Issad Belkacem, Durand Pierre-Yves, Siohan Pascale, Goffin Eric, Cridlig Joëlle, Jean Guillaume, Ryckelynck Jean-Philippe, Arkouche W, Bourdenx J-P, Cridlig J, Dallaporta B, Fessy H, Fischbach M, Giaime P, Goffin E, Issad B, Jean G, Joly D, Mercadal L, Poux J-M, Ryckelynck J-P, Siohan P, Souid M, Toledano D, Verger C, Vigeral P, Uzan M
Hôpital de la Pitié-Salpêtrière, centre hospitalier universitaire de Paris, 47/83, boulevard de l'Hôpital, 75013 Paris, France.
Nephrol Ther. 2013 Nov;9(6):416-25. doi: 10.1016/j.nephro.2013.05.005. Epub 2013 Jul 11.
The optimal method to assess the adequacy of peritoneal dialysis therapies is controversial. Today, the adequacy must not be considered as a number or a concept assessed only by two parameters (total KT/V urea and total solute clearance) but defined by many more items. In the absence of data, based on theoretical considerations, the reanalysis of the CANUSA study showed that renal kidney function, rather than peritoneal clearance, was associated with improved survival. Residual renal function is considered as a major predictor factor of cardiovascular mortality. Results of this reanalysis were supported by the adequacy data in ADEMEX, EAPOS and ANZDATA studies. Therefore, clinical assessment plays a major role in PD adequacy. The management of fluid balance, the regular monitoring of malnutrition, the control of mineral metabolism and particularly the glucose load, considered as the "corner-stone" of the system, are the main points to be considered in the adequacy of PD patients. The essential goal is to minimize glucose load by glucose-sparing strategies in order to reduce the neoangiogenesis of the peritoneal membrane.
评估腹膜透析治疗充分性的最佳方法存在争议。如今，充分性不应仅被视为一个数字或仅由两个参数（总尿素清除率KT/V和总溶质清除率）评估的概念，而是由更多项目来定义。在缺乏数据的情况下，基于理论考量，对CANUSA研究的重新分析表明，肾功能而非腹膜清除率与生存率提高相关。残余肾功能被认为是心血管死亡率的主要预测因素。ADEMEX、EAPOS和ANZDATA研究中的充分性数据支持了这一重新分析的结果。因此，临床评估在腹膜透析充分性中起着主要作用。液体平衡的管理、营养不良的定期监测、矿物质代谢的控制，尤其是被视为该系统“基石”的葡萄糖负荷，是腹膜透析患者充分性中需要考虑的要点。基本目标是通过节约葡萄糖策略将葡萄糖负荷降至最低，以减少腹膜的新生血管形成。
