Min F, Tarlo S M, Bargman J, Poonai N, Richardson R, Oreopoulos D
University Health Network, Toronto, Ontario, Canada.
Adv Perit Dial. 2000;16:129-33.
Peritoneal dialysis (PD) and hemodialysis (HD) are both common forms of dialysis for patients with end-stage renal disease. A few case reports have suggested that cough is associated with PD. From 1991 to 1998, 17 patients being treated with PD at the Toronto Western Hospital demonstrated persistent cough severe enough for referral to a respirologist. Causes of cough, often more than one cause per patient, included asthma, post-nasal drip, gastroesophageal reflux disease (GERD), chronic obstructive pulmonary disease, congestive heart failure, allergic rhinitis, pleural effusion, and respiratory infection. The aim of this cross-sectional study was to establish the prevalence of cough among PD patients, to determine if PD patients more commonly have a dry persistent cough than do HD patients, and, if the latter case is true, the possible reasons for it. A detailed survey of 92 PD patients and 91 HD patients was conducted in 1998 and 1999 at the University Health Network. Survey questions inquired about patient respiratory symptoms since onset of dialysis. Charts were reviewed to obtain information on use of medications possibly relevant to cough. In the PD and HD groups, 52% and 23% were females (p = 0.001), and the mean ages were 59.1 and 60.1 years, respectively. Angiotensin converting enzyme (ACE) inhibitors had been taken by 65% (PD) and 55% (HD) of patients, and beta-blocking medications by 43% (PD) and 51% (HD). Since initiation of dialysis--mean 2.7 years (PD) and 3.7 years (HD)--22% of PD patients reported persistent cough versus 7% of HD patients (p = 0.003). Although no significant association was seen between cough and self-reported heartburn in HD patients (p = 0.439), a significant association between cough and self-reported heartburn was seen in PD patients: 67% of PD patients with persistent cough reported heartburn versus 29% of those without cough (p = 0.008). The findings suggest that GERD and associated cough are more common in PD patients than in HD patients, perhaps owing to increases in intra-abdominal pressure from the peritoneal dialysate.
腹膜透析（PD）和血液透析（HD）都是终末期肾病患者常见的透析方式。一些病例报告表明咳嗽与腹膜透析有关。1991年至1998年期间，多伦多西部医院17例接受腹膜透析治疗的患者出现持续性咳嗽，严重程度足以促使他们转诊至呼吸科医生处。咳嗽的原因往往不止一种，每位患者通常有多种病因，包括哮喘、鼻后滴漏、胃食管反流病（GERD）、慢性阻塞性肺疾病、充血性心力衰竭、过敏性鼻炎、胸腔积液和呼吸道感染。这项横断面研究的目的是确定腹膜透析患者咳嗽的患病率，确定腹膜透析患者是否比血液透析患者更常出现持续性干咳，如果是后一种情况，找出可能的原因。1998年和1999年，在大学健康网络对92例腹膜透析患者和91例血液透析患者进行了详细调查。调查问题询问了患者自透析开始以来的呼吸道症状。查阅病历以获取有关可能与咳嗽相关药物使用情况的信息。在腹膜透析组和血液透析组中，女性分别占52%和23%（p = 0.001），平均年龄分别为59.1岁和60.1岁。65%（腹膜透析组）和55%（血液透析组）的患者服用过血管紧张素转换酶（ACE）抑制剂，43%（腹膜透析组）和51%（血液透析组）的患者服用过β受体阻滞剂。自开始透析以来（腹膜透析组平均2.7年，血液透析组平均3.7年），22%的腹膜透析患者报告有持续性咳嗽，而血液透析患者为7%（p = 0.003）。虽然在血液透析患者中咳嗽与自我报告的烧心之间未发现显著关联（p = 0.439），但在腹膜透析患者中咳嗽与自我报告的烧心之间存在显著关联：67%有持续性咳嗽的腹膜透析患者报告有烧心，而无咳嗽的患者中这一比例为29%（p = 0.008）。研究结果表明，胃食管反流病及相关咳嗽在腹膜透析患者中比在血液透析患者中更常见，这可能是由于腹膜透析液导致腹腔内压力升高所致。
