ABSTRACT
Background: This study aims to investigate the clinical characteristics of enterococcus-associated peritonitis in patients with peritoneal dialysis (PD). Methods: In this retrospective study, patients with PD-associated enterococcal peritonitis (Group E) who were treated in our center between January 2010 and September 2020 were included. Patients with PD-associated streptococcus peritonitis (Group S) and patients with coagulase-negative staphylococcus peritonitis (Group CNS) were matched 1:1 as cohort-control groups. The clinical characteristics and prognosis of these patients were analyzed. Results: A total of 21 peritonitis episodes were noted in nine males and nine females, with an average age of 60.33±14.79 years and an average dialysis duration of 63.56±35.23 months. Mixed infection was observed in 7 out of 21 cases. A total of 22 strains of enterococci were identified in bacterial culture, all sensitive to vancomycin. There were significant differences in white blood cell (WBC) count and blood urea nitrogen (BUN) level among three groups on admission (p<0.05). In all three groups, WBC count on the second and third day post-treatment was higher in Group E than in other groups (p<0.05). The cure rate in Group E was lower than in other groups (p<0.01). The mortality rate in Group E was slightly higher than in other groups (p>0.05). Kaplan-Meier analysis revealed a significant difference in the cumulative survival among three groups (p<0.05). Conclusion: Enterococcus peritonitis is a rare and severe complication of peritoneal dialysis. Although vancomycin is effective for the treatment of Enterococcus infection, Enterococcus peritonitis still has a high rate of treatment failure, poor response to treatment, and poor prognosis as compared to CNS and streptococcus-related infections.
ABSTRACT
BACKGROUND: Clinical manifestations and histological lesions of IgA nephropathy and Henoch-Schönlein purpura nephritis (HSPN) are different, but related, and are also correlated with the renal outcomes. This study aimed to compare the features of immunoglobulin A nephropathy (IgAN) and HSPN in adult patients with diffuse endocapillary proliferation (DEP) lesions aiming to clarify the differences and relationships in the clinicopathological findings and outcome. METHODS: Twelve patients with DEP-IgAN and 10 patients with DEP-HSPN were enrolled. Twenty four patients with IgAN (NDEP-IgAN) and matched 20 patients with HSPN (NDEP-HSPN) were enrolled at the same ratio (1:2). The clinicopathological features, clinical efficacy, and renal outcomes were analyzed in the four groups. RESULTS: DEP patients with IgAN or HSPN had worse clinical manifestations (more severe proteinuria, lower serum ALB, higher incidence of gross hematuria). The proteinuria in the DEP-HSPN group was more severe than in the DEP-IgAN group. There was no significant difference in the serum creatinine among four groups. The incidence of endothelial swelling was significantly higher in the DEP-HSPN group than in the NDEP-HSPN group and DEP-IgAN group. The S1 score of Oxford classification was more common in the DEP-IgAN group than in the DEP-HSPN. None in the DEP-IgAN group reached endpoint events during the follow-up period, while the renal outcomes were significantly poorer in the DEP-HSPN group than in the DEP-IgAN and NDEP-HSPN groups. No significant difference was observed in the cumulative renal survival among four groups (χ 2 =7.264, P=0.064), but patients in the DEP-HSPN group had markedly lower renal cumulative survival rate as compared to the NDEP-HSPN group (χ 2 =4.875, P=0.027). CONCLUSIONS: The DEP is significantly associated with more severe proteinuria and hematuria regardless the IgAN and HSPN. Among DEP patients, patients with HSPN have poor therapeutic efficacy and renal outcomes, even under active immunosuppressive therapy, as compared to those with IgAN.
Subject(s)
Glomerulonephritis, IGA , IgA Vasculitis , Nephritis , Purpura , Adult , Cell Proliferation , Cohort Studies , Humans , PrognosisABSTRACT
BACKGROUND: Vascular calcification significantly increases the rates of cardiovascular mortality in hemodialysis (HD) patients. Abnormalities in mineral metabolism may play a role in the pathogenesis of arterial calcification. Whether patients treated with non-calcium-based phosphate binders had reduced aortic vascular calcification compared to those treated with calcium-based phosphate binders is still unclear. METHODS: We searched multiple databases for studies published through August 2013 that evaluated the effects of non-calcium-based phosphate binders (NCBP) versus calcium-based phosphate binders (CBP) on cardiovascular calcification and bone remodeling among dialysis patients. We summarized test performance characteristics with the use of forest plots, fixed and random effects models, and Egger regression test. RESULTS: Eighteen eligible randomized controlled trials totaling 3676 patients were included. Meta-analysis results showed NCBP could significantly attenuate the progression of coronary artery calcification than CBP (WMD: -144.62, 95% CI: -285.62 to -3.63). The serum calcium levels significant lower in NCPB group than in CPB groups (WMD: -0.26, 95% CI: -0.37 to -0.14), but the serum iPTH levels were significantly higher in NCPB groups (WMD: 57.1, 95% CI: 13.42 to 100.78). The osteoid volume and osteoblast numbers were significant higher in NCPB group than in CPB group (WMD: 1.75, 95% CI: 0.78 to 2.73 for osteoid volume; WMD: 4.49, 95% CI: 1.83 to 7.15 for osteoblast numbers). The Egger regression test also showed no potential publication bias (p = 0.725). CONCLUSIONS: Based on available data, NCBPs have equally effective with CBPs for serum phosphate control. But there was significantly lower incidence of coronary artery calcification and a significant higher bone formatting rate in NCBP groups than in CBP groups. So we recommend NCBPs as phosphate binders for HD patients.
