ObjectivesTo systematically review the influence for catheter mechanical dysfunction of different peritoneal dialysis catheterization methods.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched to collect randomized controlled trials (RCTs) and cohort studies on comparisons of different peritoneal dialysis catheterization from inception to March 31st, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed by using ADDIS 1.16.6 software.ResultsA total of 33 studies (9 RCTs and 24 cohort studies) involving 3 301 patients were included. Network meta-analysis showed that the incidence of catheter mechanical dysfunctionwas the least and had statistically significant difference compared with that in percutaneous catheterization (OR=3.60; 95%CI, 1.64 and 15.38) and open surgery catheterization (OR=5.86; 95%CI, 2.68 and 14.53). Percutaneous catheterization was superior to open surgery catheterization, but there was no significant difference.ConclusionsLaparoscopic catheterization may be the best technique for catheter insertion in peritoneal dialysis considering catheter dysfunction. Each technology has its own advantages. Choice of insertion method should be based on the characteristics of both the patient and the insertion techniques.
Objective To provide evidence for clinical practice by assessing the effectiveness and safety of Ligustrazine for primary nephrotic syndrome. Methods We searched MEDLINE (1966.1-2002.12), EMBASE (1975-2002.12), CBM (1979.1-2002.12), Chinese Evidence-Based Medicine/Cochrane Centre Database (CEBM/CCD, Issue 4, 2002) , Cochrane Library, and SCI (1985-2002.12) and handsearched 15 kinds of journals (including Journal of Nephrology et al) (1980-2003.2) for the randomized controlled trials (RCTs).Jadad score was used to assess the quality of RCTs. The outcomes of short term and long term effectiveness, and adverse effect of the treatment were analyzed by RevMan 4.1. Results Thirteen RCTs involving 675 patients met inclusion criteria. Jadad scores of each trial was 1 point. Meta-analysis of 4 studies showed that Ligustrazine had significant better short term effect [OR 4.24, 95% confidence interval (CI) 1.76 to 10.19], lowered 24 h urine protein (OR -0.36, 95% CI -0.71 to -0.02), improved renal function [ creatinine level in children group: (OR -3.34, 95% CI -5.25 to -1.43), creatinine level in adult group: (OR -48.29, 95% CI -68.24 to -28.35)], and increased serum albumin level (OR 3.61, 95% CI 2.61 to 4.61). Whether Ligustrazine had long term side effect was not confirmed. No adequate evidence showed that Ligustrazine could reduce the relapse rate of primary nephrotic syndrome. Conclusions Meta-analysis of low quality RCTs suggest that Ligustrazine does work in primary nephritic syndrome in short term observation. No adequate evidence shows that Ligustrazine has severe side effect or can reduce the relapse rate of primary nephrotic syndrome. We can’t draw a conclusion that Ligustrazine is safe in primary nephrotic syndrome treatment.A rigorously designed, randomized, double blind, placebo controlled trial are required.
Objective To assess the efficacy and safety of Rhubarb and adjunvent drugs for chronic renal failure. Methods Electronic database searching including Medline, Cochrane Library and CBM from 1980 to Dec., 2000 was performed. Handsearching was applied to 15 kinds of nephrological and traditional Chinese medicine journals such as Chinese Journal of Nephology. Randomised and quasi-randomised trials concerning Rhubarb treatment for CRF were selected. The selected studies were assessed for their methodological quality and the data were extracted to perform the Meta-analysis. Results Eighteen randomised and quasi-randomised trials including 1 322 patients met the inclusion criteria, but their methodological quality was low. Compared to non-specific treatment, Rhubarb showed significant positive effects on relieving symptoms, lowering serum creatinine, improving HGB and adjusting disturbance of lipid metabolism. The effect of Rhubarb on reducing the number of death [OR 0.15, 95%CI (0.06 to 0.36), P=0.000] and the number of progressing into end-stage renal disease [OR 0.38, 95%CI (0.09 to1.64), P=0.19] was not confirmed because of the small sample size. Conclusions Rhubarb may have the same effect on CRF in the short-term observation. But its long-term effect of delaying the progression of CRF is still unclear. Well designed, randomised, double-blinded, placebo-controlled trials with long-term follow up and clinical related outcomes are warranted.
