Peritoneal dialysis （PD） is a well-established renal replacement therapy （RRT） for end-stage renal failure （ESRF） and offers certain clear advantages over hemodialysis. However, PD is often associated with a hig...Peritoneal dialysis （PD） is a well-established renal replacement therapy （RRT） for end-stage renal failure （ESRF） and offers certain clear advantages over hemodialysis. However, PD is often associated with a high risk of infection of the intraperitoneal cavity, subcutaneous tunnel and catheter exit site, which may subsequently form microbial biofilms.展开更多
The development of maintenance hemodialysis(HD)for end stage kidney disease patients is a success story that continues to save many lives.Nevertheless,intermittent renal replacement therapy is also a source of recurre...The development of maintenance hemodialysis(HD)for end stage kidney disease patients is a success story that continues to save many lives.Nevertheless,intermittent renal replacement therapy is also a source of recurrent stress for patients.Conventional thrice weekly short HD is an imperfect treatment that only partially corrects uremic abnormalities,increases cardiovascular risk,and exacerbates disease burden.Altering cycles of fluid loading associated with cardiac stretching(interdialytic phase)and then fluid unloading(intradialytic phase)likely contribute to cardiac and vascular damage.This unphysiologic treatment profile combined with cyclic disturbances including osmotic and electrolytic shifts may contribute to morbidity in dialysis patients and augment the health burdenof treatment. As such, HD patients are exposed to multiple stressors including cardiocirculatory,inflammatory, biologic, hypoxemic, and nutritional. This cascade of events can be termed thedialysis stress storm and sickness syndrome. Mitigating cardiovascular risk and morbidityassociated with conventional intermittent HD appears to be a priority for improving patientexperience and reducing disease burden. In this in-depth review, we summarize the hidden effectsof intermittent HD therapy, and call for action to improve delivered HD and develop treatmentschedules that are better tolerated and associated with fewer adverse effects.展开更多
文摘Peritoneal dialysis （PD） is a well-established renal replacement therapy （RRT） for end-stage renal failure （ESRF） and offers certain clear advantages over hemodialysis. However, PD is often associated with a high risk of infection of the intraperitoneal cavity, subcutaneous tunnel and catheter exit site, which may subsequently form microbial biofilms.
文摘The development of maintenance hemodialysis(HD)for end stage kidney disease patients is a success story that continues to save many lives.Nevertheless,intermittent renal replacement therapy is also a source of recurrent stress for patients.Conventional thrice weekly short HD is an imperfect treatment that only partially corrects uremic abnormalities,increases cardiovascular risk,and exacerbates disease burden.Altering cycles of fluid loading associated with cardiac stretching(interdialytic phase)and then fluid unloading(intradialytic phase)likely contribute to cardiac and vascular damage.This unphysiologic treatment profile combined with cyclic disturbances including osmotic and electrolytic shifts may contribute to morbidity in dialysis patients and augment the health burdenof treatment. As such, HD patients are exposed to multiple stressors including cardiocirculatory,inflammatory, biologic, hypoxemic, and nutritional. This cascade of events can be termed thedialysis stress storm and sickness syndrome. Mitigating cardiovascular risk and morbidityassociated with conventional intermittent HD appears to be a priority for improving patientexperience and reducing disease burden. In this in-depth review, we summarize the hidden effectsof intermittent HD therapy, and call for action to improve delivered HD and develop treatmentschedules that are better tolerated and associated with fewer adverse effects.
文摘目的通过腹膜平衡试验(PET)探讨我国慢性腹膜透析(PD)儿童腹膜转运特性特点。方法对6例持续性非卧床腹膜透析(cAPD)患儿(2～14岁)行10次儿童标准 PET,参照 Twardowski和儿科腹膜透析联盟(PPDSC)标准评价腹膜溶质转运类型。结果本组患儿首次 PET 于 PD 开始后平均(38.7±15.6)d 进行。4 h 肌酐清除率(4 h-D/P)和4 h 葡萄糖吸收率(4 h-D/D_0)分别为(0.85±0.24)、(0.34±0.19)。依 Twardowski 和 PPDSC 腹膜转运类型评价标准,本组腹膜溶质转运类型分别为高转运型6例(6/10)、高平均转运型1例(1/10)、低平均转运型3例(3/10),无一例低转运型;两种标准分型的总符合率100%。本组腹膜葡萄糖转运类型分别为高转运型3例(3/10)、高平均转运型4例(4/10)、低平均转运型1例(1/10),低转运型2例(2/10);两种标准分型的总符合率90%。连续 PET 显示转运类型变化不一,腹膜炎后4 h-D/P 升高。结论本组 CAPD 儿童腹膜溶质和葡萄糖转运类型均以高转运和高平均转运为主(7/10),呈偏态分布,提示儿童腹透溶质清除充分,但水超滤能力不足;标准儿童 PET 及其评价标准完全符合 Twardowski 标准 PET 要求。腹膜炎后溶质转运能力提高。
