| BackgroundPeritoneal dialysis(PD)is one of the important alternative treatments for patients with end-stage renal disease(ESRD).As the prevalence of chronic kidney disease continues to increase,the number of ESRD patients continues to increase,the social burden caused by it is increasing,and the urgent demand for the development of peritoneal dialysis is also increasing.PD has comparable efficacy to hemodialysis(HD),and has the characteristics of stable hemodynamics,home application,convenience,and better cost-effectiveness.According to previous studies,there were approximately 196,000 PD patients worldwide in 2008,accounting for 11%of the total dialysis population,of which 56%were from developing countries;the proportion of PD patients in developed countries over the past 12 years decreased by 5.3%.However,the prevalence of PD has increased by 2.5 times in developing countries,and overall the number of patients receiving PD treatment worldwide has been on the rise.Public reports have shown that the prevalence of PD patients in China has increased year by year.As of the end of 2014,the number of PD patients in China reached 55,000,accounting for 12%of the total number of dialysis patients,and continued to increase rapidly at an average annual rate of 20.8%.China has a huge rural population,as well as the current level of economic development and the uneven distribution of medical resources.Only 20%of ESRD patients receive effective kidney replacement therapy.At the same time,the follow-up and management of PD patients are particularly important,which has high requirements for the diagnosis,treatment,and follow-up of PD in hospitals at all levels.To this end,the National Institute of Health and Family Planning Hospital Management Institute launched the "Exploration Project on Access to Peritoneal Dialysis Therapy and Primary Management Models for Patients with End-stage Renal Diseases" in 2013.The long-term mechanism and management model of PD treatment for ESRD patients in urban and rural grassroots was established and perfected to suit China's national conditions.This study intends to investigate the development of PD and the incidence and prevalence of patients in Henan Province,understand the status of PD development in the province,and review and analyze the clinical characteristics and related indicators of patients with single-center PD to provide a basis for the development of PD policy and clinical management.MethodsPart ?:Collect the number of new PD hospitals,the number of existing and new PD patients,the number of medical staff,and the number of APDs.Investigations were conducted by on-site visits,online reports,and telephone follow-ups.Part ?:The clinical data of PD patients with more than one hospitalization record in the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University in 2018 were collected retrospectively by collecting information from the in-hospital electronic medical record.ResultPart ?:1.As of 2018,a total of 72 peritoneal dialysis central hospitals have been established in the province through inspection or registration,including 6 provincial hospitals,41 municipal hospitals,and 25 county-level hospitals;mainly municipal hospitals,accounting for 56.9%,county-level hospitals accounted for 34.7%,and provincial-level hospitals accounted for 8.3%.2.As of May 20,2018,there were a total of 5009 patients with maintenance peritoneal dialysis in Henan;the prevalence rate was 41.9 PMP.The number of PD patients in Zhengzhou,Xinxiang,and Nanyang was predominant.The highest prevalence was in Zhengzhou,Xinxiang,and Pingdingshan.The number of new PD patients in 2013-2017 was 739,829,1033,1076,and 1083,respectively;the incidence increased from 6.97 PMP to 9.98 PMP.3.There are 114 PD physicians in Henan province,99%of whom have a bachelor's degree or above;101 PD nurses,79%of whom have a bachelor's degree or above.53 APDs were reported,of which 24 were provincial hospitals,26 were municipal hospitals,and 3 were county-level hospitals,with an average of only 0.74 per center.Part ?:1.The average age of patients enrolled in PD was 44.1±12.18 years;the male to female ratio was 1.4:1,81.1%of PD patients were treated with antihypertensive drugs,86.8%of patients had hypertension,and 6.6%of diabetes patients;the primary disease remained mainly chronic glomerulonephritis.2.The average Hgb level was 100.95±22.84 g/L,34.9%of patients had Hgb less than 90 g/L,73.1%of PD patients received ESAs to correct anemia;47%of PD patients had ferritin<200 ng/mL,13.3%Of patients had a TAST<20%,and only 5.7%of patients received intravenous iron supplementation.3.The average ALB level is 36.2±6.17 g/L,40.9%of PD patients have ALB less than 35g/L,and the compliance rate is 59.1%;the average serum calcium is 2.18±0.27 mmol/L,and 56.0%of patients had calcium from 2.10 to 2.50 mmol/L;mean serum phosphorus was 1.82±0.54 mmol/L,46.6%of patients had phosphorus levels ranging from 1.13 to 1.78 mmol/L,and 41.2%of patients were treated with oral phosphorus-lowering drugs;compliance rates were significantly higher in female patients male.694 patients had an iPTH test result,with a median of 275 pg/ml,accounting for 61.5%between 150 and 600 pg/ml.4.Among 114 patients who were previously hospitalized for PD-related peritonitis,the positive rate of bacterial culture in PD-associated peritonitis was 49.1%,of which the pathogenic bacteria were mainly Escherichia coli(19.6%)and Staphylococcus epidermidis(17.9%);The most commonly used antibiotic drugs are cephalosporins(61.4%),vancomycin(50.9%)and aminoglycosides(34.2%).Conclusions1.The incidence and prevalence of PD in Henan Province continued to increase from 2013 to 2018.The number of PD hospitals has been increasing,and county-level primary hospitals have developed rapidly.However,there are a small number of patients at county-level hospitals,a low proportion of PD medical staff in the province,and uneven development among cities.2.The average age of PD patients is low,hypertension was frequent comorbidity,the rate of hemoglobin,albumin,and calcium and phosphorus compliance was low.And there was more PD-associated peritonitis with negative pathogen culture.The control of related indicators needs to be further improved,thus necessitating frequent monitoring of Hgb,albumin,calcium,phosphorus and iPTH. |
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