.According to the survival time,the dead patients were divided into four groups:0-1 year,1-3 years,3-5 years and more than 5 years.The first two causes of death in the four groups were cardiovascular events and cerebrovascular events.The third cause of death in 0-1 year group and 1-3 year group was pulmonary infection.The third cause of death in 3-5 year group and over 5 years group was peritonitis.(6)68 peritoneal dialysis patients died of cardiovascular events,including 46 cases of heart failure,5 cases of myocardial infarction,2 cases of arrhythmia and 15 cases of sudden cardiac death.Diabetes was the most common primary disease.39 peritoneal dialysis patients died of cerebrovascular accident,32 cases of cerebral hemorrhage,7 cases of cerebral infarction,the main primary diseases were hypertension and diabetes.26 peritoneal dialysis patients died of pulmonary infection.Diabetes mellitus and chronic glomerulonephritis were the most common primary diseases.18 peritoneal dialysis patients died of peritonitis.Chronic glomerulonephritis was the most common primary disease,followed by hypertension and diabetes.In 18 cases of peritonitis death,33 cases of peritonitis occurred,one to seven times,27 times of bacterial culture were positive,the positive rate was 81.82%.Gram-positive cocci accounted for 12 times(36.36%),followed by Gram-negative bacilli for 10 times(30.30%),followed by mixed infection and fungi for 3 times(9.09%)and 2 times(6.06%)respectively.17 peritoneal dialysis patients died of systemic failure.Hypertension was the most common primary disease.15 peritoneal dialysis patients died of malignant tumors.14 patients died of malnutrition.Chronic glomerulonephritis and diabetes were the most common primary diseases.(7)The laboratory indicators of the two groups were compared.There were statistical differences in hemoglobin,blood calcium,albumin,ferritin,creatinine,triglyceride,cholesterol,blood potassium(P<0.05).Logistic regression analysis showed that old age,anemia,hypoalbuminemia and the increase of serum ferritin were independent risk factors of death in patients with peritoneal dialysis.Conclusions:(1)The 1-year,3-year and 5-year survival rates were 94.5%,87.3%and 72.4%respectively,which were similar to the level in most areas of China.However,the proportion of elderly patients was high,the average age of the death patients who was(7.38±13.27)years old,and the average age of the patients with dialysis who was(58.04±14.68)years old.(2)The most common primary disease of death patients is diabetic nephropathy,accounting for 30.57%,which is significantly higher than that of patients with dialysis;among the dead patients,the survival period of patients with diabetic nephropathy is significantly lower than that of patients without diabetes mellitus,suggesting that the prognosis of patients with diabetic nephropathy who underwent peritoneal dialysis is worse than other primary diseases.(3)Cardiovascular and cerebrovascular diseases are the first cause of death in patients with peritoneal dialysis,followed by infection.Other factors include systemic failure,malignant tumor and malnutrition.Therefore,in order to improve the survival rate of patients with peritoneal dialysis,we should strengthen the prevention and treatment of cardiovascular and cerebrovascular diseases,and actively control infection.(4)Age,hemoglobin,albumin and ferritin may be the survival factors of patients with peritoneal dialysis. |
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