BACKGROUND & AIMS: :Conventional peritoneal dialysis fluid (PDF) is a bioincompatible solution because of several components. These unphysiological compositions might contribute to the development of peritoneal fibrosis. In the present overview we summarize the influence of each composition of PDF (acidic pH, high concentration of glucose and glucose degradation products; advanced glycation end-products and lactate) on the peritoneal fibrotic changes in long peritoneal dialysis (PD) patients. We also summarized the report of new approaches to the prevention of peritoneal fibrosis in Japan.

背景与目标： 常规腹膜透析液（PDF）由于具有多种成分，因此是一种生物不相容的解决方案。这些非生理成分可能有助于腹膜纤维化的发展。在本概述中，我们总结了PDF的每种成分（酸性pH，高浓度的葡萄糖和葡萄糖降解产物；晚期糖基化终产物和乳酸）对长期腹膜透析（PD）患者腹膜纤维化变化的影响。我们还总结了在日本预防腹膜纤维化的新方法的报告。

BACKGROUND & AIMS: :Tenckhoff peritoneal dialysis (PD) catheter malposition is one of the leading causes of catheter malfunction. Fluoroscopically directed stiff-wire manipulation of malpositioned PD catheters has been advocated as a method of catheter salvage. Two hundred eighty-nine single-cuff PD catheters were placed surgically into 203 patients during this 4-year study. Thirty-three patients developed catheter malfunction attributed to malposition. Forty-eight stiff-wire manipulations were performed on these patients. Thirty-eight (78%) of the manipulations were described as successful at the time of transfer from radiology. However, only 25 (51%) and 12 (25%) resulted in functioning catheters at 1 week and 1 month, respectively. Only 11 of 33 patients who underwent manipulation had functional prolongation of catheter life beyond 1 month. The PD catheter was replaced by a column-disk PD catheter without additional catheter dysfunction in six patients. A second single-cuff Tenckhoff PD catheter was inserted in another six patients. Three of these six catheters again malpositioned. We conclude that stiff-wire manipulation is a useful and safe technique worth using on a limited basis for the initial episode of catheter malposition. Catheters that repetitively malposition should be replaced with a catheter that is resistant to malpositioning.

背景与目标： ：Tenckhoff腹膜透析（PD）导管位置不正确是导管故障的主要原因之一。已经提出了对错位的PD导管进行荧光镜定向的硬线操作作为抢救导管的方法。在这项为期4年的研究中，将289例单袖PD导管通过外科手术置入203例患者中。 33例患者因定位不良而出现导管故障。对这些患者进行了四十八次硬线操作。从放射学转移时，有38种（78％）的操作被认为是成功的。但是，分别有25个（51％）和12个（25％）分别导致在1周和1个月时导管功能正常。在接受操作的33例患者中，只有11例具有超过1个月的功能性延长导管寿命。 6例患者的PD导管被柱盘PD导管替代，而没有其他导管功能障碍。在另外六名患者中插入了第二个单袖带Tenckhoff PD导管。这六个导管中的三个再次错位。我们得出的结论是，硬线操纵是一种有用且安全的技术，值得在导管植入不良的初始发作中有限地使用。反复错位的导管应更换为对错位有抵抗力的导管。

BACKGROUND & AIMS: OBJECTIVE:Conventional hemodialysis (HD) predominates over peritoneal dialysis (PD) around the world. Prospective and comparative studies comparing the costs of these modalities are scarce. In the present prospective assessment, we describe the resources used and total patient costs for both HD and PD. ♢ METHODOLOGY:We assessed 249 patients on HD and 228 on PD. All patients were 18 years of age or older and on stable dialysis. The information was collected at three points over 1 year, using standard questionnaires. The sources for costs were the Brazilian public and private health care systems. Societal perspective was considered. ♢ STATISTICAL ANALYSIS:Core trends and dispersions were measured. Regression models assessed the impact of modality on the average total cost per patient per year. ♢ RESULTS:Of the 249 HD patients and 228 PD dialysis patients, 189 (74%) and 160 (70%) respectively completed follow-up. The mean age for women was 55.8 years; for men, it was 59.8 years (p = 0.001). The average total cost per patient-year was US$28 570 for HD and US$27 158 for PD. By category, the costs consisted of direct medical-hospital costs (82.3% for HD, 86.5% for PD), direct nonmedical costs (5.3% for HD, 3.7% for PD), and indirect costs (12.4% for HD, 9.8% for PD). Overall costs were less for PD patients than for their HD counterparts (p = 0.025). ♢ CONCLUSIONS:Maintenance dialysis represented the most important source of costs for both modalities; loss of productivity incurred significant costs. Future studies should contemplate the social consequences arising from each modality.

