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Objective: To investigate the effect of peritonitis on all-cause mortality and cardiovascular mortality of peritoneal dialysis (PD) patients. Methods: From January 2003 to September 2017,614 patients treated with PD in the Department of Nephrology of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine were retrospectively included. The patients were divided into the peritonitis group and the peritonitis-free group according to whether peritonitis occurred after PD treatment. According to the first standard peritoneal equilibrium test results,the patients were divided into low transport group (L group),low average transport group (LA group),high average transport group (HA group) and high transport group (H group). The study endpoints were defined as all-cause mortality or cardiovascular mortality. The demographic data,clinical data at baseline (within one month of starting PD treatment) and PD outcomes were compared between the peritonitis group and the peritonitis-free group. The proportional hazards model (Cox model) was established to analyze the effect of peritonitis on all-cause death or cardiovascular death. Results: In the peritonitis group (213 cases),125 patients (58.7%) were positive for pathogenic bacteria,in whom 69 patients (32.4%) were Gram-positive bacteria,46 patients (21.6%) were Gram-negative bacteria,and 6 patients (2.8%) were fungi. Compared with the peritonitis-free group,the patients in the peritonitis group had longer dialysis duration (P=0.000),older age (P=0.001),higher proportion of lower education level (P=0.000),higher proportion of patients with cerebrovascular disease and diabetes mellitus (P=0.004,P=0.036),and lower serum albumin level (P=0.016). Multivariate Cox regression analysis showed that peritonitis was an independent risk factor for all-cause mortality and cardiovascular mortality (P=0.015,P=0.046) after age,diabetes mellitus,serum albumin and other factors being adjusted. Subgroup analysis showed that compared with the patients with high educational level,the risk of all-cause mortality [HR: 1.99 (1.14-3.46) vs 1.39 (0.74-2.62)] and cardiovascular mortality [HR: 1.95 (0.89-4.25) vs 1.14 (0.50-2.61)] were more intensively increased in patients with low educational level after peritonitis. Compared with the H group+HA group,the risk of all-cause mortality [HR: 2.31 (1.30-4.11) vs 1.22 (0.70-2.12)] and cardiovascular mortality [HR: 3.24 (1.41-7.42) vs 0.95 (0.45-2.02)] were more intensively increased in the L group+LA group after peritonitis. Conclusion: Peritonitis is an independent risk factor for all-cause mortality and cardiovascular mortality of PD patients. The risk of all-cause mortality and cardiovascular mortality after peritonitis increases more significantly in those with lower educational level or in L group+LA group than those with higher educational level or in H group+HA group.
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Objective: To investigate the role of common clinical indicators in volume assessments of peritoneal dialysis (PD) patients. Methods: Eligible PD patients in Renji Hospital, Shanghai Jiao Tong University School of Medicine from Nov. 2016 to Nov. 2017 were enrolled. Demographic data of patients were collected and clinical parameters were measured. Hydration status index overhydration (OH) was measured by bioimpedance spectroscopy, and the association between clinical indicators and OH was analyzed. Results: A total of 200 PD patients aged 56.3±13.8 years with median PD duration of 46.6 months were enrolled in the study. Among them, 117 (58.5%) patients were males and 42 (21.0%) patients were diabetic. 141 (70.5%) patients in the present study were overhydrated (OH>1.1 L). Compared to those with normal hydration, the overhydrated patients had higher blood pressure, more obvious edema and higher brain natriuretic peptide (BNP) level (P<0.05). In the overhydrated patients, 51 (36.2%) patients had normal blood pressure, 67 (47.5%) patients had no edema and 46 (32.6%) patients had BNP less than 100 pg/mL. In the normal hydrated patients, 20 (33.9%) patients had high blood pressure, 8 (13.6%) patients had edema and 1 (1.7%) patient had BNP higher than 400 pg/mL. Systolic pressure and BNP level were both correlated with OH positively (systolic pressure r=0.361, P=0.001; BNP r=0.615, P=0.000). The patients who had more obvious edema also had higher OH (P=0.000). Conclusion: Blood pressure, edema and BNP are closely associated with the hydration status, but only one of these clinical indicators can not accurately reflect the hydration status in all PD patients. Combination of different indicators may be useful in evaluation of hydration status in PD patients.
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Staphylococcus aureus is the main agent of infections during peritoneal dialysis (PD). The presence of S. aureus in the nasal cavity has been extensively studied and suggested as a risk factor of dialysis-related infections, whereas coagulase-negative Staphylococcus (CNS) species are frequently considered part of the normal human microbiota. The aim of this study was to identify Staphylococcus in the nasal cavity, pericatheter skin and peritoneal effluent from PD patients, as well as to evaluate the antimicrobial activity evolution in vitro. Thirty-two chronic PD patients were observed during 12 months and had nasal and pericatheter skin samples collected for culture. When peritonitis was detected, samples were also collected from the peritoneal effluent for culture. The activity of several antimicrobial drugs (penicillin G, oxacillin, cephalothin, ofloxacin, netilmicin and vancomycin) against different Staphylococcus species was measured by using the agar drug diffusion assay (Kirby-Bauer method). Staphylococcus was separated into S. aureus, S. epidermidis and other CNS species in order to determine the in vitro resistance level. S. epidermidis resistance to oxacillin progressively increased during the study period (p < 0.05). Resistance to ofloxacin was inexpressive, whereas resistance to netilmicin and vancomycin was not detected. Of the oxacillin-resistant species (n = 74), 83 percent were S. epidermidis, 13 percent other CNS and 4 percent S. aureus (p < 0.05). Regarding multi-drug resistant strains (n = 45), 82 percent were S. epidermidis, 13 percent other CNS, and 5 percent S. aureus (p < 0.05). This study shows the relevance of resistance to oxacillin and CNS multi-drug resistance, particularly concerning S. epidermidis, in PD patients.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Coagulase , Diálise Peritoneal/efeitos adversos , Diálise Renal/efeitos adversos , Fatores de Risco , Sepse , Staphylococcus aureusRESUMO
PURPOSE: When liver cirrhosis patients accompanying ascites need renal replacement therapy because of chronic renal failure (CRF), peritoneal dialysis (PD) can allow direct removal of ascites and prevent anticoagulants use. However, since PD might aggravate hypoalbuminemia and increase chances of peritonitis, clinicians tend to hesitate to apply it to those patients. The aim of the present study is to assess the outcome and stability of PD for the treatment of CRF patient with cirrhosis acompanying ascites. METHODS: A retrospective study based on the clinical records was performed in cirrhotic patients with ascites in whom PD was performed for the treatment of CRF and who were followed up at Samsung Medical Center unit, between January 1995 and July 2005. RESULTS: In our study, 15 patients were enrolled. Child-pugh class was worse in non-survival group than survival group (p<0.01). One-year patient survival was 40% in Class C and 75% in Class B, and patient survival differed between Class C and Class B (p=0.0014). Causes of death were terminal liver failure (n=6) and sepsis due to pneumonia (n=1). Total 27 episodes of peritonitis occurred, and the peritonitis rates were 0.91 episodes/patients-year. CONCLUSION: Although the peritonitis rates turned out somewhat high, the use of PD for the treatment of CRF in patients with liver cirrhosis accompanying ascites seems to be safe and effective. Main cause of death in our study seems to be related to liver disease.