| Objective:Chronic kidney disease(CKD)is an important non-communicable disease with a worldwide prevalence between 10.5%and 13.1%.End stage renal disease(ESRD)is the final stage of CKD,in the past 20 years,with the continuous improvement of dialysis technology and the gradual improvement of medical quality,the life span of dialysis patients has become longer,the prevalence of ESRD has increased,and the population of end-stage renal disease has increased sharply.Renal replacement therapy for ESRD patients is divided into three types:hemodialysis,peritoneal dialysis(PD)and kidney transplantation.As a country with a large population,China has about 1 to 2 million uremia patients.In recent years,peritoneal dialysis has become one of the suitable alternative treatments for uremia patients in China due to its advantages of simplicity,convenience,safety and effectiveness,and home treatment.PD has been chosen by more and more uremia patients.Although PD technology has made great progress over the years and the number of PD patients has increased year by year,peritoneal dialysis associated peritonitis(PDAP)is still its most common and important complication,and it is also the main reason for patients to withdraw from PD.In this study,we retrospectively analyzed the clinical data of PD patients who were regularly reviewed in our hospital to explore the influencing factors of peritonitis in peritoneal dialysis patients and the factors affecting the prognosis of peritonitis,and provide a basis for clinical prevention and treatment of peritonitis.Methods:The study included clinical data of peritoneal dialysis patients who were regularly reviewed in our hospital from January 1,2018 to August 31,2020.1.According to whether peritoneal dialysis associated peritonitis occurred,they were divided into peritonitis group and control group.The clinical characteristics and laboratory examinations of the two groups were compared.The Logistic regression method was used to analyze the occurrence of peritonitis in peritoneal dialysis patients.Draw receiver operating characteristic curve(ROC),and evaluate the predictive value of each influencing factor on the occurrence of peritonitis in peritoneal dialysis patients.2.According to the prognosis of patients in the peritonitis group,they were divided into cure group and treatment failure group(including relapse group and withdrawal group).The Kruskal-Wallis test and t test are used to compare the differences in clinical indicators between the three groups,and the Logistic regression method is used to analyze the influencing factors of treatment failure in patients with peritonitis.Result1.General information of patients:there are 53 males and 49 females in the peritonitis group,100 males and 58 females in the control group.The average age of patients in the peritonitis group is 46.07±11.65 years old,and the average age of patients in the control group is 46.08±11.98 years old.The primary disease status of the included patients:among the 260 included patients,235 cases were chronic glomerulonephritis(90.38%),8 cases were hypertensive renal damage(3.08%),and 9 cases were diabetic nephropathy(3.46%),3 cases were polycystic kidney disease(1.15%),and 5 cases were other diseases(1.93%).2.Comparison of clinical data between the peritonitis group and the control group:gender composition,age,primary disease,catheterization method,comorbidities,education level,dialysis age,red blood cell count,hemoglobin,platelet count,total weekly KT/V,serum potassium,serum sodium,serum chloride,serum calcium,serum magnesium,urea,fasting blood glucose,alanine aminotransferase,aspartate aminotransferase,triglycerides,total cholesterol,the difference was not statistically significant(P>0.05),white blood cell count,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),albumin,blood phosphorus,creatinine,uric acid,parathyroid hormone Comparison,the difference is statistically significant(P<0.05).3.Analysis of the influencing factors of peritonitis in peritoneal dialysis patients:taking the occurrence of peritonitis as the dependent variable,the index of P<0.05 was subjected to single-factor Logistic regression analysis.The index of P<0.05 in the univariate logistic regression analysis was included in the multivariate logistic regression analysis.The results showed that NLR(OR=1.929,95%C1 1.418-2.625)is a risk factor for peritonitis in peritoneal dialysis patients,and blood phosphorus(OR=0.462,95%C1 0.336-0.634),uric acid(OR=0.658,95%CI 0.487-0.890),albumin(OR=0.674,95%CI0.497-0.913)are protective factors.4.The predictive value of various indicators for the occurrence of peritonitis in peritoneal dialysis patients:ROC curve shows that the increase of NLR level is an important indicator for predicting the occurrence of peritonitis in peritoneal dialysis patients(AUC=0.717,P<0.001).5.Occurrence of peritonitis:A total of 170 cases of peritonitis occurred during the follow-up period of 102 patients in the peritonitis group.The positive result of pathogen culture was 101 times,and the negative result of pathogen culture was 69 times.The positive rate was 59.41%.Gram The number of infections with positive bacteria,gram-negative bacteria,and fungi were 63,35 and 3 respectively,accounting for 62.38%,34.65%and 2.97%respectively.6.Comparison of the types of infectious pathogens in the cured group,recurrence group and withdrawal group.The proportion of Gram-positive bacteria in the cured group was higher than that of the other two groups(P<0.05).7.Compared with the cured group,the withdrawal group had higher erythrocyte sedimentation rate and lower albumin level(P<0.05).Compared with the relapse group,the withdrawal group was older,higher erythrocyte sedimentation rate,lower albumin level,high platelet count,and triglyceride.The ester level is higher(P<0.05).8.Logistic regression analysis found that albumin is a protective factor for treatment failure in PDAP patients(OR=0.930,95%CI 0.869-0.994)(P<0.05).ConclusionsIncreased NLR levels,decreased albumin,uric acid,and blood phosphorus levels in peritoneal dialysis patients are risk factors for peritonitis.Albumin is a protective factor that affects the cure of peritonitis patients,which can provide a basis for clinical prevention and treatment of PDAP. |
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