Study On The Infection Status Of Peritoneal Dialysis Patients And The Effectiveness And Safety Of Thymopentin In Preventing Infections In Peritoneal Dialysis Patient

Objective: The study aims to investigate the current status and risk factors of different types of infections in peritoneal dialysis(PD)patients,and investigate the effectiveness and safety in the prevention of infection in the patients undergoing peritoneal dialysis,and evaluate the effectiveness and safety of thymopentin for the immune function and inflammation on PD patients.Methods: The first part of this study was a retrospective study.Peritoneal dialysis patients who were regularly followed up between April 2018 and June 2019 in the Peritoneal Dialysis Center of Ruijin Hospital,Shanghai Jiaotong University School of Medicine,and treated with PD for more than 3 months were enrolled.A questionnaire survey was used to collect the infections of 121 PD patients in the past year or after starting peritoneal dialysis treatment(for the patients time on PD<1 year),and the general clinical data and laboratory examination data were collected.The risk factors of infection in PD patients were analyzed.The second part is a prospective,single center randomized,and controlled clinical study.It is planned to enroll 100 cases of PD patients who are regularly followed up in the Peritoneal Dialysis Center of Shanghai Jiaotong University School of Medicine,and treated with PD for more than 3 months.Patients in the experimental group used thymopentin for 24 W.And those in the control group continued the original treatment,all patients followed up to 48 W.Unitl Oct 06 2020,a total of 62 cases were enrolled,55 cases completed 12 W follow-up and 47 completed 24 W follow-up.Infection was record in the two group of patient.Infection rate,immune function,Inflammation cytokines were compared between the two groups.Results: In the first part,a total of 121 patients undergoing peritoneal dialysis were included,there were 59 males and 62 females,with an average age of 53.31±14.48 years,with an average time on PD of 3(0.25-12)years,with an average age at onset of dialysis of 49.94±13.83 years.There were 21(17.4%)cases with diabetes.A total of 93(77.8%)patients have experienced at least one infection event.The most common infection is respiratory tract infection and PD-related infections.Risk factors for the infection in PD patients include inadequate dialysis and malnutrition(decrease of Alb and Hb)and decrease of HDL.Multivariate logistic regression showed that low serum albumin(Alb)level was an independent risk factor for lung infections and dialysis-related infections and serious infections in PD patients.In the second part of this study,a total of 46 patients who completed 24 W follow-up were analyzed,there were 23 males and 22 females,including 25 cases in experimental group,21 cases in control group.A total of 30 infections occurred in 21 patients,the incidence was about 1.3 times/patient-year,and the experimental group was 1.2 times/patient-year,and the control group was 1.4 times/patient-year,there was no statistical difference between the two groups.The repeated measures analysis was used to compare the changes in immune function and inflammatory factors between the two groups.The immune function between the two groups was no statistically significant.IL-2R in the experimental group showed an upward trend over time,while the control group showed a downward trend(P<0.05).IL-6 after thymopentin treatment was decrease in experimental group,there was statistical difference between the two groups.In addition,we found that the Alb in control group was decrease over time,there was no similar phenomenon observed in the experimental group.Conclusion: Peritoneal dialysis patients have a higher incidence of infection.The most common infection is respiratory infection,followed by dialysis-related infections.The old age,long time on PD,insufficient dialysis,malnutrition and decrease of HDL are significant risk factors of infection of PD patients.Thymopentin can increase IL-2R expression and decrease IL-6 in patients with peritoneal dialysis.IL-2R and IL-6 are related to the immune function and inflammation of PD patients.Therefore,we consider thymopentin can enhance the immune function and reduce inflammation in PD patients by regulating IL-2R and IL-6.It can also improve the malnutrition of PD patients by improving Alb levels.