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Objectives To investigate whether the presence of metabolic syndrome (MS) modifies overall survival and cardiovascular (CV) outcomes among patients undergoing long-term peritoneal dialysis (PD) and to explore suitable diagnostic criterion for PD patients.Methods A total of 258 patients on PD in Peking University Third Hospital between October 2008 and March 2009 were enrolled and followed until June 2017.According to the diagnostic criteria of WHO,IDF and ATP Ⅲ,the patients were divided into MS group and non-MS group.The median following time was 51.9 (26.8,97.9) months.Overall survival and cardiovascular death were analyzed by the Kaplan-Meier method.The analyses were also done among non-diabetic PD patients.The influence of MS and its components on outcomes was analyzed by Cox regression models.Results Among 258 PD patients,106(41.1％) fulfilled the WHO criteria,121(46.9％) the IDF criteria,and 167(64.7％) the ATP criteria.139 cases were dead,among which 50(36.0％) cases were caused by CV diseases.The patients with MS had worse outcomes than those without MS by WHO and IDF criteria (cumulative survival rates of WHO criteria:21.3％ vs 44.8％,P ＜ 0.01;cumulative surviva rats of IDF criteria:23.3％ vs 45.7％,P ＜ 0.01).It was the same even in non-diabetic PD patients.The patients with MS had more CV death than those without MS by WHO and IDF criteria (both P ＜ 0.05).Among non-diabetic PD patients,the results remained the same only by IDF criteria (P ＜ 0.05).By ATP criteria,above analyses showed no difference.By multivariate Cox regression analysis,MS and serum albumin (all P ＜ 0.01) were independently associated with increased risk for overall and cardiovascular survival.Among MS components,waist girth,low-density lipoprotein cholesterol (LDL-C) levels and blood sugar (all P ＜ 0.01) were significant risk factors for adverse survival outcomes.Conclusions In patients undergoing PD,both overall survival and cardiovascular survival were worse in patients with MS than those without MS.Waist girth,blood sugar and serum LDL-C were the main risk factors.For PD patients the IDF criterion for MS was recommended.
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Now the visiting physicians are usually trained without effective supervision and guidance mechanism.Since 2017,the Emergency Department of Peking University Third Hospital has adopted the training model under tutor system for visiting physicians.Tutors and visiting physicians are matched 1∶1.Personalized training program is made by tutors and visiting physicians depending on the level of the hospital where visiting physicians practice in,educational background,clinical experience,length and the goal of study.The training plan is refined according to the timeline in order to facilitate the tutor and training physician's own precise management.Since implementation of this training model,the visiting physicians say they are more efficient to complete the training program and learned more than before.The teaching ability of tutors has further been enhanced.
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Objective To evaluate the efficacy of imipenem-cilastin sodium as subsequent therapy on peritoneal dialysis(PD)-related peritonitis.Methods From January 2007 to December 2010,44 PD-related peritonitis patients in our hospital were enrolled in the study.These patients presented cloudy fluid after 3 days initial treatment,and bacterial culture was Gram-negative bacteria or negative.Thirteen peritonitis episodes were treated with ceftazidime,while 36 episodes with imipenem-cilastin sodium.Efficacy,outcome,pathogen and drug-resistance were analyzed retrospectively.Results The effective rates 2 d later of ceftazidime and imipenem-cilastin sodium were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Gram-negative bacteria of ceftazidime and imipenem-cilastin sodium groups were 69.4％ and 65.2％ respectively without significant difference (P＞0.05).The cure rates 3 weeks later of ceftazidime and imipenemcilastin sodium groups were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Conclusion As subsequent therapy for PD-related peritonitis,imipenem-cilastin sodium can improve the cure rate.
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To investigate association between prognosis of patients of peritoneal dialysis with their initial high peritoneal solute transport and complications. Two hundred and two patients with end-stage renal disease who began peritoneal dialysis during September 1,2006 to September 1, 2008 at Peking University Third Hospital, Beijing were recruited in the study. They were undergone peritoneal equilibration test within six weeks after initiating peritoneal dialysis, and their types of peritoneal solute transport, complications,nutrition status and outcomes were all recorded until August 31,2010. Their survival rate was estimated by Kaplan-Meier method. Compare to those with other types of solute transport, patients with high peritoneal solute transport showed higher proportion of complications ( P < 0. 05 ) during dialysis, but less ultrafiltration function ( P < 0. 05 ), worse nutrition status ( P < 0. 05 ) and lower cumulative survival rate ( P < 0. 01 ).Among patients with high peritoneal solute transport, cumulative survival rate in those with complication was lower than those without it ( P = 0. 031 ). Prognosis of patients with high peritoneal solute transport possibly varies with their complications in dialysis.
