Causes and prevention and treatment strategies of peritoneal dialysis withdrawal

doi:10.3877/cma.j.issn.2095-3216.2023.06.005

Abstract

Abstract:

Peritoneal dialysis (PD), as one of the main kidney replacement treatments for patients with end-stage kidney disease, has achieved a lot of technical progress, but its rate of withdrawal is still high. Studies have suggested that cardiovascular disease, infection-related complications, ultrafiltration failure, mechanical complications, and social psychological factors are the main reasons for the patients′ PD withdrawal. This article reviewed the research progress on PD withdrawal′s causes and prevention and treatment strategies.

Key words: Peritoneal dialysis, Withdrawal, Causes, Prevention, Treatment

Xiang Li, Xiufen Wang, Tao Zhang, Ying Li. Causes and prevention and treatment strategies of peritoneal dialysis withdrawal[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(06): 329-333.

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References 40

[1]	Zhang L, Zhao MH, Zuo L, et al. China Kidney Disease Network(CK-NET) 2016 annual data report [J]. Kidney Int Suppl (2011), 2020, 10(2): e97-e185.
[2]	李娟，卢婉君，龚书豪，等. 慢性肾衰竭腹膜透析患者微炎症状态的研究进展[J]. 南昌大学学报(医学版), 2021, 61(3): 80-83.
[3]	Lambie M, Bonomini M, Davies SJ, et al. Insulin resistance in cardiovascular disease, uremia, and peritoneal dialysis [J]. Trends Endocrinol Metab, 2021, 32(9): 721-730.
[4]	Packer M. Potentiation of insulin signaling contributes to heart failure in type 2 diabetes: a hypothesis supported by both mechanistic studies and clinical trials [J]. JACC Basic Transl Sci, 2018, 3(3): 415-419.
[5]	史春夏，李妍，史亚男，等. 自动化腹膜透析治疗持续不卧床腹膜透析并发心力衰竭患者的临床观察[J]. 中国血液净化，2020, 19(2): 99-102.
[6]	靳敬伟，张玉乾，刘梅，等. 百令胶囊联合左卡尼汀对维持性腹膜透析患者肾功能、微炎症状态、营养状况及生活质量的影响分析[J]. 解放军医药杂志，2021, 33(6): 97-100, 109.
[7]	朱贺. 不同剂量非布司他联合依托考昔，别嘌呤醇对高尿酸血症合并痛风患者的疗效比较[J]. 中国医学创新，2021, 18(34): 52-55.
[8]	Nochaiwong S, Ruengorn C, Mongkhon P, et al. Effects of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on all-cause mortality, cardiovascular death, and cardiovascular events among peritoneal dialysis patients: a protocol for systematic review [J]. Medicine (Baltimore), 2020, 99(17): e19767.
[9]	Jegatheesan D, Cho Y, Johnson DW. Clinical studies of interventions to mitigate cardiovascular risk in peritoneal dialysis patients [J]. Semin Nephrol, 2018, 38(3): 277-290.
[10]	Zoccali C, Ortiz A, Blumbyte IA, et al. Neuropeptide Y as a risk factor for cardiorenal disease and cognitive dysfunction in chronic kidney disease: translational opportunities and challenges [J]. Nephrol Dial Transplant, 2021, 37(Suppl 2): ii14-ii23.
[11]	Eikelboom J, Floege J, Thadhani R, et al. Anticoagulation in patients with kidney failure on dialysis: factor XI as a therapeutic target [J]. Kidney Int, 2021, 100(6): 1199-1207.
[12]	Merino RA, Araujo R, Pereira L, et al. Vascular calcification and the gut and blood microbiome in chronic kidney disease patients on peritoneal dialysis: a pilot study [J]. Biomolecules, 2022, 12(7): 867.
[13]	Ridker PM, Devalaraja M, Baeres F, et al. IL-6 inhibition with ziltivekimab in patients at high atherosclerotic risk (RESCUE): a double-blind, randomised, placebo-controlled, phase 2 trial [J]. Lancet, 2021, 397(10289): 2060-2069.
[14]	Li PK, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment [J]. Perit Dial Int, 2022, 42(2): 110-153.
[15]	Chang TI, Kim HW, Park JT, et al. Early catheter removal improves patient survival in peritoneal dialysis patients with fungal peritonitis: results of ninety-four episodes of fungal peritonitis at a single center [J]. Perit Dial Int, 2011, 31(1): 60-66.
[16]	Miles R, Hawley CM, Mcdonald SP, et al. Predictors and outcomes of fungal peritonitis in peritoneal dialysis patients [J]. Kidney Int, 2009, 76(6): 622-628.
