腹膜透析联合血液透析治疗终末期肾病

Clinical experiences of peritoneal dialysis combined with hemodialysis treatment in patients with ESRD

目的：探讨腹膜透析联合血液透析（PHD）治疗因腹膜透析（PD）欠充分的终末期肾病（ESRD）患者的临床经验。方法：回顾性分析南京军区南京总医院全军肾脏病研究所PD中心11例PD治疗不充分的ESRD患者，改用PHD治疗后的临床疗效。随访观察患者的一般临床表现、透析充分性、营养指标及降压药的使用情况。结果：本组患者男性8例、女性3例。透析时年龄50.6±16.5岁（23～74岁）。原发病分别为慢性肾小球肾炎9例（81.8％），糖尿病肾病2例（18.2％）。PHD前的平均行PD治疗3.1±1.2（1.2～4.4）年。经过PHD治疗后患者食欲改善，饮食限制减少；所有患者的不安腿症状得以改善；皮肤瘙痒不同程度减轻。小分子物质清除率增加，每周尿素Kt／V由1.54±0.2增至1.96±0.4（P〈0.05）。血浆白蛋白由39.4±4.1g／L升至40.7±3.8g／L（P〉0.05）；血红蛋白由86±10g／L升至96±13g／L（P〈0.05）。结论：PHD能提高透析的充分性，改善患者临床症状和营养状态，可作为一种新的肾脏替代治疗模式在临床推广。

Objective：To determine the clinical experience of using combined modality-simultaneous peritoneal dialysis （PD） and hemodialysis （HD） treatment in patients with end-stage renal disease （ESRD）. Methodology： Eleven patients on PD and diagnosed with underdialysis and/or overhydration with declining RRF were recruited in this retrospective study. Parameters of volume control, and uremic solute removal were collected. Results ：They were 8 males, 3 females,with a mean age of 50. 6 ± 16. 5 years old at the start of combined therapy. Mean duration of PD at the start of combined therapy was 3.1：1：1.2 （ 1.2 ～ 4.4 ） years. Their underlying kidney diseases were 9 easses of chronic glomerulonephritis and 2 cases of diabetic nephropathy. The weekly Kt/V urea increased to 1.96 ± 0. 4 from 1.54 ± 0. 2 （ P 〈 0.05 ）. The patients＇ hydration status improved significantly with reductions in blood pressure. The hemoglobin level was increased remarkably from 8. 6 ± 1.0 to 9. 6 ± 1.3 g/dl （ P 〈 0.05 ） even though at the same time the dose of recombinant human erythropoietin decreased significantly. The level of serum albumin was also increased after concomitant HD use. Conclusion： PD and Hemodialysis are not mutually exclusive. They can be used in combination to achieve targeted salute clearances, to improve certain clinical conditions and nutrition status.