University of Toronto, Toronto, Ontario, Canada.
Semin Nephrol. 2012 Nov;32(6):530-7. doi: 10.1016/j.semnephrol.2012.10.003.
Patient-focused dialysis modality and access selection requires a coordinated teamwork approach that emphasizes chronic kidney disease care to be a continuum of care. Individualized and detailed patient history and examination are the mainstays of dialysis modality and access selection. Preoperative vessel mapping by duplex Doppler ultrasonography can be a useful supplementary investigation to the history and physical examination to determine the optimal dialysis access type and site. Dialysis access modality and choice considers many patient factors that can be aided by a clinical risk score, asking key clinical questions, surgical expert opinion, and a multidisciplinary approach to individualized patient care. In many situations, a lifelong access utilization strategy prioritizes peritoneal dialysis as the first dialysis modality followed by appropriately planned hemodialysis. The goal of an integrated patient-focused approach is to achieve complication-free access to help patients achieve their life goals on and off dialysis.
以患者为中心的透析方式和通路选择需要采用协调的团队合作方法，强调将慢性肾脏病护理作为连续护理。个体化和详细的患者病史和检查是透析方式和通路选择的基础。术前通过双功能多普勒超声进行血管成像可以作为病史和体格检查的有用补充检查，以确定最佳的透析通路类型和部位。透析方式和选择考虑了许多患者因素，可以通过临床风险评分、询问关键临床问题、外科专家意见以及多学科方法来个体化患者护理来辅助。在许多情况下，终生使用通路的策略将腹膜透析作为首选透析方式，其次是适当计划的血液透析。以患者为中心的综合方法的目标是实现无并发症的通路，帮助患者在透析期间和透析之外实现其生活目标。
