• 【回顾透析间体重增加和死亡率与血清白蛋白相互作用的关系:日本透析结果和实践模式研究。】 复制标题 收藏 收藏
    DOI:10.1053/j.jrn.2017.05.003 复制DOI
    作者列表:Kurita N,Hayashino Y,Yamazaki S,Akizawa T,Akiba T,Saito A,Fukuhara S
    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。
  • 【腹膜透析患者的肉碱缺乏症患病率和肉碱水平降低。】 复制标题 收藏 收藏
    DOI:10.3390/nu11112645 复制DOI
    作者列表:Shimizu S,Takashima H,Tei R,Furukawa T,Okamura M,Kitai M,Nagura C,Maruyama T,Higuchi T,Abe M
    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。
  • 【修订腹膜透析患者难治性出口部位感染/隧道感染的导管修订:单中心经验。】 复制标题 收藏 收藏
    DOI:10.1111/j.1440-1797.2012.01644.x 复制DOI
    作者列表:Cho KH,DO JY,Park JW,Yoon KW
    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。
  • 【透析患者的脂质代谢-故事变得更加复杂。】 复制标题 收藏 收藏
    DOI:10.1111/j.1525-139X.2008.00470.x 复制DOI
    作者列表:Ponda MP,Barash I
    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。
  • 【腹膜透析中主动脉脉搏波速度的变化不能反映出通过生物阻抗测量的细胞外水的变化。】 复制标题 收藏 收藏
    DOI:10.1177/0391398820931109 复制DOI
    作者列表:Tangvoraphonkchai K,Davenport A
    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。
  • 【可溶性ST2和可溶性LR11对腹膜透析患者的死亡率和心血管事件的预后价值。】 复制标题 收藏 收藏
    DOI:10.1186/s12882-020-01886-7 复制DOI
    作者列表:Choi YB,Lee MJ,Park JT,Han SH,Kang SW,Yoo TH,Kim HJ
    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。
  • 【新近训练的家庭透析患者的不良事件是否与学习方式有关?来自加拿大多伦多的单中心回顾性研究。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2019-033315 复制DOI
    作者列表:Auguste BL,Girsberger M,Kennedy C,Srithongkul T,McGrath-Chong M,Bargman J,Chan CT
    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。
  • 【生物膜在腹膜透析中具有挑战性作用的最新进展。】 复制标题 收藏 收藏
    DOI:10.1080/08927014.2013.824566 复制DOI
    作者列表:Martins M,Rodrigues A,Pedrosa JM,Carvalho MJ,Cabrita A,Oliveira R
    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。
  • 【心脏再同步治疗对依赖透析的心力衰竭患者的有用性和后果。】 复制标题 收藏 收藏
    DOI:10.1016/j.amjcard.2013.07.018 复制DOI
    作者列表:Friedman DJ,Upadhyay GA,Singal G,Orencole M,Moore SA,Parks KA,Heist EK,Singh JP
    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。
  • 【美国医疗保险人口中使用导管和透析途径的种族和性别差异。】 复制标题 收藏 收藏
    DOI:10.1681/ASN.2019030274 复制DOI
    作者列表:Arya S,Melanson TA,George EL,Rothenberg KA,Kurella Tamura M,Patzer RE,Hockenberry JM
    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。
  • 【在永久性透析导管中使用低浓度柠檬酸盐锁与肝素锁的比较性前瞻性研究。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Hendrickx L,Kuypers D,Evenepoel P,Maes B,Messiaen T,Vanrenterghem Y
    BACKGROUND & AIMS: :We prospectively evaluated the efficacy and safety of a low concentrate citrate lock versus heparin lock in permanent single lumen hemodialysis catheters. The frequency of clot formation, complete catheter occlusion, flow problems and the use of urokinase as well as catheter infection episodes were monitored during 1370 dialysis sessions in 19 patients, randomised in two study groups. There was a significantly higher number of dialysis sessions with clot formation in the citrate group but regarding the need for urokinase bolus or infusion, complete obstruction of the catheter or local infections, there were no statistically significant differences between groups. The higher incidence of clotting in the citrate locked catheters had no repercussion on dialysis efficiency, effective blood flow or on the use of thrombolytic therapy. We found that low concentrate citrate is as safe as heparin for long-term interdialytic anticoagulation of permanent single lumen hemodialysis catheters but is more efficient from a pharmaco-economic viewpoint.
