Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BMC Nephrol. 2020 Jan 31;21(1):39. doi: 10.1186/s12882-020-1706-2.
The use of peritoneal dialysis (PD) has increased substantially in the United States (US) in the past decade. This was likely spurred in large part by the implementation of the expanded prospective payment system for the Medicare End Stage Renal Disease (ESRD) program in 2011. Over the same period, there has also been growing interest in urgent start PD, which is commonly defined as initiation of PD within 14 days of catheter insertion. Ye and colleagues recently reported their experience with urgent start PD in 2059 Chinese ESRD patients over a 9-year period. Rates of complications, including peri-catheter leaks and peritonitis, were very low despite initiation of PD immediately after open catheter placement via open laparotomy in nearly all patients. Long term technique survival was good, with only 75 patients developing catheter failure. This study provides further evidence to suggest that urgent start PD is feasible and effective, although the generalizability of these results to Western populations is unclear. Recent proposed changes to the payment models in the Medicare ESRD program, designed to incentivize use of kidney transplantation and home dialysis, are likely to further propel growth of PD and urgent start PD in the US. Further studies are needed to optimize use of urgent PD and patient outcomes.
在过去十年中，美国（US）腹膜透析（PD）的使用量大幅增加。这在很大程度上可能是由于 2011 年医疗保险终末期肾病（ESRD）计划扩大前瞻性支付系统的实施。在此期间，人们对紧急开始 PD 的兴趣也越来越大，通常将其定义为在导管插入后 14 天内开始 PD。Ye 及其同事最近报告了他们在 9 年期间对 2059 名中国 ESRD 患者进行紧急开始 PD 的经验。尽管几乎所有患者在剖腹手术后立即通过开放式手术放置导管，但包括导管周围渗漏和腹膜炎在内的并发症发生率非常低。长期技术生存率良好，只有 75 名患者发生导管失败。这项研究进一步证明了紧急开始 PD 是可行和有效的，尽管这些结果对西方人群的普遍性尚不清楚。最近对 Medicare ESRD 计划支付模式的修改建议旨在鼓励使用肾移植和家庭透析，这可能会进一步推动美国 PD 和紧急开始 PD 的增长。需要进一步研究以优化紧急 PD 的使用和患者的治疗效果。
