Peritoneal Dialysis Care in Mainland China: Nationwide Survey

Abstract

Background Peritoneal dialysis (PD) care in mainland China has been progressing in the past 10 years. Objective To complement information from the dialysis registry, a large-scale nationwide survey was conducted to investigate the current infrastructure and management of PD care at hospitals of different tiers. Methods A web-based multiple-choice questionnaire was distributed through the National Center for Nephrology Medical Quality Management and Control to PD centers of secondary and tertiary hospitals in October 2020. The 2-part survey collected the information of PD centers and the clinical management of patients on PD. A total of 788 effective surveys from 746 hospitals were voluntarily returned, and data were extracted and analyzed. Results The effective survey data covered 101,537 patients on PD, with 95% (96,460/101,537) in the tertiary hospitals. The median number of patients per PD center was 60 (IQR 21-152); this number was 32 (IQR 8-65) and 70 (IQR 27-192) for secondary and tertiary hospitals, respectively. There was a discrepancy in the availability of designated physical areas for different functions of PD care between the secondary and tertiary hospitals. The proportion of tertiary hospitals with PD training (P=.01), storage (P=.09), and procedure area (P<.001) was higher compared to secondary hospitals. PD catheter placement was performed in 96% (608/631) of the PD centers in tertiary hospitals, which was significantly higher compared to 86% (99/115) in secondary hospitals (P<.001). Automated PD was available in 55% (347/631) of the tertiary hospitals, which was significantly higher than that in secondary hospitals (37/115, 32%) according to the survey (P<.001). The most commonly performed PD module was continuous ambulatory peritoneal dialysis (772/788, 98%), followed by intermittent peritoneal dialysis (543/788, 69%). The overall reported nocturnal intermittent peritoneal dialysis was 31% (244/788); it was 28% (220/788) for continuous cycling peritoneal dialysis and 15% (118/788) for tidal peritoneal dialysis. Comparisons between the secondary and tertiary hospitals revealed no significant differences in prophylactic antibiotic use for PD catheter placement and therapeutic use for peritonitis. The first peritoneal equilibrium test was conducted in 58% (454/788) of patients at 4-6 weeks after initiation of PD, and 91% (718/788) reported at least one peritoneal equilibrium test per year. Overall, 79% (570/722) and 65% (469/722) of PD centers performed assessment for dialysis adequacy and residual kidney function, respectively; and 87% (685/788) of patients on PD were followed every 1 to 3 months for laboratory and auxiliary examinations. Conclusions This national survey reflects the current status and disparities of PD center management in mainland China. The study results suggest that the PD care needs to be more conveniently accessible in secondary hospitals, and quality management and staff training in secondary hospitals are still in high demand.

Deep learning assists detection of esophageal cancer and precursor lesions in a prospective, randomized controlled study

“…The detection rate of esophageal cancer (early and advanced stage) was 0.3% (5 of 1556), which was substantially higher than the national average of 24.0 per 100,000 person-years ( 18 ). Recently, a meta-analysis reported that the pooled rate of positive cases (including esophageal cancer and precancerous lesions) was 1.03% in the high-risk areas ( 19 ). Japan, a country with a high incidence of esophageal cancer, has a national crude incidence of esophageal cancer of about 37.0 per 100,000 person-years, but its early detection rate of esophageal cancer is more than 70% ( 17 ).…”

Personality traits and peritoneal dialysis patients’ prognosis

“…PD is an important treatment modality for patients with end-stage renal disease (ESRD) in China [ 12 ], and the quality of PD strongly influences the prognosis of ESRD patients [ 13 ]. PD often has peritonitis, catheter-related infection, mechanical complications, and other risks, which can eventually lead to stopping PD, switching to hemodialysis or receiving renal transplantation, and even death in severe cases, which is extremely detrimental to patients.…”

A Novel IRAK4 Inhibitor DW18134 Ameliorates Peritonitis and Inflammatory Bowel Disease

“…Peritonitis is a prevalent inflammatory disease characterized by clinical manifestations such as diarrhea, abdominal pain, abdominal infection, and multiple organ failure, with a mortality rate exceeding 60% [6,7]. Despite the incomplete elucidation of the pathogenic mechanisms underlying this disease, extensive reported research suggests a close association between peritonitis and macrophages [8,9].…”