背景与目标： 目的：常规血液透析（HD）优于全世界的腹膜透析（PD）。缺乏比较这些方式成本的前瞻性和比较性研究。在当前的前瞻性评估中，我们描述了HD和PD的资源使用和患者总费用。 ♢
方法：我们评估了249例HD患者和228例PD患者。所有患者年龄均在18岁或以上，并且透析稳定。使用标准调查表在1年中的3个时间点收集了该信息。费用来源是巴西的公共和私人卫生保健系统。考虑了社会视角。 ♢
统计分析：测量核心趋势和离散度。回归模型评估了模态对每位患者每年平均总费用的影响。 ♢
结果：在249例HD患者和228例PD透析患者中​​，分别完成了189例（74％）和160例（70％）随访。女性的平均年龄为55.8岁；男性为59.8岁（p = 0.001）。 HD患者每位患者每年的平均总费用为28 570美元，PD患者为27 158美元。按类别，这些费用包括直接医疗-医院费用（HD的82.3％，PD的86.5％），直接非医疗费用（HD的5.3％，PD的3.7％）和间接费用（HD的12.4％，9.8％）对于PD）。 PD患者的总费用比HD患者低（p = 0.025）。 ♢
结论：维持性透析是这两种方式最重要的费用来源。生产力的损失导致了巨大的成本。未来的研究应考虑每种方式产生的社会后果。

BACKGROUND & AIMS: OBJECTIVE:To evaluate the outcomes of and barriers to implementing standard guidelines (Caring for Australasians with renal impairment [CARI]), using iron management in patients having dialysis as an example. DESIGN AND SETTING:On-site review of iron management processes at six Australian dialysis units varying in size and locality. Patients' iron indices and haemoglobin levels were obtained from the Australian and New Zealand Dialysis and Transplant Registry. PARTICIPANTS:Patients with chronic kidney disease who were dependent on dialysis. MAIN OUTCOME MEASURES:Processes for assessing indices of iron stores and iron supplementation; comparison with target indices in the CARI guidelines. RESULTS:There was considerable variability among the units in achievement of haemoglobin and iron targets, with 25%-32% of patients achieving haemoglobin targets of 110-120 g/L, 30%-68% achieving ferritin targets of 300-800 microg/L, and 65%-73% achieving transferrin saturation targets of 20%-50%. Implementation barriers included lack of knowledge, lack of awareness of or trust in the CARI guideline, inability to implement the guideline, and inability to agree on a uniform unit protocol. Factors associated with achieving the CARI guideline targets included nurse-driven iron management protocols, use of an iron management decision aid, fewer nephrologists per dialysis unit, and a "proactive" (actively keeping iron levels within target range) rather than "reactive" (only reacting if iron levels are out of the range) protocol. CONCLUSIONS:Variability in achievement of iron targets, despite the availability of a clinical practice guideline, may be explained by variability in processes of care for achieving and maintaining adequate iron parameters.

背景与目标： 目的：以透析患者的铁管理为例，评估标准指南（护理患有肾功能不全的澳大利亚人[CARI]）的结果和障碍。
设计与设置：对六个澳大利亚透析单位的铁管理流程进行现场审查，这些单位的大小和位置各不相同。患者的铁指数和血红蛋白水平从澳大利亚和新西兰透析与移植注册处获得。
对象：依赖于透析的慢性肾脏病患者。
主要观察指标：储铁量和补铁指标评估过程；与CARI指南中的目标指标进行比较。
结果：各单位间达到血红蛋白和铁目标的差异很大，其中25％-32％的患者达到110-120 g / L的血红蛋白目标，30％-68％的患者达到300-800 microg /的铁蛋白目标L和65％-73％达到20％-50％的转铁蛋白饱和度目标。实施障碍包括缺乏知识，缺乏对CARI准则的认识或信任，无法实施该准则以及无法就统一的单位协议达成共识。与实现CARI指导方针目标相关的因素包括护士驱动的铁管理方案，铁管理决策辅助工具的使用，每个透析单位的肾脏病医生较少以及“主动”（将铁水平保持在目标范围内）而非“反应性”（仅在铁含量超出范围时反应）。
结论：尽管有临床实践指南，实现铁靶的可变性仍可以通过达到和维持适当铁参数的护理过程中的可变性来解释。

BACKGROUND & AIMS: :Hepatitis C virus (HCV) infection is a global health problem, common worldwide, leading to acute and chronic hepatitis and its consequences of hepatocirrhosis and hepatocellular carcinoma. Patients on hemodialysis belong to the high-risk group of HCV infection. The prevalence of HCV infection in dialysis patients ranges from 4% to more than 70% in some countries. The main reasons for such a high incidence of infections are a high prevalence of HCV infection in the general population, lack of standard infection precautions and effective vaccination, inadequate disinfection procedures of dialysis machines and other medical equipment, as well as spread of infection from patient to patient, especially in dialytic centers with a high percentage of infected patients. The diagnostic procedures useful in the evaluation of HCV infection are detection of anti-HCV antibodies, identification of HCV RNA, counts of virus copies, and identification of its genome. From the 6 major genotypes and multiple subtypes of the HCV, genotypes 1a and 1b are the most common in Europe and Japan, and 1b is responsible for more severe liver disease and aggressive course leading to liver fibrosis. Antiviral therapy of HCV+ dialysis patients with interferon-alpha (INF-alpha) gives slightly better results than in the general population, but is poorly tolerated and associated with side effects. Although ribavirin in not recommended for dialysis patients, the addition of small doses of this compound to pegylated INF is discussed, especially for patients in whom previous infection treatment failed.