[17]	Zhong HJ, Lin D, Lu ZY, et al. Use of gastric-acid suppressants may be a risk factor for enteric peritonitis in patients undergoing peritoneal dialysis: a meta-analysis [J]. J Clin Pharm Ther, 2019, 44(2): 209-215.
[18]	庄永泽，张路英，王烈，等. 延迟拔管的腹膜透析相关性腹膜炎救治新技术的建立与应用[J]. 中国中西医结合肾病杂志，2020, 21(11): 951-954.
[19]	姜鸿，吴亚琴，谭一香. 抗炎联合低浓度碘伏封管治疗难治性腹膜炎的初步探索[J]. 中国血液净化，2018, 17(6): 374-377.
[20]	Barrios R, Nadal ML, Vion VB, et al. Relapsing peritonitis and taurolidine peritoneal catheter lock: one center experience [J]. J Vasc Access, 2021, 22(2): 261-265.
[21]	Klimek K, Fosalba NA, Lopez M, et al. Taurolidine as adjuvant treatment of relapsing peritonitis in peritoneal dialysis patients [J]. Nefrologia (Engl Ed), 2020, 40(2): 197-201.
[22]	Mujais S. Evaluation and management of ultrafiltration problems in PD [J]. Perit Dial Int, 2000, 20(4): 5-21.
[23]	Ambruso SL, Teitelbaum I. Prevention of peritoneal dialysis drop-out [J]. Adv Perit Dial, 2018, 34(2018): 19-23.
[24]	Vrtovsnik F, Verger C, Biesen WV, et al. The impact of volume overload on technique failure in incident peritoneal dialysis patients [J]. Clin Kidney J, 2019, 14(2): 570-577.
[25]	Terri M, Trionfetti F, Montaldo C, et al. Mechanisms of peritoneal fibrosis: focus on immune cells-peritoneal stroma interactions [J]. Front Immunol, 2021, 12: 607204.
[26]	Krediet R. Acquired decline in ultrafiltration in peritoneal dialysis: the role of glucose [J]. J Am Soc Nephrol, 2021, 32(10): 2408-2415.
[27]	Teitelbaum I. Ultrafiltration failure in peritoneal dialysis: a pathophysiologic approach [J]. Blood Purif, 2015, 39(3): 70-73.
[28]	Song J, Yang X, Yan LJ. Role of pseudohypoxia in the pathogenesis of type 2 diabetes [J]. Hypoxia, 2019, 7(6): 33-40.
[29]	Jaques DA, Davenport A. Determinants of volume status in peritoneal dialysis: a longitudinal study [J]. Nephrology (Carlton), 2020, 25(10): 785-791.
[30]	廖梦，陈思洁，汤日宁，等. 内皮-间充质转分化在腹膜透析相关腹膜纤维化中的研究进展[J]. 临床肾脏病杂志，2021, 21(10): 848-855.
[31]	Si M, Wang Q, Li Y, et al. Inhibition of hyperglycolysis in mesothelial cells prevents peritoneal fibrosis [J]. Sci Transl Med, 2019, 11(495): eaav5341.
[32]	Li YC, Sung PH, Yang YH, et al. Dipeptidyl peptidase 4 promotes peritoneal fibrosis and its inhibitions prevent failure of peritoneal dialysis [J]. Commun Biol, 2021, 4(1): 144.
[33]	Kim YC, Kim KH, Lee S, et al. ST2 blockade mitigates peritoneal fibrosis induced by TGF-β and high glucose [J]. J Cell Mol Med, 2019, 23(10): 6872-6884.
[34]	Helmke A, Nordlohne J, Balzer MS, et al. CX3CL1-CX3CR1 interaction mediates macrophage-mesothelial cross talk and promotes peritoneal fibrosis [J]. Kidney Int, 2019, 95(6): 1405-1417.
[35]	Duan Z, Yao J, Duan N, et al. Sulodexide prevents peritoneal fibrosis by downregulating the expression of TGF-β1 and its signaling pathway molecules [J]. Evid Based Complement Alternat Med, 2021, 2021: 2052787.
[36]	Guo Y, Wang L, Gou R, et al. Ameliorative role of SIRT1 in peritoneal fibrosis: an in vivo and in vitro study [J]. Cell Biosci, 2021, 11(1): 79.
[37]	Shi Y, Hu Y, Wang Y, et al. Blockade of autophagy prevents the development and progression of peritoneal fibrosis [J]. Front Pharmacol, 2021, 12: 724141.
[38]	Liu Y, Zhang L, Lin A, et al. Impact of break-in period on the short-term outcomes of patients started on peritoneal dialysis [J]. Perit Dial Int, 2014, 34(1): 49-56.
[39]	孔德亮，李娟，赖学莉，等. 腹膜透析管安置术后患者发生大网膜包裹的危险因素分析[J]. 上海医学，2017, 40(1): 31-35.
[40]	Dufek S, Holtta T, Fischbach M, et al. Pleuro-peritoneal or pericardio-peritoneal leak in children on chronic peritoneal dialysis-a survey from the European paediatric dialysis working group [J]. Pediatr Nephrol, 2015, 30(11): 2021-2027.