To diagnose and treat a patient with rare lupus erythematosus-like syndrome and antineutrophil cytoplasmic antibodies (ANCA) positive vasculitis with graves’ disease by applying the approach of evidence-based medicine. Clinical problems were raised based on the patient condition and PubMed (1966-2003), CBM (1978-2003), EMBASE (1974-2003) were searched for the related information. We found that the best explaination for this case was antithyroid drugs’ side effect, and the patient was obvious better after treatment.
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.
Objective To investigate the efficacy and safety of ultrasound-guided TAP block for the anesthesia in peritoneal dialysis (PD) catheter implantation. Methods Patients with end-stage renal disease who intended to receive PD catheter implantation in the West China Hospital of Sichuan University were enrolled from April 2015 to February 2016. Those who met the inclusion criteria were randomly divided into two groups: the local filtration anesthesia (LF) group and the TAP group. The two groups got the ultrasound guided TAP block (The LF group got a shame TAP block by making the skin wheal and just inserting the needle into the TAP with the guidance of ultrasound), then the LF group received local filtration anesthesia twenty minutes later, with the TAP group had sham LF anesthesia by injection of saline at the incision subcutaneously. The anesthetist generated the random allocation sequence and performed all TAP/sham blocks according to the allocation of each patient. The patients, investigators were all blind to the allocation. The follow-up time was 3 months. The primary outcomes were the rate of alteration to general anesthesia and the VAS score during and after the surgery. The dosages of sufentanil for analgesia during and after were recorded. The satisfaction to the effect anesthesia by the operation doctors, PD catheter related complications and adverse events related to TAP block or anesthetic agent were also recorded. Statistic analysis was conducted using SPSS 19.0 software. Results A total of 36 patients were included, 12 cases in the LF group and 24 cases in the TAP group. The rate of alteration to general anesthesia in the TAP group was 4.12% and was significantly lower than that in the LF group (33.3%) (P=0.034). The VAS scores at the time points of incision of skin, division of subcutaneous tissue and anterior rectus sheath, opening the peritoneum, insertion of PDC, suture of skin, 2 hours and 24 hours after operation were significantly lower in the TAP group compared to the LF group (P values=0.001, 0.037, 0.000, 0.001, 0.029, 0.035, and 0.000, respectively). The TAP group consumed less sufentanil during the operation and showed a higher satisfaction of the operation doctors. There were no significant differences in the PD catheter related complications and adverse events between the two groups. Conclusion The ultrasound-guided TAP block can be an effective and safe anesthesia method for PD catheter implantation. Because of the limitation of small sample size of this study, a multiple center study with larger sample size is suggested.
Objective To assess the cost-utility study of renal transplantation compared with nemodialysis (HD) and peritoneal dialysis (PD). Methods A prospective study of end-stage renal disease patients was followed up for 3 months after renal replacement therapy. The study population included 196 patients (renal transplant [RT] n=63, hemodialysis [HD] n=82 and continious ambulatory peritoneal dialysis [CAPD] n=51) from 6 hospitals of Sichuan province. Health-related quality of life was assessed by using the WHOQOL-BRIEF questionnaire. Utility scores were obtained so as to conduct CUA (cost-utility analysis). Costs were collected from financial department and by patient interview. Results The utility values were 0.539 9± 0.013 for RT, 0.450 8± 0.014 for HD, 0.512 2±0.099 for CAPD, respectively. The mean direct cost of the first three months of renal transplant was significantly higher than dialysis (RT and CAPD). Over 3 months, the average cost per quality-adjusted life year (QALY) for patients after CAPD was lower than HD and RT. Compared to HD, incremental cost analysis showed that CAPD was more ecnomical than RT. Sensitive analysis showed that CAPD was more effective than RT when ΔQALY varied in the limit of 95% confidence interval. However, the cost-utility of RT vs HD and CAPD vs HD was varied with ΔQALY level. Conclusions Cost-utility analysis showed that CAPD was a more favorable cost-utility ratio when compared to RT at early stage RT vs HD and CAPD vs HD, but which cost-utility ratio is better, we can not draw a certain conclusion.