背景与目标： 丙型肝炎病毒（HCV）感染是全球性的健康问题，在全球范围内普遍存在，导致急性和慢性肝炎及其对肝硬化和肝细胞癌的后果。接受血液透析的患者属于HCV感染的高危人群。在某些国家，透析患者的HCV感染率从4％到70％以上不等。如此高的感染率的主要原因是普通人群中HCV感染的高流行，缺乏标准的感染预防措施和有效的疫苗接种，透析机和其他医疗设备的消毒程序不足以及患者感染的传播对患者，尤其是在感染中心患者感染率很高的透析中心。评估HCV感染有用的诊断程序是抗HCV抗体的检测，HCV RNA的鉴定，病毒拷贝数以及其基因组的鉴定。在HCV的6种主要基因型和多种亚型中，基因型1a和1b在欧洲和日本最为常见，而基因1b则导致更严重的肝病和导致肝纤维化的侵袭性病程。与一般人群相比，干扰素-α（INF-alpha）的HCV透析患者的抗病毒治疗效果稍好，但耐受性差且具有副作用。尽管不建议将利巴韦林用于透析患者，但仍讨论了在聚乙二醇化INF中添加小剂量这种化合物，特别是对于先前感染治疗失败的患者。

BACKGROUND & AIMS: BACKGROUND:The dialysis practice guideline in Japan sets a limit on the allowed interdialytic weight gain (IDWG) <6%. However, the effects of relative gain of fluid volume to body weight may differ in presence of morbid conditions. Here, we examined whether or not the associations between IDWG and mortality differ by serum albumin (sAlb), a nutritional and illness marker. DESIGN:The study type used was prospective cohort study. SUBJECTS:Patients who participated in the Japan Dialysis Outcomes and Practice Pattern Study (phase 1-4 [1999-2011]) and received thrice-weekly hemodialysis. METHODS:IDWG was the exposure of interest and was collected every 4 months, divided into 7 categories as follows: <2%, 2% to 3%, 3% to 4% (reference), 4% to 5%, 5% to 6%, 6% to 7%, and >7%. sAlb was treated as both an effect modifier and confounder and dichotomized into ≥3.8 g/dL and <3.8 g/dL segments, according to the protein-energy wasting criteria proposed by the International Society of Renal Nutrition and Metabolism. MAIN OUTCOME MEASURE:The outcome in this study was all-cause mortality. RESULTS:A total of 8,661 patients were analyzed. Time-varying Cox regression analyses revealed that, when sAlb was ≥3.8 g/dL, an IDWG >7% was associated with greater risk of mortality (adjusted hazard ratio [AHR] 2.74; 95% confidence interval [CI], 1.49-5.05). When sAlb was <3.8 g/dL, however, IDWGs <2% (AHR 1.89; 95% CI, 1.50-2.39) and 4% to 5% (AHR 0.75; 95% CI, 0.58-0.96) were associated with mortality (P for interaction = .001). Cubic spline analyses showed that the mortality increased when IDWG exceeded 6% for patients with sAlb ≥3.8 g/dL; in contrast, for patients with sAlb <3.8 g/dL, the mortality increased when IDWG was <3% and decreased when IDWG was between 4% and 6%. LIMITATION:The main limitation was possible residual confounding. CONCLUSIONS:The direction and magnitude of the associations between IDWG and mortality were modified by sAlb. Dialysis experts should take these results into account when revising the clinical practice guidelines.

背景与目标： 背景：日本的透析实践指南对允许的透析间增重（IDWG）<6％设置了限制。但是，在存在病态的情况下，体液量相对于体重的相对增加的影响可能会有所不同。在这里，我们检查了IDWG和死亡率之间的关联是否因营养和疾病标志物血清白蛋白（sAlb）而异。
设计：使用的研究类型为前瞻性队列研究。
参加日本透析结果和实践模式研究（1-4期[1999-2011]）并每周接受三次血液透析的患者。
方法：IDWG是感兴趣的暴露量，每4个月收集一次，分为7类，分别为：<2％，2％至3％，3％至4％（参考），4％至5％，5％至6％，6％至7％和> 7％。根据国际肾脏营养与代谢学会提出的蛋白质能量浪费标准，将sAlb视为效应修饰剂和混杂因素，并分为3.8 g / dL和<3.8 g / dL的区段。
主要观察指标：本研究结果为全因死亡率。
结果：共分析了8661例患者。随时间变化的Cox回归分析显示，当sAlb≥3.8 g / dL时，IDWG> 7％与更大的死亡风险相关（调整后的危险比[AHR] 2.74; 95％置信区间[CI]，1.49-5.05 ）。但是，当sAlb <3.8 g / dL时，IDWGs <2％（AHR 1.89; 95％CI，1.50-2.39）和4％至5％（AHR 0.75; 95％CI，0.58-0.96）与死亡率相关（互动的P = .001）。三次样条分析表明，当sAlb≥3.8g / dL的患者IDWG超过6％时，死亡率增加；相反，对于sAlb <3.8 g / dL的患者，当IDWG <3％时死亡率增加，而当IDWG在4％至6％之间时死亡率降低。
局限性：主要局限性是可能的残余混杂。
结论：sAlb改变了IDWG与死亡率之间的关联的方向和大小。修订临床实践指南时，透析专家应考虑这些结果。

