Objective To retrospectively analyze the incidence, influencing factors and clinical outcomes of abdominal hernia or hydrocele in peritoneal dialysis (PD) patients. Methods Based on the retrospective cohort of PD in Peking University First Hospital between 1 January 2003 and 31 July 2019, baseline data including demographic characteristics as well as blood biochemical data and residual renal functions were collected, with the occurrence of abdominal hernia or hydrocele recorded during follow-up. Patients were divided into abdominal hernia and/or hydrocele group and control group according to whether abdominal hernia and/or hydrocele occurred during follow-up. The differences in clinical manifestations between the two groups were compared. Cox regression model was used to analyze the influencing factors of abdominal hernia or hydrocele in PD patients. Results A total of 1 291 PD patients were enrolled, with age of (56.2±15.1) years. Of them, 50.9% were male, 39.6% had diabetes mellitus and 16.3% had the history of operation in abdomen. During the follow-up of 30.1(13.2, 61.7) months, a total of 54 patients (4.2%) developed abdominal hernia or hydrocele (incidence rate 0.012 per patient year), including 46(85.2%) abdominal hernias and 8(14.8%) hydroceles. Compared to the control group, the proportion of males, Karnofsky performance status score and hand grip strength were significantly higher in the abdominal hernia and/or hydrocele group (P<0.05, respectively). Male gender was the independent influencing factor for hernia or hydrocele formation during PD (HR=8.368, 95%CI 2.413-29.016, P=0.001). Among the patients with abdominal hernia or hydrocele, there were 41(75.9%) patients continued the PD after receiving hernia repair or repair of the testicular sheath membrane operations, 2(4.9%) patients recurred in the follow-up of 25.3(10.4, 39.7) months, 8(14.8%) patients gave up surgery and transferred to hemodialysis, and 5(9.3%) patients received conservative treatment and continued the PD. Conclusion The incidence rate of abdominal hernia or hydrocele in PD patients of our center is 4.2%, which is lower than that in previous studies, and 75.9% patients receiving repair operations have favorable prognosis.

Objective To analyze the clinical characteristics and prognosis for the first episode of peritonitis in elderly patients with peritoneal dialysis (PD). Methods PD patients who were aged more than 65 years old and had experienced PD-associated peritonitis (PDAP) for the first time at the PD center of the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2018, were retrospectively enrolled into this study. All patients were divided into two groups according to PD duration: short-term PD group (<36 months) and long-term PD group (≥36 months). Demographic data, clinical indicators, treatment and prognosis of the first episode of PDAP were compared between the two groups. Results A total of 163 patients were enrolled. The age was (71.7±4.9) years and the median duration of PD was 21.8(5.5, 41.3) months. Among them, male accounted for 53.4%, and diabetic nephropathy accounted for 32.5%. The leading cause of the first episode of PDAP was both contamination by operation in short-term PD group and long-term PD group, accounting for 39.8% and 46.0%, respectively. The treatment failure rate of the first episode of PDAP in long-term PD group was significantly higher than that in short-term PD group (34.0% vs 13.3%, χ²=9.437, P=0.002). All PD patients with fungal peritonitis were extubated, and the treatment failure rate was 100.0%. Logistic regression analysis showed that long-term duration of PD (OR=12.544, 95%CI 2.168-72.576, P=0.005) and lower level of serum albumin (OR=0.858, 95%CI 0.744-0.988, P=0.034) were independently influencing factors for treatment failure of the first episode of PDAP in elderly patients. Conclusion Fungal infection, long-term duration of PD and lower level of serum albumin are influencing factors for treatment failure of the first episode of PDAP in elderly patients.

