Dumler F, Schmidt R J, Cruz C, Faber M, Zasuwa G
Division of Nephrology & Hypertension, Henry Ford Hospital, Detroit, MI.
Adv Perit Dial. 1992;8:105-7.
A large end stage renal failure population treated by chronic ambulatory peritoneal dialysis (CAPD) was examined for rates of infection, CAPD modality failure and patient survival (N = 347). Nearly half were considered high risk for survival for reasons of age (39% older than 60 years), diabetes mellitus (33%), hemodialysis access failure (10%), poor cardiopulmonary reserve (16%) or technical challenges (30% had morbid obesity, history of abdominal aortic aneurysm repair or multiple abdominal surgeries). Hence, CAPD was often initiated by default rather than choice in the 347 patients studied (mean age: 51 +/- 17 years). Infections greatly outnumbered technical failures as grounds for cessation of CAPD. Over 5521 patient-months, 51% of patients developed infection with peritonitis predominating (80%) when compared to exit site infections (20%). The frequency of infections was 1.9 mean episodes per patient; however, 55% of these patients had only one episode of peritonitis. A rate of 0.75 infections per patient per year was seen with an average interval of 16 months between infections. Technique and patient survival rates at 4 years were 50% and 61% respectively. High risk status does not preclude successful CAPD and should not preclude its implementation.
对一大群接受持续性非卧床腹膜透析（CAPD）治疗的终末期肾衰竭患者进行了感染率、CAPD治疗方式失败率和患者生存率的检查（N = 347）。近一半患者因年龄（39%年龄大于60岁）、糖尿病（33%）、血液透析通路失败（10%）、心肺储备功能差（16%）或技术难题（30%患有病态肥胖、腹主动脉瘤修复史或多次腹部手术）而被认为生存风险高。因此，在347例研究患者中（平均年龄：51±17岁），CAPD往往是默认开始而非患者选择。作为停止CAPD的原因，感染的数量远远超过技术故障。在超过5521个患者月的时间里，51%的患者发生感染，其中腹膜炎占主导（80%），而出口处感染占20%。感染频率为每位患者平均1.9次发作；然而，这些患者中有55%仅发生过一次腹膜炎。每位患者每年的感染率为0.75次，两次感染之间的平均间隔为16个月。4年时的技术生存率和患者生存率分别为50%和61%。高风险状态并不排除CAPD治疗成功，也不应排除其实施。