BACKGROUND & AIMS: BACKGROUND:Carnitine deficiency is common in patients on dialysis. Serum free carnitine concentration is significantly lower in patients on hemodialysis (HD) than in healthy individuals. However, there are few reports on serum free carnitine concentration in patients on peritoneal dialysis (PD). METHODS:We examined serum concentrations of total, free, and acylcarnitine and the acylcarnitine/free carnitine ratio in 34 PD and 34 age-, sex-, and dialysis duration-matched HD patients. We investigated the prevalence of carnitine deficiency and clinical factors associated with carnitine deficiency in the PD group. RESULTS:Prevalence of carnitine deficiency was 8.8% in the PD group and 17.7% in the HD group (p = 0.283). High risk of carnitine deficiency was found in 73.5% of the PD group and 76.4% of the HD group (p = 0.604). Carnitine insufficiency was found in 82.3% of the PD group and 88.2% of HD group (p = 0.733). Multivariate analysis revealed that duration of dialysis and age were independent predictors of serum free carnitine level in the PD group. CONCLUSIONS:The prevalence of carnitine deficiency, high risk of carnitine deficiency, and carnitine insufficiency in PD patients was 8.8%, 73.5%, and 82.3%, respectively. These rates were comparable to those in patients on HD.

背景与目标： 背景：肉毒碱缺乏症在透析患者中​​很常见。血液透析（HD）患者的血清游离肉碱浓度明显低于健康个体。然而，很少有关于腹膜透析（PD）患者血清游离肉碱浓度的报道。
方法：我们检查了34名PD和34名年龄，性别和透析时间相匹配的HD患者的总，游离和酰基肉碱的血清浓度以及酰基肉碱/游离肉碱的比率。我们调查了PD组的肉碱缺乏症患病率以及与肉碱缺乏症相关的临床因素。
结果：PD组的肉碱缺乏症患病率为8.8％，HD组的肉碱缺乏症患病率为17.7％（p = 0.283）。 PD组的73.5％和HD组的76.4％发现了肉碱缺乏的高风险（p = 0.604）。 PD组有82.3％的人肉碱不足，HD组有88.2％的人肉碱不足（p = 0.733）。多因素分析显示，透析时间和年龄是PD组血清游离肉碱水平的独立预测因子。
结论：PD患者的肉碱缺乏症，肉碱缺乏症的高风险和肉碱不足的患病率分别为8.8％，73.5％和82.3％。这些比率与HD患者相当。

BACKGROUND & AIMS: AIM:Catheter-related infection is a major cause of catheter loss in peritoneal dialysis (PD). We evaluated the effect of catheter revision on the treatment of intractable exit site infection (ESI)/tunnel infection (TI) in PD patients who required catheter removal. METHODS:We reviewed the medical records of 764 continuous ambulatory peritoneal dialysis (CAPD) patients from May 1995 to April 2011 at our hospital. One hundred and twenty six patients had more than one occurrence of ESI. Catheter revision was performed to treat intractable ESI/TI. Incidence of ESI, causative organisms and the outcomes of catheter revision were analyzed. RESULTS:The total PD duration of all patients was 32,581 months. Three hundred and twelve ESI episodes occurred in 126 patients and the incidence of ESI was 1/104 patient-months (0.12/patient-year). The most common causative organism was methicillin-sensitive Staphylococcus aureus (MSSA) (98 episodes), followed by Pseudomonas aeruginosa (63 episodes) and methicillin-resistant S. aureus (MRSA) (28 episodes). Among these, catheter revision was required due to intractable ESI/TI in 36 patients. The most common causative organism was MSSA (14 episodes) followed by P. aeruginosa (10 episodes) and MRSA (six episodes) in catheter revision cases. The outcomes of catheter revision were as follows: ESI relapsed in 11 patients (30.6%) after catheter revision. Among them, five patients were treated with antibiotic treatment, two patients required secondary catheter revision, four patients required catheter removal due to ESI/TI accompanying peritonitis. The catheter survival rate after catheter revision was 89.7% in one year. There were no statistical differences in the rates of ESI relapse after catheter revision between ESI caused by P. aeruginosa (5/10, 50%) and ESI caused by S.aureus (6/21, 28.6%). CONCLUSION:Catheter revision may be an alternative treatment option to treat intractable ESI/TI before catheter removal is considered in PD patients.