Objective To explore the clinical characteristics and treatment outcomes of early-onset peritoneal dialysis-associated peritonitis (EOP). Methods Clinical data of patients with peritoneal dialysis-associated peritonitis (PDAP) from 2013 to 2018 in four tertiary hospitals of Jilin province were collected retrospectively. According to whether the dialysis time of the first PDAP was ≤12 months or not, the subjects were divided into EOP group (≤12 months) and late-onset PDAP (LOP) group (>12 months), and clinical data, pathogenic bacteria, treatment outcomes of PDAP and prognosis of two groups were compared. Results A total of 575 patients were included, including 314 patients in the EOP group, with age of (56.53±15.57) years and 152 females (48.4%), and 261 patients in the LOP group, with age of (56.61±14.42) years old and 144 females (55.2%). Compared with LOP group, the proportion of pathogenic bacteria culture-negative in EOP group was higher and the proportion of streptococcal infection was lower (both P<0.05). The initial treatment efficiency and cure rate of EOP group were higher than that of LOP group, while the extubation rate was lower than that of LOP group (all P<0.05). Multivariate logistic analysis indicated that the cure rate of EOP was 79% higher than that of LOP (OR=1.79, 95%CI 1.13-2.82, P=0.012), and the extubation rate of EOP was 68% lower than that of LOP (OR=0.32, 95%CI 0.15-0.66, P=0.002). Kaplan-Meier survival curve showed that the cumulative rates of multiple PDAP, technical failure, all-cause death, and composite end points (technical failure or all-cause death) in EOP group were higher than those in LOP group (P≤0.001). After correcting for confounding factors by multivariate Cox proportional hazard regression, the risk of multiple PDAP, technical failure, all-cause death, and composite endpoint (technical failure or all-cause death) in EOP group was 2.02 times (HR=2.02, 95%CI 1.26-3.24, P=0.004), 2.53 times (HR=2.53, 95%CI 1.58-4.05, P<0.001), 2.66 times (HR=2.66, 95%CI 1.70-4.16, P<0.001) and 2.48 times (HR=2.48, 95%CI 1.78-3.43, P<0.001) of LOP group respectively. Conclusion The treatment outcome of the first PDAP of EOP patients is good, but the long-term prognosis is poor.

Objective To investigate the incidence of gastrointestinal symptoms and diseases in peritoneal dialysis (PD) patients, and explore their associations with PD-associated peritonitis. Methods PD patients who were followed up in PD center of the First Affiliated Hospital of Sun Yat-sen University from March 1, 2016 to December 31, 2017 were prospectively enrolled and followed up until withdrew from PD or until December 31, 2019. Gastrointestinal symptoms, gastrointestinal diseases and peritonitis episodes were collected during the study period. The severity of gastrointestinal symptoms was assessed by the Gastrointestinal Symptoms Rating Scale. The demographic and clinical data were compared between patients with and without gastrointestinal diseases. The influencing factors of peritonitis were analyzed by Poisson regression model. Results A total of 471 PD patients were included. Among them, 387(82.2%) patients had at least one gastrointestinal symptom, and 142(30.2%) patients had gastrointestinal diseases. The incidence of peritonitis was 0.094 episodes per patient year, 0.034 episodes per patient year for gram-positive bacteria peritonitis and 0.027 episodes per patient year for gram-negative bacteria peritonitis. The multi-factor Poisson regression model showed that gastrointestinal disease was an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis (OR=1.852, 95%CI 1.252-6.369, P=0.002; OR=3.324, 95%CI 1.616-6.836, P=0.001, respectively), and higher score of diarrheal symptoms was an independent influencing factor for the occurrence of gram-negative bacterial peritonitis (OR=2.832, 95%CI 1.616-4.963, P<0.001). Conclusions The incidence of gastrointestinal diseases in PD patients is 30.2%. Gastrointestinal disease is an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis, and diarrhea symptom is an independent influencing factor for the occurrence of gram-negative bacteria peritonitis.

