Analysis of Clinical Characteristics and Influencing Factors of Gastrointestinal Dysfunction Associated with Peritoneal Dialysis in Uremia

Abstract

Background Gastrointestinal dysfunction is a very common complication in peritoneal dialysis patients, which not only seriously affects the appetite and mood of patients, but also induces malnutrition, dehydration, electrolyte disorders, or systemic inflammatory reactions, and even leads to a decrease in the effectiveness of peritoneal dialysis, thus increasing the difficulty of medical treatment and lowering the patients' standard of living. Objective To analyse the clinical characteristics and influencing factors of patients with peritoneal dialysis-associated gastrointestinal dysfunction, and provide reference for the clinical diagnosis and treatment of peritoneal dialysis-associated gastrointestinal dysfunction. Methods A retrospective study was conducted to select 304 uremic patients who underwent continuous ambulatory peritoneal dialysis in the Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from 2019-09-01 to 2021-09-01. The patients were divided into the gastrointestinal dysfunction group and non-gastrointestinal dysfunction according to the combination of gastrointestinal dysfunction. General data, comorbidities, laboratory test indexes, and dialysis adequacy-related indexes of the two groups of patients were collected and compared. SPSS 23.0 software was used to statistically analyze the clinical data, the clinical characteristics of peritoneal dialysis-associated gastrointestinal dysfunction, and multivariate Logistic regression analysis was used to explore the factors influencing the occurrence of peritoneal dialysis-associated gastrointestinal dysfunction in patients with uremia. Results A total of 304 peritoneal dialysis patients were included, of which 189 (62.2%) were in the gastrointestinal dysfunction group, with the median age of 62 (52, 67) years. The differences in age, proportions of primary diabetic nephropathy and combined hypertension and coronary artery disease between the two groups were statistically significant (P<0.05) ; the levels of blood calcium, cholesterol, creatine kinase, C-reactive protein, total bilirubin, blood glucose, glycosylated hemoglobin, procalcitonin, and triglyceride were compared between the two groups, and the differences were statistically significant (P<0.05) ; standardized comparison of the levels of blood urea nitrogen, residual renal urea clearance index (Kt/V), peritoneal Kt/V, total creatinine clearance (Ccr), residual kidney Ccr, and total Ccr between the two groups showed statistically significant (P<0.05). The results of multivariate Logistic regression analysis showed that primary diabetic nephropathy (OR=7.471, 95%CI=1.161-48.061, P=0.034), elevated glycosylated hemoglobin (OR=1.367, 95%CI=1.080-1.731, P=0.009) were the independent risk factors for the occurrence of peritoneal dialysis-associated gastrointestinal function in uremic patients, and elevated residual kidney Ccr (OR=0.952, 95%CI=0.908-0.997, P=0.038) was an independent protective factor for the occurrence of peritoneal dialysis-associated gastrointestinal disorders in uremic patients. Conclusion The incidence of peritoneal dialysis-related gastrointestinal dysfunction was relatively high, with a clinical prevalence in the elderly. Diabetic nephropathy and elevated glycosylated hemoglobin may be independent risk factors for peritoneal dialysis-associated gastrointestinal dysfunction in patients with uremia. Elevated residual kidney Ccr may be an independent protective factor for peritoneal dialysis-associated gastrointestinal dysfunction in uremic patients.

Keywords

• uremia|peritoneal dialysis|gastrointestinal dysfunction|clinical characteristics|root cause analysis