Brown Edwina A, Ryan Louise, Corbett Richard W
Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
Perit Dial Int. 2023 Jan;43(1):100-103. doi: 10.1177/08968608221111276. Epub 2022 Jul 11.
We have developed a supportive two-exchange assisted continuous ambulatory peritoneal dialysis (asCAPD) programme for the older frail person who cannot do autonomous PD and do not want or are considered to be too high risk for haemodialysis (HD). Evaluation of the programme was determined by data collected retrospectively from patient records. Primary outcome was comparison of symptoms at start of dialysis and 3 months following dialysis start. Secondary outcomes were survival and peritonitis rate. Over a 4-year period (2016-2020), 49 patients with mean age 79.6 years (range 47-90) enrolled in the programme with eGFR 7.7 ± 2.6 ml/min (mean ± SD) at dialysis start. Forty-one patients had been on asCAPD for 3 months. There was an improvement in all symptoms at 3 months compared to baseline: anorexia (46% to 15%), fatigue (46% to 15%), shortness of breath (27% to 2%) and oedema (51% to 32%). One-year survival was 55%. Peritonitis rate was 0.52 episodes per patient year. The novel supportive two-exchange asCAPD programme shows potential improvement of symptoms after 3 months and may provide an acceptable dialysis modality for the frail co-morbid person with established kidney failure. More detailed study and evaluation are needed.
我们为无法自主进行腹膜透析且不想或被认为进行血液透析（HD）风险过高的老年体弱患者制定了一项支持性的两次交换辅助持续性非卧床腹膜透析（asCAPD）计划。该计划的评估由从患者记录中回顾性收集的数据决定。主要结局是比较透析开始时和透析开始后3个月的症状。次要结局是生存率和腹膜炎发生率。在4年期间（2016 - 2020年），49名平均年龄79.6岁（范围47 - 90岁）的患者纳入该计划，透析开始时估算肾小球滤过率（eGFR）为7.7±2.6 ml/分钟（均值±标准差）。41名患者接受asCAPD治疗3个月。与基线相比，3个月时所有症状均有改善：厌食（从46%降至15%）、疲劳（从46%降至15%）、呼吸急促（从27%降至2%）和水肿（从51%降至32%）。一年生存率为55%。腹膜炎发生率为每位患者每年0.52次发作。新型支持性两次交换asCAPD计划显示3个月后症状有潜在改善，可能为患有慢性肾衰竭的体弱合并症患者提供一种可接受的透析方式。尚需更详细的研究和评估。
