Finkelstein F O
New Haven CAPD, Renal Research Institute, St Raphael's Hospital, Yale University School of Medicine, New Haven, CT 06511, USA.
Kidney Int Suppl. 2006 Nov(103):S118-21. doi: 10.1038/sj.ki.5001927.
Recently, there has been a decline in chronic peritoneal dialysis (CPD) utilization in several countries. And, in these countries, the percent of patients with end-sage renal disease maintained on CPD is less than nephrologists think is appropriate. The reasons for these problems are uncertain, but it is likely that difficulties with the structural organization of CPD facilities play a contributory role. This paper discusses the structural requirements for a successful CPD program, focusing attention on the following domains: (1) adequate chronic kidney disease education, (2) provision and support of physician training in the principles and practice of CPD, (3) adequate size and organization of CPD centers, (4) development of appropriate support systems within the CPD facility, and (5) development of appropriate continuous quality improvement programs to monitor a variety of domains, including adequacy of dialysis, peritonitis rates, catheter infections and problems, psychosocial status of patients, etc.
最近，几个国家的慢性腹膜透析（CPD）使用率有所下降。而且，在这些国家，接受CPD治疗的终末期肾病患者比例低于肾病学家认为合适的水平。这些问题的原因尚不确定，但CPD设施的结构组织方面的困难可能起到了一定作用。本文讨论了成功开展CPD项目的结构要求，重点关注以下几个方面：（1）充分的慢性肾脏病教育；（2）提供并支持医生进行CPD原理与实践的培训；（3）CPD中心的规模和组织架构要适当；（4）在CPD设施内建立适当的支持系统；（5）制定适当的持续质量改进项目，以监测包括透析充分性、腹膜炎发生率、导管感染及问题、患者心理社会状况等在内的多个领域。
