Terada Kohsuke, Aratani Sae, Hirama Akio, Kashiwagi Tetsuya, Sakai Yukinao
Department of Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Int J Nephrol Renovasc Dis. 2021 Feb 11;14:33-40. doi: 10.2147/IJNRD.S295948. eCollection 2021.
Peritoneal dialysis (PD)-related peritonitis and lower limb ulcer are the important complications in patients undergoing PD. Although the association between lower limb ulcer and peritonitis in patients undergoing PD is unclear, based on our clinical experience and the clinical importance of the complications in patients undergoing PD, we hypothesized that lower limb ulcer is associated with peritonitis in patients on PD.
In this single center, retrospective cohort study, we studied 87 patients who started undergoing PD at our hospital from April 2015 to March 2020. We compared these 8 patients with lower limb ulcer with the other 79 patients without lower limb ulcer. We compared between the patients in the objection period of this study about peritonitis using Log rank test, and used the unpaired -test and Fisher's exact test to compare the clinical factors between the two groups. Moreover, we used univariate and multivariate logistic regression analyses to study the association of PD-related peritonitis with the clinical factors.
The period developed first peritonitis of the patients on PD with lower limb ulcer was significant shorter than those without lower limb ulcer in Log rank test (P = 0.011). The Fisher's exact test and unpaired -test showed that the difference in the prevalence of PD-related peritonitis (P = 0.009), peritonitis/patient years (P = 0.036), the BMI (P = 0.007) and icodextrin (P = 0.001) were significant. Lower limb ulcer had significant associations with peritonitis in patients on PD in both univariate [odds ratio (OR) 8.461, 95% confidence interval (CI) 1.854-45.60, P = 0.006] and multivariate [OR 7.169, 95% CI 1.519-39.480, P = 0.013] logistic regression analysis.
In conclusion, lower limb ulcer may be associated with peritonitis in patients undergoing PD. Further large-scale, prospective studies are required to confirm these results.
腹膜透析(PD)相关腹膜炎和下肢溃疡是接受PD治疗患者的重要并发症。虽然PD患者下肢溃疡与腹膜炎之间的关联尚不清楚,但基于我们的临床经验以及这些并发症对PD患者的临床重要性,我们推测PD患者下肢溃疡与腹膜炎有关。
在这项单中心回顾性队列研究中,我们研究了2015年4月至2020年3月在我院开始接受PD治疗的87例患者。我们将这8例有下肢溃疡的患者与其他79例无下肢溃疡的患者进行了比较。我们使用对数秩检验比较了本研究观察期内患者之间的腹膜炎情况,并使用不成对t检验和Fisher精确检验比较了两组之间的临床因素。此外,我们使用单因素和多因素逻辑回归分析研究PD相关腹膜炎与临床因素的关联。
对数秩检验显示,有下肢溃疡的PD患者首次发生腹膜炎的时间显著短于无下肢溃疡的患者(P = 0.011)。Fisher精确检验和不成对t检验表明,PD相关腹膜炎的患病率(P = 0.009)、腹膜炎/患者年数(P = 0.036)、体重指数(P = 0.007)和艾考糊精(P = 0.001)的差异具有统计学意义。在单因素[比值比(OR)8.461,95%置信区间(CI)1.854 - 45.60,P = 0.006]和多因素[OR 7.169,95%CI 1.519 - 39.480,P = 0.013]逻辑回归分析中,下肢溃疡与PD患者的腹膜炎均有显著关联。
总之,PD患者下肢溃疡可能与腹膜炎有关。需要进一步进行大规模的前瞻性研究来证实这些结果。