Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.
Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China.
Perit Dial Int. 2020 May;40(3):282-292. doi: 10.1177/0896860819895365. Epub 2020 Jan 17.
Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for "High-quality PD prescription" necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy.
A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted.
There were no randomized controlled trials on blood pressure intervention and six randomized trials of bioimpedance-guided volume management. Generally, all studies were of small sample size, short duration, and used surrogate markers as primary outcomes. As a consequence, only "practice points" were drawn. High-quality goal-directed PD prescription should aim to achieve and maintain clinical euvolemia taking residual kidney function and its preservation into account, so that both fluid removal from peritoneal ultrafiltration and urine output are considered and residual kidney function is not compromised. Blood pressure should be included as a key objective parameter in assessing the quality of PD prescription but there is currently no evidence for a specific target in PD. Clinical examination remains the keystone of routine clinical care.
High-quality goal-directed PD prescription should include volume management as one of the key dimensions.
适当的容量控制是腹膜透析（PD）处方的关键目标之一。因此，它是国际腹膜透析学会（ISPD）“高质量 PD 处方”指南的重要组成部分，需要对容量管理文献进行回顾。工作组认识到在其范围内纳入处方高质量 PD 治疗时的容量状况和血压测量的重要性。
对自 2015 年 ISPD 成人心血管和代谢指南发布以来，2014 年 10 月至 2019 年 7 月期间发表的关于 PD 中容量状况及其管理的出版物，进行了 Medline 和 PubMed 搜索。
没有关于血压干预的随机对照试验，只有 6 项生物阻抗指导的容量管理随机试验。一般来说，所有研究的样本量都较小，持续时间较短，并且使用替代标志物作为主要结局。因此，只能得出“实践要点”。高质量的目标导向 PD 处方应旨在实现和维持临床等容状态，考虑残余肾功能及其保留，以便同时考虑腹膜超滤和尿液排出的液体去除，并避免残余肾功能受损。血压应作为评估 PD 处方质量的关键目标参数之一，但目前 PD 没有特定的目标证据。临床检查仍然是常规临床护理的基石。
高质量的目标导向 PD 处方应将容量管理作为关键维度之一。
