Dell Aquila R, Ronco C
Department of Nephrology, Dialysis and Transplantation, St. Bortlo Hospital, Vicenza, Italy.
Nefrologia. 2008;28 Suppl 6:67-70.
Peritoneal dialysis (PD) and hemodialysis (HD) are the most used therapies for endstage renal disease (ESRD). Peritoneal dialysis offers the advantages of long, slow, continuous ultrafiltration and preserve residual renal function (RRF) one of the most important factors affecting outcomes in PD. In contrast, HD offers superior solute removal but with undesirable cardiovascular tolerance of high rates of sodium and water removal. Peritoneal dialysis (PD) represents an effective way to maintain residual renal function and should be the first choice dialysis technique. However, with the loss of RRF, some limitations of PD alone in controlling the uremic state appear. Combination of the two techniques therapies, PD + HD (also called bimodal dialysis BMD), is the simplest way to deal with these limitations. The general prescription for BMD should be 5-6 days of PD and 1 or 2 HD sessions weekly. One of the most important controversy is how to evaluate the adequacy of the combined treatment: some Authors adopted the equivalent renal clearance (EKR), first transforming the weekly PD adequacy index (Kt/V), and then evaluating total clearance from both modalities. However, the EKR may overestimate the dialysis dose. Thus to accurately track dialysis dose some use the total effluent (PD, RRF, and HD) sampling method to yield Kt/Vef and creatinine clearance (CCref).
腹膜透析（PD）和血液透析（HD）是终末期肾病（ESRD）最常用的治疗方法。腹膜透析具有长时间、缓慢、持续超滤的优点，并能保留残余肾功能（RRF），这是影响腹膜透析预后的最重要因素之一。相比之下，血液透析能更有效地清除溶质，但对高钠和高水清除率的心血管耐受性较差。腹膜透析（PD）是维持残余肾功能的有效方法，应作为首选的透析技术。然而，随着残余肾功能的丧失，单纯腹膜透析在控制尿毒症状态方面的一些局限性逐渐显现。两种技术联合治疗，即PD+HD（也称为双峰透析BMD），是解决这些局限性的最简单方法。BMD的一般处方应为每周进行5-6天的腹膜透析和1或2次血液透析。最重要的争议之一是如何评估联合治疗的充分性：一些作者采用等效肾清除率（EKR），先将每周的腹膜透析充分性指数（Kt/V）进行转换，然后评估两种方式的总清除率。然而，EKR可能会高估透析剂量。因此，为了准确跟踪透析剂量，一些人使用总流出液（腹膜透析、残余肾功能和血液透析）采样方法来得出Kt/Vef和肌酐清除率（CCref）。
