Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 （57.6±13.2） years. They were put on dialysis 3-98 （25.2±30.6） months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure，two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was （125.8±33.5）minutes, aortic clamp time was（77.2±25.5） minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.
ObjectiveTo investigate the prevalence of gallbladder stone in dialysis patients, determine whether it is higher than that in the general population, find out the difference of prevalence between hemodialysis and peritoneal dialysis patients, and analyzes the possible causes. MethodsWe analyzed the prevalence of gallbladder stone in 358 dialysis patients (126 cases of hemodialysis and 232 cases of peritoneal dialysis) followed up in our hospital from January 2009 to October 2012. And we compared it with 376 patients diagnosed with chronic kidney disease stage 5 (CKD5) and the general population. ResultsThe prevalence of gallbladder stone in dialysis patients followed up in our hospital was 23.5%, which was higher than CKD5 patients (P=0.002). The prevalence was significantly greater in dialysis patients than that in the general population (P<0.000 5). In the dialysis patients who were younger than sixty years old, the prevalence of gallbladder stone in peritoneal dialysis patients was obviously higher than that in the hemodialysis patients (P<0.05). The albumin level was significantly lower in peritoneal dialysis patients than in the hemodialysis patients. At the same time, cholesterol, low density lipoprotein, and the ratio of low density lipoprotein to high density lipoprotein were much higher with statistical significance. Logistic regression analysis showed that increasing age (OR=2.581, P=0.001), female (OR=2.554, P=0.000), the primary disease (diabetes mellitus) (OR=1.947, P=0.044) and dialysis period (OR=1.000, P=0.006) were risk factors for gallbladder stone in dialysis patients. ConclusionThe prevalence of gallbladder stone in dialysis patients is higher than that in the general population. Peritoneal dialysis patients have more risk factors to get gallbladder stone than hemodialysis patients. Risk factors for gallbladder stone in dialysis patients are increasing age, female, primary disease (diabetes mellitus), dyslipidemia, hypoalbuminemia, long dialysis period and so on.
ObjectiveTo observe whether proteinuria is relate to the decline of residual renal function (RRF) in peritoneal dialysis (PD) patients. MethodsThis is a prospective cohort study including 45 PD patients (underwent PD between January 2011 and January 2013) with a 12-month follow-up. All the patients were divided into 2 groups with respect to the initial proteinuria level: massive proteinuria group A (n=20) and non-massive proteinuria group B (n=25) at baseline. We established regression models to do univariate analysis and multivariate analysis of the relationship between the decline of RRF≥50% of baseline and the indices of age, sex, PD-associated peritonitis, baseliner residual glomerular filtration rate (rGFR), initial proteinuria, and use of ACEI/ARB. ResultsThe primary outcome (RRF>50% of baseline) at 12 months was 65% in group A, and 80% in group B (P<0.05). Based both on the results of univariate and multivariate Cox regression analysis, non-massive proteinuria and higher rGFR at baseline were factors to protect RRF from decline (P<0.05). ConclusionThe study demonstrates that massive proteinuria and lower rGFR at baseline may be associated with a rapid decline of RRF in PD patients. Treatment aimed at reducing albuminuria may lead to protect RRF and improve life quality of patients.
ObjectiveTo investigate whether continuous quality improvement (CQI) measures can reduce the episodes of peritonitis. MethodsWe analyzed the data of 114 cases of peritoneal dialysis related peritonitis from January to December 2011 before applying CQI measures and 72 cases from January and December 2012 after applying CQI measures in West China Hospital. Then we studied the episodes, cause and pathogenic bacteria species of peritonitis in peritoneal dialysis patients. We implemented the process of reducing the episodes of peritonitis by applying PDCA four-step design: plan-do-check-act. ResultsThe episodes of peritonitis were reduced from per 60.8 patient-months (0.197/patient-years) to per 66.6 patient-months (0.180/patient-years) after applying CQI measures. The positive rate of pathogenic bacteria culture was both 50.0% before and after applying CQI measures, in which 66.7% were gram-positive cocci. The curing rate of peritonitis was increased from 57 case/times (76.3%) to 87 case/times (79.2%). Switching to hemodialysis rate was reduced from 17 cases/times (14.9%) to 10 cases/times (13.9%). Death cases was reduced from 9 cases/times (7.9%) to 5 cases/times (6.9%). ConclusionThese results show that the incidence of peritoneal dialysis related peritonitis decreases and the curing rate increases through CQI measures.
Objective To investigate the change of cardiac structure and function in patients with uremia before and after peritoneal dialysis (PD). Methods Eighty three standard continuous ambulatory peritoneal dialysis (CAPD) patients treated between October 2009 and October 2014 were selected in this study. According to the ultrasound cardiogram before and 6 months after the PD, we analyzed the influence of age, diabetes mellitus, dialysis interval, hemoglobin, serum albumin, serum creatinine, serum calcium and phosphate and parathyroid hormone (PTH) on the cardiac structure and function. Results Hemoglobin increased significantly after PD (P <0.01), while albumin and PTH decreased significantly (P <0.01). The changes in creatinine, triglyceride and cholesterol were not statistically significant (P > 0.05). For CAPD patients, cardiac systolic function did no t obviously change before and after dialysis, while the diastolic function improved obviously after dialysis. Conclusion PD may improve cardiac diastolic function of CAPD patients.
