Kawanishi Hideki, Moriishi Misaki
Tsuchiya General Hospital, Hiroshima, Japan.
Perit Dial Int. 2007 Jun;27 Suppl 2:S126-9.
The fundamental objective of dialysis is to maintain the dose of solute clearance and ultrafiltration (UF). When peritoneal dialysis (PD) patients cannot maintain target clearances, the dialysis dose needs to be increased. The means of increasing dose by PD alone are limited, especially in patients with UF failure. Combination therapy with PD and hemodialysis (PD+HD) is the simplest way to solve this problem. The general prescription for PD+HD should be 5-6 days of PD and 1 session of HD weekly. To determine the adequacy of PD+HD, we adopted the equivalent renal clearance (EKR), transforming the weekly Kt/V from PD and then evaluating the total clearance from both modalities. The weekly PD+HD regimen improves clinical status in patients in whom PD alone does not result in dialysis adequacy, and it permits a substantial prolongation of PD. The complementary effects of PD and HD improve clinical status and prognosis in patients undergoing dialysis; we therefore propose to use the term "complementary dialysis" for this technique.
透析的基本目标是维持溶质清除率和超滤（UF）的剂量。当腹膜透析（PD）患者无法维持目标清除率时，就需要增加透析剂量。仅通过PD增加剂量的方法有限，尤其是在超滤失败的患者中。PD与血液透析联合治疗（PD+HD）是解决这一问题的最简单方法。PD+HD的一般处方应为每周进行5-6天的PD和1次HD。为了确定PD+HD的充分性，我们采用了等效肾清除率（EKR），将每周的PD的Kt/V进行转换，然后评估两种方式的总清除率。每周的PD+HD方案可改善仅进行PD无法达到透析充分性的患者的临床状况，并能显著延长PD的使用时间。PD和HD的互补作用可改善透析患者的临床状况和预后；因此，我们建议将这种技术称为“互补透析”。