背景与目标： 目的：与导管相关的感染是腹膜透析（PD）中导管丢失的主要原因。我们评估了导管修订术对需要拔除导管的PD患者顽固性出口部位感染（ESI）/隧道感染（TI）的治疗效果。
方法：我们回顾了1995年5月至2011年4月在我院进行的764例连续性非卧床腹膜透析（CAPD）患者的病历。 126位患者发生了一次以上的ESI。进行导管翻修以治疗顽固性ESI / TI。分析了ESI的发生率，病原体和导管翻修的结果。
结果：所有患者的总PD持续时间为32,581个月。 126例患者发生了312次ESI发作，ESI的发生率为1/104患者-月（0.12 /患者-年）。最常见的致病菌是对甲氧西林敏感的金黄色葡萄球菌（MSSA）（98次），其次是铜绿假单胞菌（63次）和耐甲氧西林的金黄色葡萄球菌（MRSA）（28次）。其中，由于36例患者的ESI / TI难以治疗，因此需要进行导管修订。在导管翻修病例中，最常见的致病菌是MSSA（14次），其次是铜绿假单胞菌（10次）和MRSA（6次）。导管翻修的结果如下：导管翻修后ESI复发11例（30.6％）。其中，有5例患者接受了抗生素治疗，其中2例患者需要二次导管修订，由于ESI / TI伴有腹膜炎而需要移除导管4例。一年内导管翻修后的导管生存率为89.7％。铜绿假单胞菌引起的ESI（5/10，50％）和金黄色葡萄球菌引起的ESI（6/21，28.6％）在导管翻修后ESI复发率方面无统计学差异。
结论：在PD患者考虑拔除导管之前，导管修订可能是治疗顽固性ESI / TI的另一种治疗选择。

BACKGROUND & AIMS: :Cardiovascular disease continues to be the foremost cause of morbidity and mortality in dialysis patients. Compared with the general population, dialysis patients suffer from an accelerated disease course that is, at least in part, resistant to conventional therapy. While there are a myriad of potential explanations for this resistance, derangements in lipid metabolism probably play an important role. Here, we discuss the significance of altered lipid metabolism in uremia, such as oxidative lipoprotein modification and the pathophysiology of adipose tissue; limitations of conventional approaches to dyslipidemia such as statin therapy and traditional lipid profiles; and areas of investigation with potential for new therapy, such as reverse cholesterol transport.

背景与目标： ：心血管疾病仍然是透析患者发病和死亡的首要原因。与普通人群相比，透析患者的疾病病程加速，至少部分对常规治疗有抵抗力。尽管对此耐药性有许多潜在的解释，但脂质代谢紊乱可能起着重要作用。在这里，我们讨论了尿毒症中脂质代谢改变的重要性，例如氧化脂蛋白的修饰和脂肪组织的病理生理学。常规血脂异常方法的局限性，例如他汀类药物疗法和传统的脂质谱；以及可能进行新疗法（例如胆固醇逆向转运）的研究领域。

BACKGROUND & AIMS: BACKGROUND:Pulse wave velocity is a measurement of arterial stiffness and associated with increased cardiovascular mortality. Previous reports in peritoneal dialysis have linked increased pulse wave velocity with an expansion in extracellular water. As cardiovascular mortality is increased in peritoneal dialysis patient, we wished to determine whether changes in pulse wave velocity mirrored changes in extracellular water. METHODS:We repeated aortic pulse wave velocity and bioimpedance-derived extracellular water measurements in peritoneal dialysis patients attending for assessment of peritoneal membrane function. RESULTS:Sixty-six patients, 41 males (62.1%), mean age of 66.2 ± 13.9 years, median duration of peritoneal dialysis treatment (14.3 (3.1-31.9) months) had repeated measurement 6.4 (5.8-10.2) months apart, with no significant change in aortic pulse wave velocity (10.1 ± 3.2 to 9.9 ± 2.8 m/s). In univariate analysis, the initial aortic pulse wave velocity was associated with extracellular water (r = 0.26, p = 0.034) and serum N-terminal pro brain-type natriuretic peptide (r = 0.25, p = 0.04), and on follow-up, aortic pulse wave velocity with N-terminal pro brain-type natriuretic peptide (r = 0.31, p = 0.01). Aortic pulse wave velocity increased in 50% of patients, and these patients had greater serum C-reactive protein 3(2-10) versus 2(1-4) mg/L, and ferritin (778(444-1099) versus 585(313-811), p < 0.05), but there were no differences in either absolute or adjusted extracellular water. Both log C-reactive protein (odds ratio 4.7 (95% confidence limits 1.3-17.1), p = 0.019) and prescription of calcium channel blockers (odds ratio 4.9 (95% confidence limits 1.2-19.1), p = 0.024) were independently associated with an increase in aortic pulse wave velocity. CONCLUSION:We did not find an independent association between a change in aortic pulse wave velocity and extracellular water, suggesting that changes in aortic stiffness in peritoneal dialysis patients are more complex than simply following changes in extracellular water.

