Kasuga Hirotake
Department of Nephrology, Nagoya Kyoritsu Hospital, Nagoya, Japan.
J Vasc Access. 2019 May;20(1_suppl):31-34. doi: 10.1177/1129729817751620. Epub 2018 Mar 12.
Most of the peritoneal dialysis patients stop their peritoneal dialysis therapy and transfer to hemodialysis or kidney transplantation. In Japan, most end-stage kidney disease patients select hemodialysis after peritoneal dialysis discontinuation. Peritoneal dialysis catheter will be removed after stopping peritoneal dialysis. If peritoneal dialysis patients suffer from refractory peritonitis or severe tunnel infection, we remove the peritoneal dialysis catheter immediately. However, the causes of peritoneal dialysis discontinuation are ultrafiltration failure or peritoneal membrane dysfunction, and we have to consider the timing of peritoneal dialysis catheter removal. Encapsulating peritoneal sclerosis is the most important adverse event of peritoneal dialysis. And encapsulating peritoneal sclerosis often develops after stopping peritoneal dialysis. Risk factors associated with encapsulating peritoneal sclerosis are high peritoneal equilibration test values, longer peritoneal dialysis period, frequent peritonitis, and so on. There is no evidence to prevent encapsulating peritoneal sclerosis completely. Therefore, we can preserve the peritoneal dialysis catheter and assess the changes of peritoneal function after peritoneal dialysis discontinuation, if patient is suspected to have high risk of encapsulating peritoneal sclerosis.
大多数腹膜透析患者会停止腹膜透析治疗，转而接受血液透析或肾移植。在日本，大多数终末期肾病患者在停止腹膜透析后选择血液透析。停止腹膜透析后将拔除腹膜透析导管。如果腹膜透析患者患有难治性腹膜炎或严重的隧道感染，我们会立即拔除腹膜透析导管。然而，停止腹膜透析的原因是超滤失败或腹膜功能障碍，我们必须考虑拔除腹膜透析导管的时机。包裹性腹膜硬化是腹膜透析最重要的不良事件。而且包裹性腹膜硬化常发生在停止腹膜透析后。与包裹性腹膜硬化相关的危险因素有腹膜平衡试验值高、腹膜透析时间长、腹膜炎频繁发作等。目前尚无完全预防包裹性腹膜硬化的证据。因此，如果怀疑患者有发生包裹性腹膜硬化的高风险，我们可以保留腹膜透析导管，并评估停止腹膜透析后腹膜功能的变化。