ObjectiveTo investigate the clinical characteristics, treatment and outcomes of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis.MethodsWe retrospectively analyzed the clinical data of patients with Acinetobacter baumannii peritoneal dialysis-related peritonitis in the First Affiliated Hospital of Airforce Military University from January 2011 to December 2018. The clinical baseline data, treatment process, microbiological data, antibiotic susceptibility test of the bacterial isolates and outcomes were analyzed.ResultsA total of 10 patients were enrolled, including 4 males and 6 females. The average age of all patients was (44.90±17.03) years, the average age of peritoneal dialysis was (21.70±17.06) months. Seven cases were infected for the first time, and 3 cases were reinfected. The infections were mainly caused by mechanical failure of catheter connection system (3 cases) or enterogenous infection (3 cases). The main symptoms were abdominal pain (10 cases), fever (7 cases) and diarrhea (3 cases). Empirical anti-infective treatment was given after admission, only 1 case was effective, and the treatment of the other 9 cases were adjusted according to the results of drug sensitivity. Acinetobacter baumannii was sensitive to cefoperazone, carbapenem (meropenem, imipenem), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin) and polymyxin. Only one case was resistant to ceftazidime. Among the 10 patients, 8 cases were cured (continued peritoneal dialysis), 1 case died, and 1 case dropped out from peritoneal dialysis to hemodialysis.ConclusionsAcinetobacter baumannii peritoneal dialysis-related peritonitis in this hospital is mainly caused by mechanical disturbance of catheter connection system or enterogenic infection. Appropriate measures, including aseptic standard operation, follow-up and effective anti-infective treatment, should be taken to decrease the incidence and mortality of Acinetobacter baumannii peritoneal dialysis-related peritonitis.
ObjectiveTo investigate the status of exit-site care in patients undergoing peritoneal dialysis, and analyze the relationship between exit-site care practice and exit-site infection.MethodsThe patients undergoing peritoneal dialysis in Nanfang Hospital, Southern Medical University between January and October 2019 were recruited by convenience sampling method. The Exit-site Schaefer Scale was used to diagnose the occurrence of exit-site infection. According to the guidelines of the International Society of Peritoneal Dialysis and relevant research, a questionnaire was developed to investigate the status of exit-site care in all peritoneal dialysis patients. Logistic regression analysis was used to analyze the influence of care practice on exit-site infection.ResultsA total of 208 peritoneal dialysis patients were recruited. There were 39 patients with (totally 43 times of) exit-site infections, with an exit-site infection incidence of 0.06 episodes per patient-year. The main bacteria were Staphylococcus aureus (30.2%) and Pseudomonas aeruginosa (16.3%). Of the 39 infected patients, 8 (20.5%) had peritonitis and 3 (7.7%) had been infected more than once. The exit-site Schaefer score of the 208 patients was 3.14±2.75. Of the 208 patients, 204 (98.1%) had received training of exit-site care from nurses, 166 (79.8%) could wash their hands and wear masks as required, 196 (94.2%) covered dressings on the exit site, and 184 (88.5%) fixed catheters, but the application of antibiotic ointment did not follow the latest guidelines. The logistic regression analysis revealed that the history of redness and swelling at the exit site [odds ratio (OR)=7.926, 95% confidence interval (CI) (2.367, 26.535), P=0.001] and the history of traction-associated bleeding [OR=5.750, 95%CI (1.878, 17.610), P=0.002] were risk factors of exit-site infection.ConclusionsExit-site infection is common in peritonealdialysis patients. Most patients can perform the exit-site care as required, but the care content is yet to be updated. Nursing staff should improve the training content according to the latest guidelines, strengthen the exit-site assessment, follow-up, and retraining, treat the redness and swelling at the exit site timely, and tell the patients to pay attention to catheter fixation and avoiding excessive traction, to prevent the exit-site infection and the further development of peritonitis.
ObjectiveTo systematically review the pharmacoeconomics of hemodialysis and peritoneal dialysis in patients with end-stage renal disease. MethodsCRD, NICE, CADTH, HITAP, NECA, IWIQG, ISPOR, PubMed, EMbase, CNKI, and WanFang Data databases were electronically searched to collect pharmacoeconomic studies on the hemodialysis and peritoneal dialysis in the treatment of end-stage renal disease from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, the conclusions of research models, pharmacoeconomic evaluation results, and sensitivity analysis were summarized. ResultsA total of 15 pharmacoeconomic studies were included, among which 9 studies used the Markov state transition model, and 6 were observational studies. From the perspective of health outcomes, peritoneal dialysis had cost-effectiveness advantages over hemodialysis in the treatment of end-stage renal disease under the condition of a clear threshold. ConclusionsCurrent evidence shows that compared with hemodialysis, peritoneal dialysis has certain cost-effectiveness advantages in the treatment of end-stage renal disease. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.