背景与目标： 背景：脉搏波速度是对动脉僵硬度的一种测量，并与心血管死亡率的增加有关。腹膜透析的先前报道已将脉搏波速度增加与细胞外水的膨胀联系起来。随着腹膜透析患者心血管疾病死亡率的增加，我们希望确定脉搏波速度的变化是否反映了细胞外水的变化。
方法：我们对参加腹膜透析功能评估的腹膜透析患者重复进行主动脉脉搏波速度和生物阻抗来源的细胞外水测量。
结果：66例患者，男性41例（62.1％），平均年龄为66.2±13.9岁，腹膜透析治疗的中位时间为14.3（3.1-31.9）个月，重复测量间隔为6.4（5.8-10.2）个月，主动脉脉搏波速度无明显变化（10.1±3.2±9.9±2.8μm/ s）。在单变量分析中，初始主动脉脉搏波速度与细胞外水（r = 0.26，p = 0.034）和血清N端脑前利尿钠肽（r = 0.25，p = 0.04）有关，并随诊N端脑部利钠肽前体的主动脉脉搏波速度（r = 0.31，p = 0.01）。 50％的患者主动脉脉搏波速度增加，这些患者的血清C反应蛋白3（2-10）比2（1-4）mg / L和铁蛋白（778（444-1099）对585（ 313-811），p <0.05），但绝对或调整后的细胞外水均无差异。 log C反应蛋白（比值4.7（95％置信度极限1.3-17.1），p = 0.019）和钙通道阻滞剂的处方（ods比4.9（95％置信度1.2-19.1），p = 0.024）是独立的与主动脉脉搏波速度增加有关。
结论：我们没有发现主动脉脉搏波速度变化与细胞外水之间存在独立的联系，这表明腹膜透析患者的主动脉僵硬度变化比单纯跟随细胞外水变化更为复杂。

BACKGROUND & AIMS: BACKGROUND:Although the soluble form of suppression of tumorigenicity 2 (sST2) and soluble low-density lipoprotein receptor relative with 11 ligand-binding repeats (sLR11) have emerged as novel cardiovascular biomarkers in patients with cardiovascular disease, their prognostic value has not been fully investigated in peritoneal dialysis (PD) patients. METHODS:We included 74 prevalent PD patients from a prospective cohort and measured serum sST2 and sLR11 concentrations by an enzyme-linked immunosorbent assay. The association of these biomarkers and all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) was evaluated. RESULTS:During a follow-up of 38.5 months, all-cause deaths and MACCEs were observed in 13 (17.6%) patients and 23 (31.3%) patients. Multivariable Cox analyses demonstrated that greater sST2 was independently associated with higher risk of all-cause mortality (≥75.8 ng/mL; hazard ratio [HR] = 5.551; 95% confidence interval [CI] = 1.360-22.660) and MACCEs (≥72.5 ng/mL; HR = 4.609; 95% CI = 1.608-13.208). Furthermore, sST2 showed additive predictive value for mortality to the base model including traditional risk factors (net reclassification index = 0.598, P = 0.04). sLR11 was not significantly associated with all-cause mortality or MACCE. CONCLUSIONS:sST2, but not sLR11, indicated a significant prognostic value for all-cause mortality and cardiovascular events in PD patients. Further research is needed to validate emerging biomarkers in these populations.

背景与目标： 背景：尽管抑制致癌性2（sST2）的可溶性形式和相对于11种配体结合重复序列（sLR11）的可溶性低密度脂蛋白受体已成为心血管疾病患者的新型心血管生物标志物，但其预后价值尚未完全在腹膜透析（PD）患者中进行了调查。
方法：我们纳入了来自前瞻性队列的74名流行的PD患者，并通过酶联免疫吸附测定法测量了血清sST2和sLR11的浓度。评估了这些生物标记物与全因死亡率以及主要不良心脏和脑血管事件（MACCE）的关联。
结果：在38.5个月的随访中，观察到13例（17.6％）和23例（31.3％）患者的全因死亡和MACCE。多变量Cox分析表明，更大的sST2与更高的全因死亡率风险（≥75.8ng / mL；危险比[HR] = 5.551； 95％置信区间[CI] = 1.360-22.660）和MACCEs（≥72.5）独立相关ng / mL； HR + ＝ 4.609； 95％CI ＝ 1.608-13.208）。此外，sST2对包括传统危险因素在内的基本模型的死亡率显示出附加的预测价值（净重分类指数= 0.598，P = 0.04）。 sLR11与全因死亡率或MACCE无关。
结论：sST2而非sLR11提示PD患者全因死亡率和心血管事件具有重要的预后价值。需要进一步的研究来验证这些人群中新兴的生物标志物。

BACKGROUND & AIMS: OBJECTIVES:Home haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients' learning styles are associated with differing risk of adverse events in both home HD and PD patients. DESIGN:Retrospective cohort study. SETTING:Tertiary care hospital in Toronto, Ontario, Canada. PARTICIPANTS:One hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study. INTERVENTIONS:Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles. PRIMARY AND SECONDARY OUTCOME MEASURES:Home HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles. RESULTS:Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694). CONCLUSIONS:Different learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.

