Normandie Univ, UNICAEN, CHU de Caen Normandie, Néphrologie, 14000, Caen, France.
Normandie Université, Unicaen, UFR de Médecine, 2 rue des Rochambelles, 14032, Caen-Cedex, France.
J Nephrol. 2022 Dec;35(9):2411-2415. doi: 10.1007/s40620-022-01397-8. Epub 2022 Jul 18.
Thanks to the progress of dialysis, survival of patients with end-stage renal disease is increasing. For those patients who cannot benefit from a kidney transplantation, several dialysis alternatives exist, but the transition between dialysis techniques may be difficult. Home dialysis offers many advantages but requires personal commitment from the patients and the caregivers. How can we ensure smooth transitioning to the best dialysis technique at the right time for the right person? One of the main caveats of peritoneal dialysis is its limited technique survival, however, it combines the advantages of preserving residual kidney function, avoiding the need for a vascular access, or preserving it, when present, while providing good cost-effectiveness. On the other hand, home hemodialysis has excellent long-term technique survival. The home integrated model of peritoneal dialysis followed by home hemodialysis has been described as the ideal pathway of care. Eventually, in-center hemodialysis can be provided according to several schedules to adapt to the needs of the patients. The issue of technique survival and the possible need to switch to another technique should be part of the initial discussion, when the patient needs to choose the first dialysis modality. Unplanned transfers are associated with poor outcomes and unwanted shifts to in-center hemodialysis. Therefore, transfers from home-based techniques should be anticipated as much as possible in order to establish a shared decision modality process and to choose the desired new modality. Dialysis units dedicated to "transition care" should answer the needs of patients and smooth the transition process between dialysis modalities.
由于透析技术的进步，终末期肾病患者的生存率正在提高。对于那些不能从肾移植中获益的患者，有几种透析替代方法，但透析技术之间的转换可能很困难。家庭透析有许多优势，但需要患者和护理人员的个人承诺。我们如何确保在适当的时间为适当的人顺利过渡到最佳的透析技术？腹膜透析的一个主要缺点是其技术生存能力有限，但它结合了保留残余肾功能、避免或保留血管通路的优点，同时具有良好的成本效益。另一方面，家庭血液透析具有极好的长期技术生存能力。描述了腹膜透析家庭综合模式随后进行家庭血液透析作为理想的护理途径。最终，可以根据几种时间表提供中心血液透析，以适应患者的需求。技术生存能力问题以及可能需要切换到另一种技术的问题应该是初始讨论的一部分，当患者需要选择第一种透析方式时。无计划的转移与不良结局和不必要的转为中心血液透析有关。因此，应尽可能预期从家庭技术的转移，以便建立共同决策模式过程，并选择所需的新方式。专门用于“过渡护理”的透析单位应满足患者的需求，并使透析方式之间的过渡过程顺利进行。
