Department of Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-ku, Nagoya, Japan.
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Clin Exp Nephrol. 2011 Oct;15(5):727-737. doi: 10.1007/s10157-011-0471-8. Epub 2011 Jun 21.
In Japan, the population of patients on peritoneal dialysis (PD) is <4% of the total number of patients with end-stage renal disease. Few systemic analyses have examined why the number of PD patients has not increased in Japan. We organized a registry to analyze PD patients and retrospectively investigated 561 PD patients (about 5% of all Japanese PD patients) from 13 hospitals in the Tokai area for 3 years from 2005.
We investigated background, physical status, laboratory data, status of PD therapy, and the occurrence of PD-related complications, and analyzed reasons for withdrawal from PD.
Nutrition did not change significantly during our observation. Urinary volume showed continued decreases after the introduction period. In contrast, PD fluid demand and ultrafiltration volume were significantly increased. For calcium metabolism, multiple phosphate binders were required after the second year of PD therapy. Early drop-out within 3 years after starting PD therapy comprised 50.9% of total withdrawals, with PD-related peritonitis as the most common reason, mainly caused by Gram-positive organisms. Incidence of peritonitis was 42.8 months/patient. Culture-negative results were obtained for 32% of peritonitis cultures. Diabetes affects the prognosis of PD therapy, but not the incidence of peritonitis.
We examined clinical status over 3 years in the Tokai area. The results suggest that the incidence of peritonitis needs to be decreased to prevent early withdrawal of PD patients. Education systems to decrease the incidence of peritonitis and techniques to decrease culture-negative results might be important for improving the prognosis of peritonitis.
在日本,腹膜透析(PD)患者人数占终末期肾病患者总数的<4%。很少有系统分析研究过为什么日本 PD 患者人数没有增加。我们组织了一个登记处来分析 PD 患者,并对来自东海地区 13 家医院的 561 名 PD 患者(约占日本所有 PD 患者的 5%)进行了为期 3 年的回顾性研究,从 2005 年开始。
我们调查了背景、身体状况、实验室数据、PD 治疗状况以及 PD 相关并发症的发生情况,并分析了退出 PD 的原因。
在我们的观察期间,营养状况没有明显变化。在引入 PD 治疗后的时期,尿排量持续减少。相比之下,PD 液需求和超滤量显著增加。对于钙代谢,在 PD 治疗的第二年开始需要使用多种磷酸盐结合剂。在开始 PD 治疗后的 3 年内早期退出占总退出的 50.9%,PD 相关腹膜炎是最常见的原因,主要由革兰氏阳性菌引起。腹膜炎的发生率为 42.8 个月/患者。腹膜炎培养中 32%的结果为阴性。糖尿病影响 PD 治疗的预后,但不影响腹膜炎的发生率。
我们在东海地区检查了 3 年的临床状况。结果表明,需要降低腹膜炎的发生率,以防止 PD 患者早期退出。减少腹膜炎发生率的教育系统和降低阴性培养结果的技术可能对改善腹膜炎的预后很重要。