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Objective: To study the possible mechanism of malnutrition in peritoneal dialysis patients. Methods: Multicenter prospective cohort study was designed . Forty-four peritoneal dialysis patients who survived two years after a cross-sectional study were included in the present study. We divided our patients into two groups according to the dietary protein intake(DPI) during follow-up period, DPI lower than 0.78 g/( kg?d) or DPI higher than 0.78 g/( kg?d). Patients' nutritional status was evaluated during the cross-sectional study and at the end of follow-up. 22 patients were divided into two groups according to the nutritional status improved or worsened in subjective global assessment (SGA) during the follow-up period. Besides nutritional status, patient's residual renal function, volume status and the incidence of cardiovascular event during the follow-up period were also evaluated. Results: Based on SGA , the incidence of malnutrition in low-DPI group was 60.9% in the cross-sectioned study and 45.5% after the follow-up. In high-DPI group, it decreased from 57.1% to 28.6%. The residual renal function declined significantly in worse nutritional status group, the incidences of volume overload and cardiovascular events during follow-up study were significantly higher in worse nutritional status group than that in improved nutritional status group. Conclusion: Malnutrition in peritoneal dialysis patients may not be simply due to lower protein intake. The changes in residual renal function, fluid overload and cardiovascular disease, accompanied with low dietary protein intake may be the possible cause of malnutrition in peritoneal dialysis patients.
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Objective: To investigate the impact of nutritional status, inflammation and cardiovascular disease on the mortality of 90 patients with continuous ambulatory peritoneal dialysis (CAPD) . Methods: A cross sectional study was performed in 90 clinically stable CAPD patients. Patients’ nutritional status (by SGA), chronic inflammation (by CRP), cardiovascular disease (CVD) were evaluated. All patients were followed for 24 months. Results: Thirty three of the 90 (36.67%) patients died during the follow up, five patients transferred to hemodialysis and 3 patients received transplantation. The causes of death were CVD in 12, infection in 13 and other causes in 7. Seventeen patients who died were malnourished. Malnourished patients had significantly higher mortality than well nourished patients ( P
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Objective To investigate the early impact of incremental peritoneal dialysis.Methods 109 new peritoneal dialysis patients treated with incremental peritoneal dialysis were included in the present study.Clinical data,dialysis adequacy and nutritional status were evaluated at the initiation of dialysis and at 3 months after PD.Results The peritoneal dialysis patients achieved good results in the dialysis adequacy and nutrition at the end of the 3rd month.The patients' comorbidities reduced.BP and blood work improved significantly during the first 3 months.Conclusion Our results suggest that incremental PD improve patients clinical status even at the early stage of dialysis.
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Objective In order to investigate plasma total homocysteine(tHCY) level,its influential factors,and the relationship between total homocysteine(tHCY)and N 5,N 10 -methylenetetrahydrofolate reductase(MTHFR) gene in hemodialysis patients.Method Pre-and posthemodialysis plasma tHCY and MTHFR genotype were measured by high performance liquid chromatography(HPLC) method and polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) method respectively,and dialysis related indexes were detected simultaneously.Results Plasma tHCY in hemodialysis patients was(28 4?5 8)?mol/L,and it was significantly higher than normal control(P
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Objective:To find the rate of anxiety and depression in peritoneal dialysis (PD) patients,and the relationship between these emotion disorder and PD processes.Method:88 PD patients were studied, their mood state was evaluated with Hamilton Anxiety Scale and Hamilton Depression Scale. Nutritional indexes, residual renal function and dialysis adequacy, and inflammation status were also recorded as well as history of cardiac-cerebral vascular disease. These patients were followed for 2 years.Result:44.3% patients were detected as anxiety, and 56.8% depression. Higher SGA was associated with higher Hamilton anxiety/depression scale. Patients with higher anxiety and higher depression had lower serum albumin, lower protein intake, lower body index, and lower mid-arm muscle area and fat area. Anxiety and depression is related to cardiac-cerebral vascular diseases and diabetes.There was no significant relationship between Hamilton anxiety/depression score and patient's survival.Conclusion:There is a high rates of anxiety and depression in PD patients and it may be a potential risk factor of malnutrition.
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The animal models for pharmacologic assessment of drugs against premature delivery arereviewed, which include the measure of spontaneous delivery time between the first and the second pups in term pregnancy rats, the delay in the onset of labor in rats and premature delivery artificially induced by lipopolysaccharide, interleukin 1 ? and prostaglandin F 2? in mice.