Continuous ambulatory peritoneal dialysis in Australia, Europe, and the United States: 1981.
Continuous ambulatory peritoneal dialysis in Australia, Europe, and the United States: 1981.
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澳大利亚、欧洲和美国的连续门诊腹膜透析：1981 年。
DOI：
10.1038/ki.1983.2
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发表时间：
1983
影响因子：
19.6
通讯作者：
Keith W. Pyle
中科院分区：
文献类型：
--
作者：
Karl D. Nolph;Fred S. T. Boen;Peter C. Farrell;Keith W. Pyle
澳大利亚的CAPD目前有25个肾脏单位参与了持续性非卧床腹膜透析（CAPD）计划。截至1981年12月31日，CAPD患者总数为210例，其中维多利亚89例，新南威尔士46例。（表1列出了各州的详细情况。）1980年12月，约有140名患者接受CAPD治疗，使当年CAPD患者数量增加了50%。持续性非卧床腹膜透析病人的数目会继续增加，但预期增幅会稍低，为30%至40%，因此，到一九八二年年底，病人总数约为300名，即每100万名病人中约有20名是持续性非卧床腹膜透析病人。相比之下，澳大利亚约有1，500名移植物功能正常的患者和约1，675名透析患者，包括CAPD，间歇性腹膜透析（IPD）和血液透析（HD）。CAPD目前占透析患者总数的近12.5%，占所有肾脏患者的6.6%，而一年前分别为9%和4.7%。1981年期间，该技术遇到的主要问题是导管部位感染，以及与大多数其他国家一样的复发性腹膜炎。导管部位感染是一个相对较新的问题，可能需要对导管进行翻修，从而导致对导管护理和初始导管插入技术进行重新评估。腹膜炎问题的重要性因单位而异。从质量上讲，经验最少的单位通常结果最差。不幸的是，目前仍根据每患者月的发作次数报告腹膜炎数据。正如我们和其他研究者所指出的[1，21]，这不是一种完全令人满意的方法，通过使用寿命表分析在统计学上比较单位会更好;这避免了目前与患者人群内发作分布和个体患者内时间分布相关的困难[21]。此外，可以使用Peto等人[31]的对数秩方法在单位、国家或其他任何单位之间进行合理的统计比较。虽然我们更喜欢使用寿命表分析，但由于当时的实际限制，我们无法获得足够的数据来进行这种类型的分析。因此，值得一提的是，1981年腹膜炎的发病率从每3个月发生一次的严重病例到每10个患者月发生一次。大多数患者每天更换4次输液袋。在这方面也有相当高的减员率，
CAPD in Australia There are currently 25 renal units in Australia involved in a continuous ambulatory peritoneal dialysis (CAPD) program. The total number of patients on CAPD as of December31, 1981, was 210 with 89 patients in Victoria and 46 in New South Wales. (A complete breakdown on a state-by-state basis is given in Table 1.) In December 1980 there were approximately 140 patients on CAPD creating a 50% increase for the year in the number of CAPD patients. The increase in the number of CAPD patients will continue, but the expected increase rate is a little less at 30 to 40%, so that the total number of patients at the end of 1982 will be about 300 patients or about 20 CAPD patients per million. As a comparison, there are about 1,500 patients in Australia with functioning grafts and about 1,675 dialysis patients, which include CAPD, intermittent peritoneal dialysis (IPD), and hemodialysis (HD). CAPD presently accounts for nearly 12.5% of the total of dialysis patients, or 6.6% of all kidney patients compared to 9% and 4.7%, respectively, a year ago. The major problems experienced with the technique during 1981 have been catheter site infections and, as in most other countries, recurrent peritonitis. Catheter site infection has been a relatively recent problem which can require catheter revision, causing a reassessment of techniques of both catheter care and initial catheter insertion. The significance of peritonitis problems varies from unit to unit. Qualitatively, those units with the least experience generally tend to have the worst results. Unfortunately, peritonitis data at this time are still being reported on the basis of the number of episodes per patient-month. As we and other investigators have indicated [1, 21, this is not an entirely satisfactory approach and it would be better statistically to compare units by using life-table analysis; this obviates current difficulties associated with the distribution of episodes within the patient population and temporal distribution within individual patients [21. In addition, rational statistical comparisons can be made between units, countries, or whatever, using the log rank method of Peto et al [31. Although we preferred use of the life-table analysis, we were unable, due to practical limitations at this time, to obtain enough data to perform this type of analysis. So, for what it may be worth, the incidence of peritonitis during 1981 varied from a severe case experience of nearly one episode every 3 months to one episode every 10 patient-months. The majority of the patients use four bag exchanges per day. There has also been a rather high attrition rate on the