Objective To compare the differences of blood pressure variability (BPV) and blood pressure rhythm (BPR) between maintenance peritoneal dialysis (MPD) and maintenance hemodialysis (MHD) patients, and explore the relationship of BPV and BPR with cardiovascular disease (CVD)-related death. Methods This was a prospective cohort study. Patients with maintenance dialysis treatment for more than 3 months in the General Hospital of Ningxia Medical University and stable clinical status were recruited from December 2015 to July 2016. The patients' general data, biochemical indexes and dialysis-related indexes were collected. BPV and BPR were observed by ambulatory blood pressure monitoring in all patients. The prospective follow-up was up to February 2020. All patients were divided into high 24 h systolic blood pressure variability (24hSBPV) group and low 24hSBPV group based on the median of 24hSBPV, and the baseline data of the two groups were compared. The BPV and BPR between MPD and MHD patients were compared. Kaplan-Meier method was used for survival analysis. The relationship between BPV and CVD-related death was analyzed by Cox regression. Results A total of 120 dialysis patients were included in the study, including 76 males (63.33%). The age was (50.89±14.61) years old and the median dialysis age was 42(28, 58) months. There were 60 patients in the high 24hSBPV group and 60 patients in the low 24hSBPV group, and the differences in total Kt/V (urea clearance), calcium channel blocker and β-blockerrs between the two groups were statistically significant (all P<0.05). There were no statistically significant differences in age, gender, primary disease, CVD, hemoglobin, blood calcium, blood phosphorus, estimated glomerular filtration rate, blood uric acid, intact parathyroid hormone, serum iron and so on between the two groups. 24hSBPV in MHD patients was significantly higher than that in MPD patients [(13.92±3.79) mmHg vs (12.49±3.99) mmHg, t=2.01, P=0.041]. The incidence of abnormal circadian rhythm of blood pressure in all patients was 93.33%(112/120), and non-dipper blood pressure accounted for 84.17%(101/120). There was no significant difference in BPR between the MPD and MHD patients. With follow-up of 42.00(14.25, 42.00) months, a total of 60 cases (50%) CVD events occurred, of which there were 31 cases (25.83%) CVD-related death. The multivariate Cox regression analysis showed that the high 24hSBPV was an independent influencing factor for CVD-related death in patients with MHD and MPD after the confounding factors (ages, sex, body mass index, serum creatinine, hemoglobin, uric acid, hypersensitivity C-reactive protein and so on) were corrected (HR=1.25, 95% CI 1.06-1.47, P=0.007; HR=1.24, 95%CI 1.09-1.40, P=0.001). Conclusions The 24hSBPV in MHD patients is higher than that in MPD patients. With the increase of 24hSBPV, the risk of CVD increases in patients with MHD and MPD. 24hSBPV is an independent influencing factor for CVD-related death in both MHD and MPD patients.

Objective To analyze the effects of dialysis therapy initiation on the prognosis of peritoneal dialysis (PD) patients. Methods PD patients who were newly catheterization and long-term followed-up in Peking University Shenzhen Hospital from January 1, 2012 to March 25, 2019 were retrospectively analyzed. According to the estimate glomerular filtration rate (eGFR) at the time of patients catheterization, the patients were divided into early-dialysis group [eGFR>5.5 ml·min^-1·(1.73 m²)^-1] and late-dialysis group [eGFR≤5.5 ml·min^-1·(1.73 m²)^-1]. The endpoint events were transferred to other renal replacement therapy (such as hemodialysis, kidney transplantation) or death. Kaplan-Meier method was used to draw survival curve, and log-rank test was used to compare the difference of survival rate between the two groups. Cox proportional hazard model was used to analyze the influencing factors of all-cause death and technical death in PD patients. Results A total of 342 PD patients were enrolled in this study, and there were 165 cases and 177 cases in the early-dialysis and the late-dialysis group respectively. Compared with the early-dialysis group, the proportion of patients with diabetes and men, and the level of hemoglobin, serum calcium and CO₂ binding capacity in the late-dialysis group were lower, while the incidence of hypertension, serum phosphorus, blood uric acid and blood urea nitrogen level were higher in the late-dialysis group (all P<0.05). The median follow-up time was 33(16, 57) months. Kaplan-Meier survival analysis showed that the cumulative survival rate of late-dialysis group was significantly higher than that of early-dialysis group (Log-rank χ²=12.004, P<0.001). After adjusting for gender, age of catheterization, body mass index (BMI), diabetes mellitus and hypertension, the risk ratio of all-cause death in the early-dialysis group was 1.950 times higher than that in the late-dialysis group (HR=1.950, 95%CI 1.019-3.730, P=0.044). Subgroup analysis showed that the timing of dialysis and the risk of end-point events were not affected by BMI, diabetes stratification and other factors (interactive P>0.05), but there was interaction between dialysis time and catheter age (interactive P<0.05). According to the age of catheterization, the risk of all-cause death were higher in the early dialysis group at a young age (≤48 years old) (HR=21.287, 95%CI 2.609-173.665, P=0.004). Conclusions The mortality rate of PD patients is higher in early-dialysis group, which is independent of gender, age, BMI, diabetes and hypertension. The difference is more distinct in low age group.