Medical School, University of Western Australia, Perth, Western Australia, Australia.
Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Perit Dial Int. 2020 May;40(3):254-260. doi: 10.1177/0896860819898307. Epub 2020 Jan 14.
The International Society for Peritoneal Dialysis guidelines for small solute clearance and fluid removal in peritoneal dialysis (PD) were published in 2005. The aim of this article is to update those guidelines by reviewing the literature that supported those guidelines and examining publications since then.
An extensive search of publications was performed through electronic databases and a hand search through reference lists from the existing guideline and selected articles.
There have been no prospective intervention trials to inform the area of small solute clearance in PD since the publication of the original guideline in 2005. The trials to date are largely limited to a few prospective cohort studies and retrospective studies. These have, however, consistently demonstrated that residual renal function (RRF) is more often associated with patient outcome than peritoneal clearance. One of the few randomised controlled trials performed in this area does suggest that a weekly / of 2.27 ± 0.02 provides no statistically significant survival advantage over a weekly / of 1.80 ± 0.02. The lower limit of / is unknown but there is weak evidence to suggest that anuric people doing PD should have a weekly / of at least 1.7.
There continues to be very poor evidence in the area of small solute clearance and fluid removal in PD. The evidence that exists suggests that RRF is more important than peritoneal clearance and that there appears to be no survival advantage in aiming for a weekly / >1.70.
国际腹膜透析学会（ISPD）的腹膜透析（PD）中小溶质清除率和液体清除指南于 2005 年发布。本文旨在通过回顾支持这些指南的文献并检查自那时以来的出版物，对这些指南进行更新。
通过电子数据库进行广泛的文献检索，并通过现有指南和选定文章的参考文献进行手工检索。
自 2005 年原始指南发布以来，关于 PD 中小溶质清除率的前瞻性干预试验尚无报道。迄今为止，这些试验主要限于少数前瞻性队列研究和回顾性研究。然而，这些研究一致表明，残余肾功能（RRF）比腹膜清除率更能与患者预后相关。在这一领域进行的为数不多的随机对照试验之一表明，每周 / 2.27±0.02 与每周 / 1.80±0.02 相比，在统计学上没有显著的生存优势。/ 的下限尚不清楚，但有微弱的证据表明，进行 PD 的无尿患者每周 / 应至少为 1.7。
在 PD 中小溶质清除率和液体清除方面，证据仍然非常有限。现有的证据表明，RRF 比腹膜清除率更重要，并且在目标每周 / >1.70 时似乎没有生存优势。
