Cotovio P, Rocha A, Rodrigues A
Nephrology Department, Centro Hospitalar de Coimbra (CHC), Quinta dos Vales, 3041-801 S. Martinho do Bispo, Portugal.
Int J Nephrol. 2011;2011:914849. doi: 10.4061/2011/914849. Epub 2011 Oct 16.
End stage renal disease diabetic patients suffer from worse clinical outcomes under dialysis-independently of modality. Peritoneal dialysis offers them the advantages of home therapy while sparing their frail vascular capital and preserving residual renal function. Other benefits and potential risks deserve discussion. Predialysis intervention with early nephrology referral, patient education, and multidisciplinary support are recommended. Skilled and updated peritoneal dialysis protocols must be prescribed to assure better survival. Optimized volume control, glucose-sparing peritoneal dialysis regimens, and elective use of icodextrin are key therapy strategies. Nutritional evaluation and support, preferential use of low-glucose degradation products solutions, and prescription of renin-angiotensin-aldosterone system acting drugs should also be part of the panel to improve diabetic care under peritoneal dialysis.
终末期肾病糖尿病患者在透析治疗下临床结局较差，且与透析方式无关。腹膜透析为他们提供了居家治疗的优势，同时避免损害其脆弱的血管资源并保留残余肾功能。其他益处和潜在风险值得探讨。建议进行透析前干预，包括早期转诊至肾病科、患者教育和多学科支持。必须制定技术娴熟且与时俱进的腹膜透析方案以确保更好的生存率。优化容量控制、采用节省葡萄糖的腹膜透析方案以及选择性使用艾考糊精是关键的治疗策略。营养评估与支持、优先使用低葡萄糖降解产物溶液以及处方作用于肾素 - 血管紧张素 - 醛固酮系统的药物也应成为改善腹膜透析下糖尿病治疗的一部分。
