Department of Surgery, Wan Fang Hospital, Taipei Medical University, No. 111 Sec. 3, Xinlong Rd, Taipei 11696, Taiwan.
Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, No. 111 Sec. 3, Xinlong Rd, Taipei 11696, Taiwan.
Medicina (Kaunas). 2024 Oct 21;60(10):1723. doi: 10.3390/medicina60101723.
Chronic kidney disease (CKD) poses a significant global health challenge, necessitating effective renal replacement therapies. Peritoneal dialysis (PD) offers a patient-friendly, home-based alternative to hemodialysis. The Stepwise Initiation of Peritoneal Dialysis (SIPD) method, used in the SPD group and involving a gradual introduction of PD, presents a potential advantage over traditional protocols, yet the scientific literature on its efficacy and safety is limited. : We conducted a retrospective analysis of 39 end-stage renal disease patients undergoing SIPD and 78 patients receiving conventional PD (CPD) at a single center from 1 January 2010 to 31 December 2023. Patients were matched for age and sex. Surgical techniques, early and late complications, infection rates, and catheter survival were evaluated. Data were analyzed using statistical methods, including the chi-square test, -test, and negative binomial regression. : The mean break-in period was significantly more extended for the SPD group (176.05 ± 154.39 days) compared to the CPD group (26.87 ± 58.45 days). Early complications were similar between groups, but late complications, including peritonitis, were significantly higher in the CPD group. The SPD group experienced fewer infection events (28 vs. 80, = 0.043). Median catheter survival times were 1486 days for SPD and 1774 days for CPD, with no statistical difference. Age was a significant factor in peritonitis incidence, increasing with age in both groups. : Our study suggests that SPD may reduce the incidence of catheter-related infections and peritonitis compared to CPD. The extended break-in period in SPD could enhance tissue healing and reduce biofilm formation, thereby contributing to fewer infectious complications. Despite these findings, no significant difference in overall catheter survival was observed. Further multi-center studies with larger sample sizes are recommended to confirm these results and explore the economic impact of SPD vs. CPD.
慢性肾脏病（CKD）是一个全球性的健康挑战，需要有效的肾脏替代治疗。腹膜透析（PD）为血液透析提供了一种患者友好、家庭为基础的替代方案。逐步开始腹膜透析（SIPD）方法在 SPD 组中使用，涉及 PD 的逐步引入，与传统方案相比具有潜在优势，但关于其疗效和安全性的科学文献有限。：我们对 2010 年 1 月 1 日至 2023 年 12 月 31 日在单一中心接受 SIPD 的 39 例终末期肾病患者和 78 例接受传统 PD（CPD）的患者进行了回顾性分析。患者按年龄和性别匹配。评估了手术技术、早期和晚期并发症、感染率和导管生存率。使用统计方法分析数据，包括卡方检验、t 检验和负二项回归。：SIPD 组的突破期明显延长（176.05±154.39 天），而 CPD 组为 26.87±58.45 天。两组早期并发症相似，但 CPD 组晚期并发症，包括腹膜炎，明显更高。SIPD 组感染事件较少（28 例与 80 例，=0.043）。SIPD 组的导管中位生存时间为 1486 天，CPD 组为 1774 天，无统计学差异。年龄是腹膜炎发生率的一个重要因素，两组的发病率都随年龄增加而增加。：我们的研究表明，与 CPD 相比，SIPD 可能降低导管相关感染和腹膜炎的发生率。SIPD 中延长的突破期可以增强组织愈合，减少生物膜形成，从而减少感染性并发症。尽管有这些发现，但观察到总体导管生存时间没有显著差异。建议进行更多的多中心研究，以确认这些结果，并探讨与 CPD 相比，SIPD 的经济影响。