一般防治策略	具体措施及作用
改变生活方式和定期监测	1.戒烟、戒酒、低盐、低脂饮食、适当锻炼，并控制血压、血糖，形成良好的生活习惯
	2.每隔1～3个月对患者相关生化指标进行监测，并及时给予调整
改善容量状态	1.艾考糊精溶质清除能力优于传统透析液，对高血糖及胰岛素抵抗状态有益
	2.自动化腹膜透析对于降低血压，缓解心力衰竭有效
改善微炎症状态	1.左卡尼汀联合百令胶囊有利于改善腹膜透析患者微炎症状态
	2.非布司他可以降尿酸，并对血管内皮功能和炎症状态有改善作用
药物治疗	1.肾素-血管紧张素-醛固酮系统抑制剂可抑制和改善心肌重塑，可能会提高患者的存活率
	2.沙库巴曲缬沙坦已成为指南推荐的心力衰竭治疗一线药物，且具有肾脏保护作用

一般防治策略	具体措施及作用
改变生活方式和定期监测	1.戒烟、戒酒、低盐、低脂饮食、适当锻炼，并控制血压、血糖，形成良好的生活习惯
	2.每隔1～3个月对患者相关生化指标进行监测，并及时给予调整
改善容量状态	1.艾考糊精溶质清除能力优于传统透析液，对高血糖及胰岛素抵抗状态有益
	2.自动化腹膜透析对于降低血压，缓解心力衰竭有效
改善微炎症状态	1.左卡尼汀联合百令胶囊有利于改善腹膜透析患者微炎症状态
	2.非布司他可以降尿酸，并对血管内皮功能和炎症状态有改善作用
药物治疗	1.肾素-血管紧张素-醛固酮系统抑制剂可抑制和改善心肌重塑，可能会提高患者的存活率
	2.沙库巴曲缬沙坦已成为指南推荐的心力衰竭治疗一线药物，且具有肾脏保护作用

研究团队	具体措施	研究结果
庄永泽等^[18]	腹腔镜或剖腹探查＋肠黏连松解术＋腹腔双套管负压持续冲洗引流的综合救治新技术	明显提高延迟拔管的腹膜炎患者的存活率
姜鸿等^[19]	在抗感染治疗基础上联合低浓度碘伏封管治疗	提高难治性腹膜炎治愈率
Barrios等^[20]	应用牛磺罗定封管液封管，防止导管管腔内的病原菌定植、抑制生物膜形成	减少复发性和难治性腹膜炎导致的退出腹膜透析
Klimek等^[21]	外涤纶套刮除法	抢救难治性出口处感染

研究团队	具体措施	研究结果
庄永泽等^[18]	腹腔镜或剖腹探查＋肠黏连松解术＋腹腔双套管负压持续冲洗引流的综合救治新技术	明显提高延迟拔管的腹膜炎患者的存活率
姜鸿等^[19]	在抗感染治疗基础上联合低浓度碘伏封管治疗	提高难治性腹膜炎治愈率
Barrios等^[20]	应用牛磺罗定封管液封管，防止导管管腔内的病原菌定植、抑制生物膜形成	减少复发性和难治性腹膜炎导致的退出腹膜透析
Klimek等^[21]	外涤纶套刮除法	抢救难治性出口处感染

作用核心环节	研发制剂	作用机制
抑制上皮细胞间充质转化	腺病毒三联体^a	以糖酵解和纤维化信号通路为靶点，阻止间皮-间充质转化的发展
	二肽基肽酶4抑制剂	抑制Smad-3途径激活导致的内皮-间充质转化
	阻断抑癌基因2	抑制Smad通路和高糖诱导的上皮-间充质转化
	CX3C趋化因子受体1	抑制巨噬细胞-间皮细胞通过CX3C趋化因子受体1-CX3C趋化因子配体1的相互作用，减少间皮细胞TGF-β的产生
	舒洛地特	下调TGF-β1及其信号通路分子的表达，改善腹膜组织增厚和炎症反应
	沉默信息调节因子-1	抑制TGF-β信号通路诱导的蛋白基质的分泌
阻断自噬	3-甲基腺嘌呤	下调TGF-β/Smad3信号通路及其下游的Slug和Snail基因转录，逆转上皮-间充质转化

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