Hashimoto Y, Matsubara T
Department of Nephrology, Shizuoka City Hospital, Japan.
Adv Perit Dial. 2000;16:108-12.
The Dialysis Outcomes Quality Initiative (DOQI) guidelines recommend that, for patients on continuous ambulatory peritoneal dialysis (CAPD), a weekly creatinine clearance (WCC) of at least 60 L/1.73 m2 is needed for adequate dialysis. As residual renal function (RRF) declines, maintaining these target levels may become difficult. Over time, declines in ultrafiltration (UF) caused by increases in peritoneal permeability, in conjunction with decreases in RRF, may limit continuation of CAPD therapy. In an effort to achieve adequate solute clearance and ultrafiltration in several CAPD patients at our center who have declining RRF or poor UF, we use combined peritoneal dialysis and hemodialysis (PD + HD) as a therapeutic strategy when individualization of peritoneal dialysis is unsuccessful. At our center, PD + HD consists of five days of PD therapy followed by one HD session per week on Saturday. After the weekly HD session, patients are liberated from bag exchanges until Sunday evening. This PD + HD therapy was used in six cases where poor solute clearance and water retention were refractory to PD therapy alone. The combined therapy was well tolerated, and symptoms related to uremia improved in all six cases. Additionally, improvements in quality of life (QOL) were documented in all patients who were managed with the combined therapy. The improvements in QOL may have resulted from decreases in uremic symptomatology or freedom from bag exchanges. The PD + HD therapy can best be applied in the uremic PD patient without residual renal function whose peritoneal membrane is not deteriorated. The therapy allows for the continuation of PD without shifting to total HD in PD patients who continue to have uremic symptoms even after individualization of the PD prescription. Our patients readily accepted combined therapy, and we have noted excellent compliance with this therapy at our center.
透析预后质量倡议（DOQI）指南建议，对于持续非卧床腹膜透析（CAPD）患者，充分透析需要每周肌酐清除率（WCC）至少达到60 L/1.73 m²。随着残余肾功能（RRF）下降，维持这些目标水平可能变得困难。随着时间的推移，腹膜通透性增加导致的超滤（UF）下降，连同RRF降低，可能会限制CAPD治疗的继续进行。为了使我们中心一些RRF下降或超滤不佳的CAPD患者实现充分的溶质清除和超滤，当腹膜透析个体化不成功时，我们采用腹膜透析联合血液透析（PD + HD）作为治疗策略。在我们中心，PD + HD包括五天的PD治疗，随后每周六进行一次HD治疗。每周HD治疗后，患者直至周日晚上无需更换透析袋。这种PD + HD治疗用于6例单独PD治疗对溶质清除不佳和水潴留无效的患者。联合治疗耐受性良好，所有6例患者与尿毒症相关的症状均有改善。此外，所有接受联合治疗的患者生活质量（QOL）均有改善。QOL的改善可能是由于尿毒症症状减轻或无需更换透析袋。PD + HD治疗最适用于无残余肾功能且腹膜未恶化的尿毒症PD患者。对于即使在PD处方个体化后仍有尿毒症症状的PD患者，该治疗方法可使PD得以继续，而无需转为完全HD治疗。我们的患者很容易接受联合治疗，并且我们注意到在我们中心该治疗的依从性极佳。
