Rottembourg Jacques, Rostoker Guy
Service de néphrologie, groupe hospitalier Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
Service de néphrologie et de dialyse, hôpital privé Claude-Galien, RAMSAY-Générale de Santé, 20, route de Boussy-Saint-Antoine, 91480 Quincy-sous-Sénart, France.
Nephrol Ther. 2018 Dec;14(7):507-517. doi: 10.1016/j.nephro.2018.02.021. Epub 2018 Apr 11.
The share of peritoneal dialysis (PD) in the spectrum of chronic dialysis has decreased in France over the last ten years. Despite various facilities offered by the health authorities, PD remains confidential in many private units and some public hospitals. The enthusiasm present at the beginning of this technology, forty years ago, is declining, despite a real improvement in new developments, a real increase in patient survival, today at least similar to that on hemodialysis. Then, the aim of this review is first to give a summary of the principles and practice of patient and staff education and to describe the role of the medical contribution in decision-making. The second aim is to review patient and technique survival data of PD patients henceforth prolonged, and the new insights into dialysis adequacy. The presence of residual renal function is a main determinant of patient comfort together with prevention of over-hydratation. Improvement of the peritoneal catheter is underlined. The prevention and management of infections is reviewed, and also the regular assessment of peritoneal function. Free water transport is a predictor of encapsulating peritoneal sclerosis, which should be assessed regularly. The physiopathology and the pathogenesis of this devastating complication allow now the prevention, and a better treatment.
在过去十年中，法国腹膜透析（PD）在慢性透析领域所占的份额有所下降。尽管卫生当局提供了各种便利条件，但在许多私立机构和一些公立医院中，腹膜透析仍处于保密状态。尽管这项技术在新进展方面有了切实改进，患者生存率也确实有所提高，如今至少与血液透析相当，但四十年前这项技术刚出现时的热情正在消退。那么，本综述的目的首先是总结患者及工作人员教育的原则与实践，并描述医疗贡献在决策中的作用。第二个目的是回顾此后延长的腹膜透析患者的患者及技术生存数据，以及透析充分性方面的新见解。残余肾功能的存在与预防水钠潴留一起，是患者舒适度的主要决定因素。强调了腹膜导管的改进。对感染的预防和管理进行了综述，以及腹膜功能的定期评估。自由水转运是包裹性腹膜硬化的一个预测指标，应定期进行评估。这种毁灭性并发症的病理生理学和发病机制现在使得预防和更好的治疗成为可能。
