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.
目的 分析持续腹膜透析患者发生腹膜炎的情况及相关因素，降低腹膜透析患者腹膜炎发生率、退出率，提高患者的生存率、生活质量。 方法 回顾分析2011年1月－6月收治的41例在家中行持续非卧床性腹膜透析且发生腹膜炎患者的临床资料，观察腹膜炎的发生率及转归，腹膜炎症状出现后初始的处理，对腹膜炎的诱因进行分析。 结果 41例腹膜透析患者共发生腹膜炎43例次，痊愈35例（85.4%），转血液透析3例（7.3%），死亡3例（7.3%）。在症状出现初期，3例（7.3%）患者继续在家观察，10例（24.4%）患者立即到当地就医，15例（36.6%）患者采用电话咨询，13例（31.7%）患者到腹膜透析中心就诊；18例（43.9%）患者直接将腹膜透析引流液带到医院进行药敏试验。就感染诱因而言，16例（39.0%）患者未严格进行空气消毒，13例（31.7%）患者未严格进行环境清洁，10例（24.4%）患者操作过程存在污染行为。 结论 加强对居家行腹膜透析患者的初次培训、操作指导及监测，可避免腹膜炎的发生，提高患者生活质量。
目的 比较两种不同方法护理腹膜透析患者导管出口处的效果。 方法 选取2008年7月－2009年12月51例患者作为试验组，直接采用聚维酮碘溶液擦洗导管出口处，2007年1月－2008年7月45例患者作为对照组，先用生理盐水清洗遂道口，再用聚维酮碘溶液擦洗导管出口处。比较两组导管出口处感染的情况及操作所需时间。 结果 试验组出口评分系统（ESS）＜2分15例，2～3分34例，≥4分7例；对照组＜2分10例，2～3分24例，≥4分16例；两组差异有统计学意义（P＜0.05）。试验组护士操作时间为（3.0 ± 1.0）min，患者操作时间为（5.0 ± 1.5）min；对照组护士操作时间为（8.0 ± 2.0）min，患者操作时间为（10.0 ± 2.0）min；两组差异有统计学意义（P＜0.05）。 结论 聚维酮碘溶液直接清洗、消毒导管出口处降低了感染的发生率，减少了操作环节和所需物品，缩短了操作时间。
ObjectiveTo reduce the incidence of peritoneal dialysis (PD) catheter complications through a continuous quality improvement (CQI) process. MethodsTwenty-nine patients with catheters inserted (from January 2011 to March 2011) before CQI, and another 41 patients with catheters inserted (between April 2011 and January 2012) after CQI were observed and analyzed. The possible causes of complications of catheter were summarized, and then on the basis of that, a PDCA four-step (plan-do-check-act) method was designed with a view to reducing the incidence of postoperative complications. ResultsPD catheter dysfunction decreased from 6.90% to 2.44%. The incidence of leakage decreased from 44.83% to 9.76%. ConclusionCQI is a useful method to reduce the incidence of postoperative complications of PD catheter in peritoneal dialysis.
ObjectivesTo explore the association between initial peritoneal transport characteristics and patient survival, and to evaluate the risk factors for mortality of continuous ambulatory peritoneal dialysis (CAPD) patients.MethodsBetween January 2011 and December 2016, the patients diagnosed with end stage renal disease commencing CAPD in West China Hospital were enrolled. According to the value of dialysate to plasma ratio for creatinine at 4 hour [D/P Cr (4 h)], CAPD patients were divided into two groups: the lower transport group [D/P Cr (4 h)<0.65] and the higher transport group [D/P Cr (4 h)≥0.65]. The survival of these two groups of peritoneal dialysis patients were plotted using survival analysis. CAPD patient outcomes were analyzed using multivariable Cox proportional hazards regression models.ResultsCompared with the lower transporter (n=246), higher transporter (n=345) were older, and with more peritoneal protein loss, lower level of serum albumin, lower level of hemoglobin, and less ultrafiltration (P<0.001). Higher transport group had lower survival rate compared to those in the lower transport group (P=0.001). The 1-, 3- and 5-year patient survival rates were 97.0%, 83.2%, and 71.7% in the higher transport group, and 98.7%, 93.9%, and 86.1% in the lower transport group, respectively. There was a positive relationship between D/P Cr (4 h) and serum peritoneal protein loss (P<0.001). D/P Cr (4 h) was inversely related to serum albumin (P<0.001). Cox regression analysis demonstrated that lower albumin [hazard ratio (HR)=0.921, 95% CI (0.885, 0.958), P<0.001], presence of cardiovascular disease [HR=1.996, 95% CI (1.256, 3.173), P=0.003], elder age [HR=1.049, 95% CI (1.033, 1.065), P<0.001], lower hemoglobin [HR=0.988, 95% CI (0.976, 1.000), P=0.044] and lower urea clearance index (KT/V)[HR=0.680, 95%CI (0.465, 0.994), P=0.046] could independently predicted mortality with significance in CAPD patients. But higher peritoneal transport was not a risk factor for mortality [HR=1.388, 95%CI (0.829, 2.322), P=0.212] in either model including serum albumin.ConclusionsFor CAPD patients, initial higher transporter had a higher mortality than lower transporter. However, initial higher peritoneal transport was not a risk factor for mortality independent of serum albumin in CAPD patients. Relationship between D/P Cr (4 h) and serum peritoneal protein loss and serum albumin suggests that higher peritoneal transport characteristics might worsen prognosis by lowering serum albumin level at initiation of peritoneal dialysis.
ObjectiveTo investigate the status of roxadustat in patients undergoing maintenance peritoneal dialysis and analyze the factors affecting drug compliance. MethodsPatients with renal anemia undergoing maintenance peritoneal dialysis in West China Hospital of Sichuan University from July 2020 to March 2021 were selected. All patients took roxadustat orally. According to the medication compliance, the patients were divided into good compliance group and poor compliance group. The general information questionnaire and Morisky Medication Adherence Scale-8 (MMAS-8) were used to investigate and analyze the included patients, and their clinical examination indexes were collected. ResultsA total of 100 patients were included, Including 39 cases (39%) in the good compliance group and 61 cases (61%) in the poor compliance group. The average score of medication compliance of roxadustat was 5.19±1.72. Logistic regression analysis showed that drug cognition [odds ratio (OR)=0.099, 95% confidence interval (CI) (0.027, 0.365), P=0.001], medication troubles/complex protocol [OR=5.330, 95%CI (1.567, 18.132), P=0.007], and adverse drug reactions [OR=5.453, 95%CI (1.619, 18.368), P=0.006] were factors affecting patient compliance. Hemoglobin in the good compliance group was lower than that in the poor compliance group (Z=−2.259, P=0.024); there was no significant difference in other clinical examination indexes (P>0.05). ConclusionsThe overall compliance of oral roxadustat in maintenance peritoneal dialysis patients is poor, and the corresponding follow-up management system should be improved. Nurses should provide comprehensive and systematic medication guidance to patients, encourage them to fully understand the clinical manifestations, treatment schemes and prognosis of renal anemia, clarify the time, dose, possible adverse reactions and mitigation methods of roxadustat, etc., and help them to treat the disease with correct cognition and attitude, so as to improve their drug compliance.