建立高质量目标导向性腹膜透析

High-quality goal-directed peritoneal dialysis

2006年国际腹膜透析协会发布腹膜透析(PD)临床实践指南,指出应充分透析以解决终末期肾病患者溶质清除与容量控制问题.2020年该指南获得更新,提出建立高质量目标导向性PD,强调透析患者生命质量重要意义,指出需要建立紧密的医患合作与共同决策机制,科学利用有限资源,妥善保护残余肾功能,维持液体平衡、营养状态和代谢毒素清除,并关怀衰老患者实际需求.本文结合相关文献和国家肾脏疾病临床研究中心实践经验,对指南更新部分进行介绍,解读指南亮点内容即透析患者生命质量与建立高质量目标导向性PD.

The International Society for Peritoneal Dialysis(ISPD)last published guidelines on prescribing peritoneal dialysis(PD)in 2006,which stated with the terminology“adequate dialysis”and focused primarily on targets for small solute removal volume control.By 2020,ISPD updated guide lines to propose high-quality goal-directed PD.The present recommendations are updated on the following sections.Emphase the importance of quality of life in patients and PD is aimed to provide the best health outcome possible for an individual.PD should be prescribed using shared decision-making between the person doing PD and the care team.The PD prescription should take into account the local country resources.Management should focus on preserving kidney function.Paients fluid status,nutrition status and removal of toxins should be measured to help ensure the delivery of PD.PD should be modified prescription to minimize the burden of treatment on frail individuals.The discussion herein will introduce update of the guideline with practical experience of National Clinical Research Center of Kidney Diseases,and review current available literature on the research status.