Javaid Muhammad M, Khan Behram A, Subramanian Srinivas
School of Rural Health Mildura, Monash University, Mildura, VC, Australia.
Department of Medicine, Mildura Base Hospital, Mildura, VC, Australia.
Clin Kidney J. 2019 Mar 21;12(3):443-446. doi: 10.1093/ckj/sfz008. eCollection 2019 Jun.
Over the last decade, urgent start peritoneal dialysis (USPD), defined as initiation of peritoneal dialysis (PD) before the traditionally recommended break-in period of 2-4 weeks, has increasingly been seen as a viable option for late-presenting end-stage renal disease patients, obviating the need for haemodialysis via central venous catheter. Different prescriptions and protocols involving both manual and automated exchanges have been published, but there is no head-to-head comparison of the two modalities and no consensus on the most suitable modality exists. Evaluation of the available evidence suggests that PD can be initiated urgently using either or both options without much difference in the outcome. The two most critical aspects dictating the success of a USPD programme are using low dwell volumes and keeping patients in a strict supine position during the dialysis exchanges in the first couple of weeks of the therapy. These measures are crucial in keeping the intraperitoneal pressure to a minimum and reduce the risk of mechanical complications, including catheter leaks and malpositioning.
在过去十年中，紧急开始腹膜透析（USPD），即定义为在传统推荐的2至4周的导入期之前开始腹膜透析（PD），越来越被视为晚期终末期肾病患者的一种可行选择，从而无需通过中心静脉导管进行血液透析。已经发表了涉及手动和自动交换的不同处方和方案，但两种方式之间没有直接比较，对于最合适的方式也没有达成共识。对现有证据的评估表明，使用其中一种或两种方式都可以紧急开始腹膜透析，结果没有太大差异。决定USPD计划成功的两个最关键方面是使用低驻留量，并在治疗的头几周透析交换期间让患者保持严格的仰卧位。这些措施对于将腹腔内压力保持在最低水平并降低机械并发症的风险至关重要，包括导管渗漏和位置不当。
