Crepaldi Carlo, Possidoni Alessandro, Caputo Flavia, Dell'Aquila Roberto, Galli Emilio Giulio, Costanzo Anna Maria, Gualberti Giuliana, di Luzio Paparatti Umberto, Russo Roberto
Dialisi e Trapianto Renale, ULSS6 di Vicenza Ospedale San Bortolo U.O.C. Nefrologia, Vicenza, Italy.
AbbVie Italy Srl, Campoverde di Aprilia (LT).
Clin Kidney J. 2018 Apr;11(2):275-282. doi: 10.1093/ckj/sfx092. Epub 2017 Sep 12.
In Italy, few studies have examined the clinical management of peritoneal dialysis (PD) patients, resulting in a lack of information and awareness.
A total of 378 PD patients (64.7 ± 14.3 years, 58.9% males) were enrolled across 15 centres in a 12-month retrospective and 6-month prospective study. The primary objective was to evaluate the achievement of Kidney Disease Outcomes Quality Initiative and Kidney Disease Improving Global Outcomes guidelines on recommended target values for anaemia, high blood pressure and mineral metabolism. Comorbidities, hospitalizations, treatment and quality of life were also assessed.
Frequent comorbidities included hypertension (87.8%) and cardiovascular disease (39.7%). Peritonitis was the leading cause of hospitalization [12 admissions per 100 person-years (95% confidence interval 9.3-15.2)]. At 6 months, anaemia corrected by erythropoiesis-stimulating agents was observed in 30% of patients and 73% received erythropoiesis-stimulating agents. Systolic and diastolic blood pressures were recorded in 50% and 20% of patients, respectively. Sixty-four percent of echocardiograms revealed left ventricular hypertrophy and 30% of patients had vitamin D <10 ng/mL. Medication to treat intact parathyroid hormone (PTH) included calcitriol (36.3%), paricalcitol (29.2%), cholecalciferol (23.6%) and cinacalcet (21.5%). In a subgroup of patients matched for baseline PTH treated for 1 year, a significant reduction in PTH with paricalcitol (-41%; P < 0.001) but not cinacalcet (+2%; P = 0.63) was observed. Comparison of quality of life domains revealed significant differences for symptoms (P = 0.049), cognitive function (P = 0.019) and social support (P = 0.04) (baseline versus 6 months).
Hypertension and cardiovascular diseases were frequent comorbidities and peritonitis was the leading cause of hospitalization. Secondary hyperparathyroidism and anaemia were common, thus necessitating frequent monitoring of PTH, calcium, phosphorus and haemoglobin.
在意大利，很少有研究对腹膜透析（PD）患者的临床管理进行调查，导致信息和认知的缺乏。
在12个月的回顾性研究和6个月的前瞻性研究中，共纳入了来自15个中心的378例PD患者（64.7±14.3岁，男性占58.9%）。主要目的是评估肾脏病预后质量倡议（KDIGO）和改善全球肾脏病预后组织（KDIGO）关于贫血、高血压和矿物质代谢推荐目标值的指南的达成情况。还评估了合并症、住院情况、治疗和生活质量。
常见的合并症包括高血压（87.8%）和心血管疾病（39.7%）。腹膜炎是住院的主要原因[每100人年12次入院（95%置信区间9.3 - 15.2）]。在6个月时，30%的患者使用促红细胞生成素刺激剂纠正了贫血，73%的患者接受了促红细胞生成素刺激剂治疗。分别有50%和20%的患者记录了收缩压和舒张压。64%的超声心动图显示左心室肥厚，30%的患者维生素D<10 ng/mL。治疗完整甲状旁腺激素（PTH）的药物包括骨化三醇（36.3%）、帕立骨化醇（29.2%）、胆钙化醇（23.6%）和西那卡塞（21.5%）。在一组基线PTH匹配且治疗1年的患者亚组中，观察到帕立骨化醇使PTH显著降低（-41%；P<0.001），而西那卡塞则无显著变化（+2%；P = 0.63）。生活质量领域的比较显示，症状（P = 0.049）、认知功能（P = 0.019）和社会支持（P = 0.04）（基线与6个月）存在显著差异。
高血压和心血管疾病是常见的合并症，腹膜炎是住院的主要原因。继发性甲状旁腺功能亢进和贫血很常见，因此需要频繁监测PTH、钙、磷和血红蛋白。
