Effect Of Early Peritoneal Dialysis Combined With Hemodialysis In The Treatment Of End-stage Renal Disease

Background End-stage renal disease is one of the major chronic diseases in China.At present,the incidence of chronic kidney disease?CKD?in our country is about 11%,and a variety of chronic kidney disease most will eventually progress to end-stage kidney disease namely uremia period,with many complications and high mortality,the more must maintain life through renal replacement therapy.Now,renal replacement therapy is mainly kidney transplantation and blood purification?peritoneal dialysis,hemodialysis?.However,due to the constrainsts of insufficient kidney source,match difficultly,high cost and other factors such as social ethics,so choose the proportion of patients with kidney transplantation is low.Maintenance peritoneal dialysis or hemodialysis are widely used in the vast majority of ESRD patients.Both PD and HD therapies have their individual advantages and disadvantages.The purpose of this study was to investigate the clinical efficacy of early peritoneal dialysis combined with hemodialysis in the treatment of end-stage renal disease.Objective To compare the efficacy of continuous ambulatory peritoneal dialysis?CAPD?combined with hemodialysis?HD?at early stage and CAPD alone in the treatment of end-stage renal disease?ESRD?.Methods Choose 97 ESRD patients who were treated with continuous ambulatory peritoneal dialysis,the age of dialysis was within 24-36 months and followed up in the Department of Nephrology of Nanyang Centeral Hospital from January 2016 to February 2018.They were randomly divided into the joint group?n=47?and the single group?n=50?,and the joint group adopt continuous ambulatory peritoneal dialysis with regular hemodialysis therapy,the single group use continuous ambulatory peritoneal dialysis treatment only.And the observation period was 1 year.The changes of hemoglobin?Hb?,serum albumin?Alb?,left ventricular ejection fraction?LVEF?,blood urea nitrogen?BUN?,serum creatinine?Scr?,serum calcium(Ca²⁺)and serum phosphorus(P³⁺)before and after treatment and the incidence of complications were compared between the two groups.Results 1.Among the 97 patients with ESRD,57?58.8%?were males and 40?41.2%?were females.A total of 47?29 males and 18 females?were in the combined group,aged between 24 and 80 years old,with an average age of 56.68 8.10 years old.A single group of 50 patients?28 males and 22 females?aged 20 to 76 years old,with an average age of58.11 9.46 years old.Primary morbidity:?1?48 cases of chronic glomerulonephritis?22cases in the combined group and 26 cases in the single group?;?2?diabetic nephropathy:12 cases in the combined group and 13 cases in the single group;?3?hypertensive nephropathy:8 cases in the combined group and 7 cases in the single group;?4?others:5cases in the combined group and 4 cases in the single group.There was no significant difference in age,gender and protopathy between the two groups.?P>0.05?.2.Urea nitrogen and serum creatinine decreased after treatment in both the combined group and the single group,and urea nitrogen and serum creatinine were significantly lower in the combined group than in the single group,with statistically significant differences?P?0.05?.3.The hemoglobin,albumin and left ventricular ejection fraction in the combined group were?112.03±9.14?g/L??44.03±1.45?g/L and?61.73±2.98?%,which were significantly higher than those in the single group?P?0.05?,the difference was statistically significant.4.There were 1 case of hypoproteinemia,1 case of peritoneal infection,1 case of pericardial effusion in the combined group,and 4 cases of hypoproteinemia,2 cases of cardio-cerebrovascular accident,3 cases of peritoneal infection and 2 cases of pericardial effusion in the single group?P?0.05?,the difference was statistically significant.5.Comparing the blood calcium and blood phosphorus between the combined group and the single group after treatment?P>0.05?,the difference was statistically insignificant.Conclusion 1.Early CAPD combined with general hemodialysis can effectively remove urea nitrogen and creatinine in CKD patients,maintain the balance of calcium and phosphorus metabolism,improve the nutritional status and left ventricular ejection function,and reduce the incidence of related complications.2.More high-quality,multi-center,large-sample,prospective,randomized controlled studies are needed to further confirm,develop unified and recognized standards for starting combined dialysis treatment,and provide more objective and sufficient basis for clinical promotion and application.