    背景与目标: :我们前瞻性评估了永久性单腔血液透析导管中低浓度柠檬酸盐锁与肝素锁的疗效和安全性。在19个患者的1370次透析期间,对血凝块形成的频率,完全的导管阻塞,流量问题和尿激酶的使用以及导管感染的发作进行了监测,并随机分为两个研究组。柠檬酸盐组的透析时间明显增加,但有凝块形成,但考虑到需要尿激酶推注或输注,完全阻塞导管或局部感染,两组之间在统计学上没有显着差异。柠檬酸盐锁定导管中较高的凝结发生率对透析效率,有效血流量或溶栓治疗的使用没有影响。我们发现低浓度的柠檬酸盐对永久性单腔血液透析导管的长期透析间抗凝治疗与肝素一样安全,但从药物经济学角度来看更有效。
  • 【自体干细胞移植过程中卡莫司汀和依托泊苷后需要透析的急性肾损伤。】 复制标题 收藏 收藏
    DOI:10.1159/000343661 复制DOI
    作者列表:Li J,Khot A,Burbury K
    BACKGROUND & AIMS: BACKGROUND:The Stanford BCNU protocol (carmustine, etoposide and cyclophosphamide) is a high-dose conditioning regimen widely used prior to autologous stem cell transplantation. While acute renal failure requiring renal replacement therapy is a known but rare complication of autologous stem cell transplantation, acute nephrotoxicity following carmustine and etoposide has not yet been reported. CASE:We present the first case of carmustine-induced acute kidney injury in the setting of autologous stem cell transplantation and perform a review of the literature. Renal failure was associated with a sharp rise in serum creatinine, oliguria and trace proteinuria. Urgent haemodialysis was required; however, renal failure resolved after 7 days. CONCLUSION:Although a rare complication, its severity mandates close monitoring of renal function as early recognition and treatment may limit long-term sequelae.
    背景与目标: 背景:斯坦福大学BCNU协议(卡莫司汀,依托泊苷和环磷酰胺)是一种高剂量的调理方案,在自体干细胞移植之前被广泛使用。尽管需要肾脏替代治疗的急性肾功能衰竭是自体干细胞移植的已知但罕见的并发症,但尚未报告卡莫司汀和依托泊苷后的急性肾毒性。
    案例:我们介绍了自体干细胞移植中卡莫斯汀引起的急性肾脏损伤的第一例病例,并进行了文献复习。肾衰竭与血清肌酐,少尿和微量蛋白尿的急剧升高有关。需要紧急血液透析;但是,肾功能衰竭在7天后消失。
    结论:尽管并发症少见,但其严重性要求密切监测肾功能,因为早期识别和治疗可能会限制长期后遗症。
  • 【透析方式和其他处方因素对腹膜透析中腹膜蛋白排泄的影响。】 复制标题 收藏 收藏
    DOI:10.3265/Nefrologia.pre2012.Jul.11465 复制DOI
    作者列表:Rodríguez-Carmona A,Pérez-Fontán M,Pértega-Díaz S,López-Calviño B,López-Muñiz A,García-Falcón T
    BACKGROUND & AIMS: BACKGROUND:There is a deficit of information regarding the factors that influence peritoneal protein excretion (PPE) during PD therapy. In particular, the effects of the modality of PD and other conditions of the dialysis prescription remain unclear. METHOD:This prospective, observational study analysed the effects of prescription characteristics on 24-hour PPE (study variable) in a cohort of patients starting PD. Our statistical analysis included a multi-level mixed model and standardised estimations of peritoneal protein transport during serial four-hour peritoneal equilibrium tests in order to control for disparities in the characteristics of patients managed on different regimens. RESULTS:We evaluated 284 patients, 197 on CAPD and 87 on automated PD (APD), at the start of PD treatment. The two groups differed in terms of clinical characteristics and peritoneal function. Univariate, serial estimates of 24-hour PPE were marginally higher in CAPD patients, and remained essentially stable over time in both groups. Multivariate analyses identified CAPD (B=888.5mg, 95% CI: 327.5/1448.6), total dialysate volume infused per day (B=275.9 mg/Ll; 153.9/397.9) and ultrafiltration (B=0.41 mg/mL; 0.02/0.80) as independent predictors of 24-hour PPE. The model also revealed a minor trend for a lower 24-hour PPE as time on PD increases. CONCLUSIONS:The individual characteristics of peritoneal protein transport are the major determinants of 24-hour PPE. The use of CAPD as the dialysis modality is associated with higher PPE rates than the APD technique, although this difference is counterbalanced by a direct correlation between PPE and the volume of dialysate infused per day. Ultrafiltration and time on dialysis also act as minor independent predictors of PPE during PD therapy.
