渐进性腹膜透析的临床应用

Clinical application of gradual peritoneal dialysis

渐进性腹膜透析(peritoneal dialysis,PD)是对于残余肾功能较好的患者,起始采用低于传统“全量”腹膜透析的剂量,结合适量的蛋白饮食及水盐限制,使残余肾功能和腹膜对溶质和液体达到总清除目标。随着残余肾功能的变化,逐渐递增或递减透析剂量及超滤量,以保证总溶质清除及液体清除不变的个体化治疗模式。与传统PD比较,更有利于延缓残余肾功能减退,减少并发症,节省费用,提高生活质量。但更优的临床结局现有的证据尚不足。目前对于这种治疗模式仍存在适合人群,透析处方调整时机及方法以及依从性和安全性等多种问题值得探讨。

Gradual peritoneal dialysis(PD)is suitable for patients with better residual renal function.At the initial period,lower than the“full dose”dialysis combined with an appropriate protein diet and water and salt restriction were adopted to achieve the clearance of solute and fluid by both the residual renal and peritoneum.As the residual renal function changes with time,dialysis dose and ultrafiltration volume must be regulated gradually to maintain adequate clearance of solute and fluid.Gradual PD has the advantages of delayed loss of residual renal function,less complications,less medical expenses,and higher quality of life,as compared with the routine PD method.However,whether gradual PD leads to better clinical outcome remains to be identified.The suitable patients for this treatment profile,the schedule of PD dose adjustment,compliance of the patients and safety of gradual PD are yet controversial.