背景与目标： 目标：过去几年，家庭血液透析（HD）和腹膜透析（PD）的使用率在全球范围内有所增长。然而，家庭透析及其伴随的技术复杂性和不良事件的风险继续为广泛采用带来挑战。我们检查了家庭HD和PD患者中患者学习方式的差异是否与不良事件发生风险的不同相关。
设计：回顾性队列研究。
地点：加拿大安大略省多伦多的三级医疗医院。
参与者：入选了118位普遍的成年人（≥18岁）家庭透析患者（40位PD和78位家庭HD）。本研究不包括接受家庭透析少于6个月或接受家庭护理透析的患者。
干预措施：已入组的患者完成（VARK）视觉，听觉，阅读写作和动觉问卷，以确定学习方式。
主要和次要指标：在完成家庭透析培训后的6个月内发现家庭HD和PD不良事件。然后将事件发生率分层，并根据学习风格进行比较。
结果：30例患者共发生53例不良反应。我们使用逻辑回归分析来确定单个不良事件的未调整和调整后的OR。非视觉学习者发生不良事件的可能性高4.35倍（p = 0.001）。在调整了年龄，性别，透析方式，培训时间，透析时间，先前的肾脏替代治疗，视觉障碍，教育和识字能力之后，非视觉学习者的不良事件发生率仍然是视觉学习者的四倍（p = 0.008） ）。对家庭高清患者的亚组分析显示，非视觉学习者中发生不良事件的可能性更高（OR 11.1； p = 0.003），而PD患者呈现非视觉学习者中发生不良事件的趋势（OR：1.60； p = 0.694）。 ）。
结论：家庭透析患者存在不同的学习方式。在完成培训的前6个月内，视觉学习方式与家庭透析患者的不良事件较少相关。必须通过学习方式来个性化家庭透析培训。

BACKGROUND & AIMS: :Biofilms are commonly associated with an increased risk of patient infection. In peritoneal dialysis (PD), catheter associated infection, especially peritonitis, remains a clinically relevant problem. Although the presence of a biofilm is recognized in relapsing, repeat, and catheter-related peritonitis, it remains poorly characterized. In this review, an update on the role of biofilms in PD infections is presented. The emerging concept that host cells and tissue associated biofilms, in addition to the biofilms on the catheters themselves, contribute to the recalcitrance of infections is discussed. Furthermore, the evidence of biofilms on PD catheters, their developmental stages, and the possible influence of the PD environment are reviewed. The focus is given to ex vivo and in vitro studies that contribute to the elucidation of the interplay between host, microbial, and dialysis factors. The key issues that are still to be answered and the challenges to clinical practice are discussed.

背景与目标： 生物膜通常会增加患者感染的风险。在腹膜透析（PD）中，导管相关的感染，尤其是腹膜炎，仍然是临床相关的问题。尽管在复发性，重复性和与导管相关的腹膜炎中都可以识别出生物膜的存在，但生物膜的特征仍然很差。在这篇综述中，介绍了生物膜在PD感染中的作用的最新进展。除了导管本身上的生物膜之外，还讨论了宿主细胞和组织相关生物膜的新兴概念，它们也有助于抵抗感染。此外，综述了PD导管上生物膜的证据，它们的发育阶段以及PD环境的可能影响。重点是体外研究和体外研究，这些研究有助于阐明宿主，微生物和透析因子之间的相互作用。讨论了仍有待解决的关键问题以及对临床实践的挑战。

BACKGROUND & AIMS: :Cardiac resynchronization therapy (CRT) is often deferred in dialysis-dependent patients with heart failure (HF) because of a perceived lack of benefit and potentially higher risks, although the outcomes associated with CRT in dialysis have not been reported. We therefore studied our center's experience with CRT in dialysis-dependent patients. We constructed a descriptive assessment of these patients (n = 15) and performed a case-control analysis matching for age, gender, bundle branch morphology, diabetes mellitus, cardiomyopathy origin, and β-blocker and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use. Baseline and 6-month echocardiograms were assessed for evidence of reverse remodeling. No periprocedural or long-term complications were observed among dialysis patients. Heterogenous improvement in ejection fraction (+3.1 ± 9.2%) was noted and 2 patients derived absolute improvements of 8% and 22%, respectively. Dialysis patients demonstrated the following 3-year event rates: HF hospitalization, 31%; all-cause hospitalization, 100%; mortality, 73%; and HF hospitalization or death, 82%. In the case-control analysis, controls demonstrated superior reverse remodeling (+9.2 ± 9.5% increase in ejection fraction), decreased mortality (73% vs 44%, p = 0.038), and all-cause hospitalizations (76% vs 100%, p = 0.047), with no difference in HF hospitalizations (p = 0.39), compared with dialysis patients. In conclusion, at our center, the dialysis-dependent patients with HF who underwent CRT implantation did so safely and no serious complications were observed. Certain dialysis patients demonstrated compelling improvement after device implantation. Compared with matched controls, dialysis patients were at increased risk for adverse events and worsened echocardiographic outcomes.

