腹膜透析结合血液透析治疗终末期肾脏病3例长期疗效并文献复习

Long-term clinical effects of combined therapy with peritoneal dialysis and hemodialysis: report of 3 cases and review of the literature

目的探讨腹膜透析结合血液透析(Combined therapy with Peritoneal Dialysis and Hemodialysis,PHD)治疗终末期肾病(End stage renal disease ESRD)患者的长期临床疗效。方法对3例长期行PHD治疗的患者临床资料进行分析并复习相关文献。结果 3例患者经过PHD治疗后临床症状改善。例1周尿素清除指数[Kt/(V?W)]1.46增至1.90,周肌酐清除率(Weekly creatinine clearance WCC)36.52增至60.72L/1.73m2,血浆白蛋白、血红蛋白升高,左室肥厚(Left ventricle hypertrophy LVH)改善。例2[Kt/(V?W)]1.43增至1.81,WCC 35.34增至55.79 L/1.73m2,血浆白蛋白、血红蛋白升高。例3[Kt/(V?W)]1.55增至1.82,WCC 46.0增至56.53 L/1.73m2,血浆白蛋白、血红蛋白升高,LVH改善。结论 PHD能有效改善ESRD患者临床症状,提高透析充分性,可作为补充的肾脏替代治疗模式在临床应用。

Objective To evaluate the long-term clinical effect of combined therapy with peritoneal dial- ysis and hemodialysis （PHD） in the treatment of patients with end-stage renal disease （ESRD）. Methods We summarized the effect of PHD in 3 ESRD cases and reviewed the related literature. Results The 3 male ESRD cases were 34-54 years old, and were undergone PHD for 1-4 years. The primary disease was chronic glomerulonephritis in 2 cases, diabetic nephropathy in one case. After PHD treatment, clinical status im- proved. In case 1, weekly urea Kt/V increased from 1.46 to 1.90, weekly creatinine clearance （WCC） from 36.52 to 60.72 L/1.73 m2, plasma albumin from 3.30 mg/dl to 3.60 mg/dl, and hemoglobin from 8.1 g/dl to 11.0 g/dl. Echocardiography showed the improvement of left ventricular hypertrophy. In case 2, weekly urea Kt/V increased from 1.43 to 1.81, WCC from 35.34 to 55.79 L/1.73 m2, plasma albumin from 3.50 mg/dl to 3.92 mg/dl, and hemoglobin from 9.6 g/dl to 11.6 g/dl. In case 3, weekly urea Kt/V increased from 1.55 to 1.82, WCC from 46.0 to 56.53 L/1.73 m2, plasma albumin from 3.50 mg/dl to 4.02 mg/dl, and hemoglobin from 7.8 g/dl to 9.2 g/dl. Echocardiography showed the improvement of left ventricular hypertrophy. Conclu- sion PHD can effectively improve the clinical symptoms and dialysis adequacy in ESRD patients. It may be used as a supplementary alternative of renal replacement therapy in clinical practice.