Piraino Beth
Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Semin Dial. 2017 Mar;30(2):158-163. doi: 10.1111/sdi.12571. Epub 2017 Jan 8.
Early innovations in the delivery of peritoneal dialysis (PD) markedly improved its acceptability and lowered peritonitis rates. The standard osmotic agent was, and continues to be dextrose, an agent that is not ideal as it is readily absorbed. The development of icodextrin-containing dialysis fluid has allowed a long dwell time to provide more effective ultrafiltration. The development of a smaller, more easily used automated cycler, led to an increase in the proportion of patients on the cycler as opposed to CAPD. Recently, new cyclers with better teaching tools and ease of use and communication with the training team have come on the market; data on outcomes using these cyclers are not yet available. Peritonitis continues to be a serious complication of PD although improvements in connectology and research on Staphylococcus aureus carriage have decreased peritonitis risk. Peritonitis rates continue to vary tremendously from one program to another, which may be in part due to failure to follow best demonstrated practices in training, care of the l catheter exit site, and prevention of peritonitis. Peritonitis rates should be expressed as episodes per year at risk and as organism-specific rates to allow comparisons from one program to another, from one period to another and from a program to the published literature. The term technique failure is misused in PD. Patients leave PD for a host of reasons including transplantation. Transfer from PD to hemodialysis can be planned and have an excellent outcome or can be delayed or done emergently and have a less optimal outcome. The life plan of the patient with ESRD needs to be not only considered but also periodically revised as circumstances and patient wishes change.
腹膜透析（PD）早期的创新显著提高了其可接受性并降低了腹膜炎发生率。标准渗透剂过去是、现在仍然是葡萄糖，这种物质并不理想，因为它很容易被吸收。含艾考糊精透析液的开发使得长时间留腹成为可能，从而能提供更有效的超滤。更小、更易于使用的自动循环机的研发，使得使用循环机的患者比例相对于持续性非卧床腹膜透析（CAPD）有所增加。最近，具有更好教学工具、更易于使用且能与培训团队进行沟通的新型循环机已投放市场；使用这些循环机的结局数据尚不可得。尽管连接技术有所改进以及对金黄色葡萄球菌携带情况的研究降低了腹膜炎风险，但腹膜炎仍然是腹膜透析的严重并发症。不同项目之间的腹膜炎发生率仍然差异巨大，这可能部分归因于在培训、导管出口部位护理以及腹膜炎预防方面未能遵循最佳实践。腹膜炎发生率应以每年每例患者的发病次数以及特定病原体的发生率来表示，以便在不同项目之间、不同时间段之间以及与已发表文献之间进行比较。术语“技术失败”在腹膜透析中被误用。患者因多种原因退出腹膜透析，包括移植。从腹膜透析转为血液透析可以是有计划的，并且预后良好，也可能被推迟或紧急进行，预后则不太理想。不仅需要考虑终末期肾病（ESRD）患者的生活规划，而且随着情况和患者意愿的变化，还需要定期进行修订。
