Saxena Ramesh, West Cheryl
Department of Internal Medicine, Division of Nephrology, University of Texas, Southwestern Medical Center; Dallas, TX 75390-8856, USA.
J Am Board Fam Med. 2006 Jul-Aug;19(4):380-9. doi: 10.3122/jabfm.19.4.380.
As the population of chronic kidney disease (CKD) and end-stage renal disease (ESRD) grows at an alarming rate, primary care physicians will increasingly be involved in the management of these patients. Early recognition of CKD and timely referral to a nephrologist when glomerular filtration rate approaches 30 mL/min/1.73 m(2) is extremely important to improve ESRD outcome and appropriate selection of dialysis modality. Peritoneal dialysis (PD) remains a viable treatment option for ESRD patients. PD is less expensive dialysis modality and may provide a survival advantages over hemodialysis in first 2 to 4 years of treatment. Preserving residual renal function (RRF) is of paramount importance to prolong the survival outcomes in PD patients. Thus preservation of RRF is an important goal in the management of PD patients. Every effort should be made to avoid nephrotoxic drugs like aminoglycosides and nonsteroidal anti-inflammatory drugs, and limit the use of radiocontrast agents in PD patients with RRF. Judicious use of prophylactic antibiotics to prevent peritonitis would further help to reduce morbidity from PD. Protecting peritoneal membrane from long-term toxic and metabolic effects of the conventional glucose-based solutions is another objective to further improve PD outcome. Development of new, more biocompatible PD solutions holds promise for the future. One such solution, icodextrin, is now approved for use in the United States. Although extremely safe to use, it is associated with unique metabolic effects that may concern primary care physicians. They include false elevation of blood glucose, a reversible increase in serum alkaline phosphatase and a false decline in serum amylase. Monitoring of glycemia by assays that use glucose dehydrogenase pyrroloquinoline quinone enzymes should be avoided and serum amylase alone should not be relied on in diagnosing pancreatitis in patients on icodextrin.
随着慢性肾脏病（CKD）和终末期肾病（ESRD）患者数量以惊人的速度增长，初级保健医生将越来越多地参与这些患者的管理。早期识别CKD并在肾小球滤过率接近30 mL/min/1.73 m²时及时转诊至肾病科医生，对于改善ESRD的预后和适当选择透析方式极为重要。腹膜透析（PD）仍然是ESRD患者可行的治疗选择。PD是一种成本较低的透析方式，在治疗的前2至4年可能比血液透析具有生存优势。保留残余肾功能（RRF）对于延长PD患者的生存预后至关重要。因此，保留RRF是PD患者管理中的一个重要目标。应尽一切努力避免使用氨基糖苷类和非甾体类抗炎药等肾毒性药物，并限制在有RRF的PD患者中使用放射性造影剂。合理使用预防性抗生素以预防腹膜炎将进一步有助于降低PD的发病率。保护腹膜免受传统葡萄糖基溶液的长期毒性和代谢影响是进一步改善PD预后的另一个目标。开发新型、生物相容性更好的PD溶液有望改善未来的情况。一种这样的溶液，艾考糊精，现已在美国获批使用。尽管使用起来极其安全，但它具有独特的代谢效应，可能会引起初级保健医生的关注。这些效应包括血糖假性升高、血清碱性磷酸酶可逆性升高以及血清淀粉酶假性下降。应避免使用使用葡萄糖脱氢酶吡咯喹啉醌酶的检测方法监测血糖，并且在诊断使用艾考糊精的患者的胰腺炎时，不应仅依赖血清淀粉酶。