    背景与目标: 背景:关于PD治疗期间影响腹膜蛋白排泄(PPE)的因素的信息不足。特别是,PD方式和透析处方其他条件的影响仍不清楚。
    方法:这项前瞻性观察性研究分析了处方特征对一群开始PD的患者24小时PPE(研究变量)的影响。我们的统计分析包括一个多级混合模型和一系列连续四个小时的腹膜平衡测试过程中的腹膜蛋白运输的标准化估计,以控制采用不同方案治疗的患者的特征差异。
    结果:在PD治疗开始时,我们评估了284例患者,其中CAPD为197例,自动PD为87例。两组的临床特征和腹膜功能不同。 CAPD患者24小时PPE的单变量,系列估计略高,两组随时间的推移基本保持稳定。多变量分析确定了CAPD(B = 888.5mg,95%CI:327.5 / 1448.6),每天注入的总透析液体积(B = 275.9 mg / Ll; 153.9 / 397.9)和超滤(B = 0.41 mg / mL; 0.02 / 0.80 )作为24小时个人防护装备的独立预测指标。该模型还显示出随着PD持续时间的增加,PPE降低的趋势很小。
    结论:腹膜蛋白运输的个体特征是24小时PPE的主要决定因素。使用CAPD作为透析方式比使用APD技术具有更高的PPE率,尽管这种差异可以通过PPE和每天注入的透析液量之间的直接相关性来抵消。超滤和透析时间也是PD治疗期间PPE的次要独立预测指标。
  • 【香港透析患者的生活质量。】 复制标题 收藏 收藏
    DOI:10.1046/j.1365-2648.2001.01839.x 复制DOI
    作者列表:Suet-Ching WL
    BACKGROUND & AIMS: AIM:This study set out to measure the quality of life (QoL) of the dialysis patient. The first aim was to investigate the QoL of Hong Kong dialysis patients, and the second to understand the relationship between the demographic data and the QoL of the subjects. RATIONALE:Patients undergoing dialysis experience problems with disease-specific symptoms. The combination of a decrease in energy, the unavoidable emergence of socioeconomic problems, and emotional reactions compounds the stress facing the patient. The life of a dialysis patient may be lacking in quality. Few studies have examined the QoL of Hong Kong dialysis patients. More information is needed to establish how patients can be helped to lead more productive lives. METHODS:The Chinese Dialysis QoL Scale was used. A convenience sampling method was used to recruit patients from the outpatient clinics of dialysis centres. The distribution score on each item and the overall score were computed, with a lower score indicating greater negative impact of dialysis. To compare whether there is a difference in the average QoL score obtained between different groups on each of the demographic variables, one-way ANOVA followed by Tukey's post hoc analysis were used. Pearson's product moment correlation was used to examine the relationships between the demographic variables and the overall QoL score. FINDINGS:Of the 180 scales distributed, 164 were returned, giving a response rate of 91%. The mean of the total score was 132.5 with SD 16.68, varying between 97 and 179. The item mean score was 3.31. Marital status, type of modalities, and age appear to have no relationship to QoL. CONCLUSION:Patients undergoing dialysis in this study experienced multiple physical, social, economic and psychological changes. The priority of healthcare services should therefore be to provide support in the areas of family and social life, information and employment.