背景与目标： ：由于尚无与透析相关的CRT结局的报道，由于认为缺乏获益和潜在的更高风险，通常在依赖透析的心力衰竭（HF）患者中推迟进行心脏再同步治疗（CRT）。因此，我们研究了我们中心在依赖透析的患者中使用CRT的经验。我们对这些患者（n = 15）进行了描述性评估，并根据年龄，性别，束支形态，糖尿病，心肌病起源，β受体阻滞剂和血管紧张素转换酶抑制剂或血管紧张素II受体进行了病例对照分析阻止者使用。评估基线和6个月的超声心动图，以寻找逆向重构的证据。在透析患者中​​未观察到围手术期或长期并发症。观察到射血分数的异质性改善（3.1±9.2％），2例患者的绝对改善分别为8％和22％。透析患者的3年事件发生率如下：心衰住院率为31％；心衰住院率为31％。全因住院，100％；死亡率73％；而心衰住院或死亡的比例为82％。在病例对照分析中，对照表现出优异的逆向重构（射血分数增加9.2±9.5％），死亡率降低（73％对44％，p = 0.038）和全因住院（76％对100％，p = 0.047），与透析患者相比，HF住院患者没有差异（p = 0.39）。总之，在我们中心，接受CRT植入的依赖透析的HF患者安全地这样做，并且未观察到严重的并发症。某些透析患者在装置植入后表现出令人信服的改善。与对照组相比，透析患者发生不良事件的风险增加，超声心动图结果恶化。

BACKGROUND & AIMS: BACKGROUND:Despite efforts to increase arteriovenous fistula and graft use, 80% of patients in the United States start hemodialysis on a central venous catheter (CVC). METHODS:To better understand in incident hemodialysis patients how sex and race/ethnicity are associated with time on a central venous catheter and transition to an arteriovenous fistula and graft, our observational cohort study analyzed US Renal Data System data for patients with incident ESKD aged ≥66 years who started hemodialysis on a CVC in July 2010 through 2013. RESULTS:At 1 year, 32.7% of 74,194 patients transitioned to an arteriovenous fistula, 10.8% transitioned to an arteriovenous graft, 32.1% stayed on a CVC, and 24.5% died. Women spent a significantly longer time on a CVC than men. Compared with white patients, patients who were black, Hispanic, or of another racial/ethnicity minority spent significantly more days on a CVC. In competing risk regression, women were significantly less likely than men to transition to a fistula and more likely to transition to a graft. Compared with white patients, blacks were significantly less likely to transition to a fistula but more likely to transition to a graft, Hispanics were significantly more likely to transition to a fistula, and other races/ethnicities were significantly more likely to transition to either a fistula or a graft. CONCLUSIONS:Female patients spend a longer time on a CVC and are less likely to transition to permanent access. Compared with white patients, minorities also spend longer time on a CVC, but are more likely to eventually transition to permanent access. Strategies to speed transition to permanent access should target groups that currently lag in this area.

背景与目标： 背景：尽管努力增加动静脉瘘和移植物的使用，美国80％的患者开始通过中央静脉导管（CVC）进行血液透析。
方法：为了更好地了解事件性血液透析患者的性别和种族/民族与时间在中心静脉导管上以及过渡到动静脉瘘和移植物之间的关系，我们的观察性队列研究分析了美国肾脏数据系统对≥≥ESKD事件的患者的数据。 66岁的人从2010年7月至2013年开始在CVC上进行血液透析。
结果：在1年中，74194例患者中有32.7％转变为动静脉瘘，10.8％转变为动静脉移植物，32.1％留在CVC上，有24.5％死亡。女性在CVC上花费的时间比男性长得多。与白人患者相比，黑人，西班牙裔或其他少数种族/民族的患者在CVC上花费的时间明显更多。在竞争性风险消退中，女性比男性更不可能转换为瘘管，而更有可能转换为移植物。与白人患者相比，黑人转移到瘘管的可能性要小得多，但移植到瘘管的可能性要大得多，西班牙裔人转移到瘘管的可能性要大得多，其他种族/族裔的人转移到任一瘘管的可能性都更大或嫁接。
结论：女性患者在CVC上花费的时间更长，并且不太可能过渡到永久使用。与白人患者相比，少数族裔在CVC上花费的时间也更长，但最终过渡到永久性访问的可能性更大。加快向永久访问权过渡的策略应针对当前滞后于该领域的人群。