Chow Kai Ming, Szeto Cheuk Chun, Leung Chi Bon, Kwan Bonnie Ching-Ha, Law Man Ching, Li Philip Kam-Tao
Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
Perit Dial Int. 2005 Jul-Aug;25(4):374-9.
We studied the clinical characteristics that influence the risk of dialysis-related peritonitis complication in incident Chinese patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
A single center, retrospective, observational cohort study was carried out to examine the risk factors of developing a first episode of dialysis-related peritonitis.
Between 1995 and 2004, 246 incident CAPD patients were recruited for analysis. During the study period of 897.1 patient-years, 85 initial episodes of peritonitis were recorded. The median peritonitis-free time for diabetic subjects was significantly worse than for nondiabetic subjects (49.0 +/- 10.5 vs 82.3 +/- 12.6 months, p = 0.0019). The difference was due mainly to a higher likelihood of developing peritonitis with gram-negative organisms in patients with diabetes mellitus (p = 0.038). Low serum albumin concentration was also associated with worse peritonitis-free survival. There was a nonsignificant trend toward an increased risk for peritonitis in the group of patients with cerebrovascular disease. According to multivariate Cox proportional hazards model for the analysis of time to first peritonitis episode, the two independent risk factors were presence of diabetes mellitus and initial serum albumin concentration. In particular, diabetes mellitus was associated with a hazard ratio of 1.50 and a 95% confidence interval of 1.05 - 2.40 (p = 0.030) to develop an initial peritonitis. Lower serum albumin level at the start of CAPD was a significant predictor of peritonitis, with hazard ratio of 1.67 for every decrease of 10 g/L, and 95% confidence interval 1.08 - 2.60 (p = 0.021).
Our results confirm the susceptibility of diabetic CAPD and hypoalbuminemic patients to peritonitis, and highlight the role of further studies in reducing this complication.
我们研究了影响中国新接受持续性非卧床腹膜透析（CAPD）患者发生透析相关腹膜炎并发症风险的临床特征。
开展了一项单中心、回顾性、观察性队列研究，以检查首次发生透析相关腹膜炎的危险因素。
1995年至2004年期间，招募了246例新接受CAPD的患者进行分析。在897.1患者年的研究期间，记录了85例腹膜炎初始发作。糖尿病患者无腹膜炎的中位时间显著短于非糖尿病患者（49.0±10.5 vs 82.3±12.6个月，p = 0.0019）。这种差异主要是由于糖尿病患者发生革兰氏阴性菌引起的腹膜炎的可能性更高（p = 0.038）。低血清白蛋白浓度也与无腹膜炎生存期较差相关。脑血管疾病患者组发生腹膜炎的风险有增加的非显著趋势。根据多变量Cox比例风险模型分析首次腹膜炎发作时间，两个独立的危险因素是糖尿病的存在和初始血清白蛋白浓度。特别是，糖尿病发生初始腹膜炎的风险比为1.50，95%置信区间为1.05 - 2.40（p = 0.030）。CAPD开始时较低的血清白蛋白水平是腹膜炎的显著预测因素，每降低10 g/L风险比为1.67，95%置信区间为1.08 - 2.60（p = 0.021）。
我们的结果证实了糖尿病CAPD患者和低白蛋白血症患者易患腹膜炎，并强调了进一步研究在减少这种并发症方面的作用。
