| Objective: The modality choice of renal replacement therapy for patients with liver cirrhosis(LC)complicated with end-stage renal disease(ESRD)is still controversial.It is reported that peritoneal dialysis(PD)has some advantages in cirrhotic patients with ESRD due to its little effect on hemodynamics,no need of anticoagulant and no effect on hepatic encephalopathy.However,there are still relatively few studies on the application of PD in LC patients with ESRD,especially in PD associated peritonitis.The purpose of this study is to analyze the clinical characteristics of PD treatment in LC patients with ESRD in our PD Center,and to explore the effectiveness and safety of PD treatment in such patients,so as to provide a theoretical basis for better management of this special group.Methods: Baseline and follow-up data of patients aged ≥18 years who were regularly followed up for ≥6 months in our PD center from January 2013 to March 2020 were collected,excluding patients with acute renal failure,conversion from hemodialysis to PD,transferred to other PD centers for follow-up,and incomplete medical records.Endpoint was study cutoff(September 30,2020)or withdrawal from peritoneal dialysis(patient death,kidney transplant,conversion to hemodialysis).A total of 241 patients were enrolled.The patients were divided into LC-PD group and non-LC-PD group according to whether they had cirrhosis or not.The demographic data and the baseline data of primary kidney diseases were compared between the two groups.Propensity score matching(PSM)was used to match the LC-PD group and the non-LC-PD group with 1:4 ratio,and the matching variables were age,gender and diabetes,with a score tolerance of 0.1.Finally,13 patients in LC-PD and 52 patients in non LC-PD were included.The differences of dialysis adequacy,peritonitis occurrence and prognosis were compared between the two groups.Results: 1.A total of 241 PD patients were included in this study,including 136 males(56.4%)and 105 females(43.6%),with an average age of50.2±14.1 years.There were 13 patients(5.4%)with LC.According to Child-Pugh scoring system,3 patients(23.1%)with grade A,10 patients(76.9%)with grade B,and 0 patients(0)with grade C.The mean follow-up time was 32(18,57.5)months.2.Before PSM,there were 13 cases in LC-PD group and 228 cases in non LC-PD group.Compared with the non LC-PD group,LC patients had a higher proportion of males(84.6% vs 54.8%P=0.035),less baseline urine volume [600(150,1050)vs 1500(900,1500)ml P=0.0],and a higher incidence of peritonitis(0.59/patient-year vs0.14/patient-year P=0.001).There was no difference in age(P=0.106)and diabetes(46.2%vs 31.6 P=0.431)between the two groups.The mean follow-up time was [39(16.5,59)vs 40(22,57.8)month].3.After PSM,13 patients in LC group and 52 patients in non LC-PD group were included.There was no significant difference in age,gender and diabetes between the two groups.The mean follow-up time was [39(16.5,59)vs 29.5(20,53)month].(1)Compared with the non LC-PD group,the LC group had lower baseline urine volume [600(150,1050)vs 1500(962.5,1500)ml P=0.0],lower serum albumin [32.1(27,35.9)vs 38(32.2,41)g/L P=0.009],higher ALT[17(11.5,38.5)vs 10.5(8,16)u/L P=0.002],higher AST [20(17.5,44.5)vs 13(10,17)u/L P=0.0],and the differences were statistically significant.(2)At the follow-up of 3,6,12 and 24 months,the serum albumin(33.9±4.1 vs 39.2±4.2g/L P=0.0),triglyceride [1.1(0.8,1.4)vs 1.4(1.0,2.1)mmol/L P=0.024] and serum phosphorus [1.4(1.2,1.8)vs 1.7(1.5,2.0)mmol/L P=0.03] of LC patients were lower than those of the control group.ALT [23.8(21.4,27.6)vs15.5(12.3,20.9)u/L P=0.001),AST [26.7(18.7,30.0)vs 16.6(11.7,18.9)u/L P=0.0)were higher than those in non LC-PD group.During the follow-up period,the serum albumin in LC patients was significantly increased(P=0.001),while that in the control group was not significantly changed(P=0.208),but the serum albumin in LC group was still lower than that in the control group(P<0.05),and there was no statistical difference between the two groups at 2 years(P=0.694).(3)The decrease rate of residual renal function in LC group was slower than that in non LC-PD group(P=0.0).(4)The incidence of peritonitis in LC patients was higher than that in the control group,with a statistically significant difference(0.59/patient-year vs0.20/patient-year P=0.033).In the LC group,a higher proportion of operational factors were associated with peritonitis(84% vs 53.3%,P=0.016).Pathogen analysis showed that there was no significant difference in the constituent ratio of pathogens between the two groups,and the proportion of Gram-positive bacteria was more in both groups(40% vs 36.7%,P=0.8).However,the proportion of Streptococcus in LC group was higher than that in control group(40% vs 0,P=0.035).In the first peritonitis pathogen analysis,the proportion of Escherichia coli was higher in LC group(44.4% vs 4.5%,P=0.017).(5)There was no significant difference in technical survival rate(P=0.523)and patient survival rate(P=0.484)between the two groups.Conclusions:1.PD is a safe and effective treatment for LC patients with ESRD,and the technical and patient survival rate are comparable to those of patients without LC.2.LC patients in PD center of our hospital have a relatively high incidence of peritonitis,mainly Gram-positive bacteria,suggesting that we should pay attention to strengthen the management and training of patients. |
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