    背景与目标: 目的:该研究旨在测量透析患者的生活质量(QoL)。第一个目的是调查香港透析患者的生活质量,第二个目的是了解人口统计学数据与受试者的生活质量之间的关系。
    理由:接受透析的患者会遇到疾病特定症状的问题。能量减少,不可避免的社会经济问题的出现以及情绪反应的结合加剧了患者面临的压力。透析患者的生活质量可能不高。很少有研究检查香港透析患者的生活质量。需要更多的信息来确定如何可以帮助患者过上更有生产力的生活。
    方法:采用中国透析质量量表。使用便利采样方法从透析中心的门诊诊所招募患者。计算每个项目的分布得分和总得分,得分越低表明透析的负面影响越大。为了比较在每个人口统计学变量的不同组之间获得的平均QoL分数是否存在差异,使用了单向方差分析和Tukey事后分析。皮尔逊的乘积矩相关性用于检验人口统计学变量与总体QoL得分之间的关​​系。
    结果:在分配的180个量表中,返回了164个,响应率为91%。总分的平均值为132.5,标准差为16.68,介于97和179之间。项目的平均分数为3.31。婚姻状况,方式类型和年龄似乎与生活质量没有关系。
    结论:本研究中接受透析的患者经历了多种生理,社会,经济和心理变化。因此,医疗保健服务的优先重点应该是在家庭和社会生活,信息和就业领域提供支持。
  • 【体重指数,糖尿病和年龄对日本突发性血液透析患者长期死亡率的协同影响:一项大型国家透析登记的队列研究。】 复制标题 收藏 收藏
    DOI:10.1053/j.jrn.2019.09.007 复制DOI
    作者列表:Toida T,Sato Y,Ogata S,Wada A,Masakane I,Fujimoto S
    BACKGROUND & AIMS: OBJECTIVES:The relationships among body mass index (BMI), diabetes, age, and all-cause mortality in hemodialysis patients remain unclear. We examined BMI-stratified relationships between diabetes, age, and the risk of long-term mortality in incident hemodialysis patients. METHODS:This is a cohort study. Data were obtained from the national dialysis registry in Japan 2007 that included 35,415 incident hemodialysis patients and 6,061 patients aged ≥20 years with BMI data. Patients were divided into 6 categories according to baseline BMI (low: <18.5, normal: 18.5-25, Obesity: ≥25) and the presence or absence of diabetes. The primary outcome was all-cause mortality during a 5-year follow-up. Hazard ratios were estimated using Cox's model for the relationships among diabetes, BMI categories, and all-cause mortality, and adjusted for potential confounders. Patients with a normal BMI and non-diabetic were the reference category. We also examined the effects of age on these relationships. RESULTS:A total of 6,061 patients, including 3,239 with diabetes, were enrolled. During the follow-up, 31.0% and 30.7% of all and diabetic patients, respectively, died. Cox's regression analysis showed that low BMI, but not obesity, was independently associated with an increased risk of all-cause death in patients with and without diabetes. When patients were divided into 2 groups-younger and older than 60 years-the risk of mortality in both groups was increased in low BMI with diabetes. CONCLUSIONS:Among Japanese incident hemodialysis patients, low BMI increases the risk of all-cause mortality. The markedly high mortality rate in diabetic patients with low BMI regardless of age warrants attention.
    背景与目标: 目的:血液透析患者的体重指数(BMI),糖尿病,年龄和全因死亡率之间的关系尚不清楚。我们检查了糖尿病,年龄和事件性血液透析患者长期死亡风险之间的BMI分层关系。
    方法:这是一项队列研究。数据是从2007年日本国家透析注册中心获得的,其中包括35,415名事件性血液透析患者和6,061名年龄≥20岁的患者的BMI数据。根据基线BMI(低:<18.5,正常:18.5-25,肥胖:≥25)以及是否存在糖尿病将患者分为6类。主要结局是5年随访期间的全因死亡率。使用Cox模型估算了糖尿病,BMI类别和全因死亡率之间的关系,并针对潜在的混杂因素进行了调整。 BMI正常且非糖尿病的患者为参考类别。我们还研究了年龄对这些关系的影响。
    结果:共纳入6061例患者,其中3239例患有糖尿病。在随访期间,所有和糖尿病患者分别死亡31.0%和30.7%。 Cox回归分析显示,低BMI(而非肥胖)与患有和不患有糖尿病的患者全因死亡风险增加独立相关。当将患者分为年龄小于60岁和年龄大于60岁的两组时,在低BMI的糖尿病患者中,两组的死亡风险均增加。
    结论:在日本发生血液透析的患者中,低BMI会增加全因死亡的风险。无论年龄大小,低BMI糖尿病患者的死亡率均显着较高,值得关注。

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