Van Biesen Wim, Vanholder Raymond, Veys Nic, Lameire Norbert
Semin Dial. 2002 Sep-Oct;15(5):305-10. doi: 10.1046/j.1525-139x.2002.00075.x.
Most recent studies have found an equivalent survival for patients on peritoneal dialysis (PD) and hemodialysis (HD); evidence even suggests that PD might be the preferred modality during the first 3-4 years of renal replacement therapy. This is probably related to the continuous and minimally invasive character of PD as compared to HD, resulting in better preservation of residual renal function (RRF) and less cardiovascular strain. On the other hand, blood pressure control, fluid balance, and adequacy targets may be difficult to obtain in long-term PD patients. The question arises whether PD is a feasible option in anuric patients. It is clear that the answer depends on the body size and the peritoneal membrane transport characteristics of the patient, so that PD will be feasible in some anuric patients, whereas in others it will not be. Evaluation of the peritoneal transport characteristics and adaptation of the PD prescription is warranted. A constant evaluation of the fluid balance, nutritional, and cardiovascular status is needed. This article reviews the physiologic insights and clinical evidence necessary for a good PD prescription in anuric patients.
最近的研究发现，腹膜透析（PD）患者和血液透析（HD）患者的生存率相当；有证据甚至表明，在肾脏替代治疗的最初3至4年里，PD可能是首选的治疗方式。这可能与PD相较于HD具有持续且微创的特点有关，从而能更好地保留残余肾功能（RRF），并减轻心血管负担。另一方面，长期接受PD治疗的患者可能难以实现血压控制、液体平衡及充分性目标。于是问题就来了，PD对无尿患者来说是否是一个可行的选择。很明显，答案取决于患者的体型和腹膜转运特性，所以PD在一些无尿患者中可行，而在另一些患者中则不可行。有必要评估腹膜转运特性并调整PD处方。需要持续评估液体平衡、营养状况和心血管状态。本文综述了为无尿患者制定良好PD处方所需的生理学见解和临床证据。
