Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili, Brescia, Italy.
Servizio di Nefrologia, Ospedale Regionale di Lugano, Ospdeale Civico, Ente Ospedaliero Cantonale, Via Tesserete 46, 6903, Lugano, Switzerland.
J Nephrol. 2023 Sep;36(7):1763-1776. doi: 10.1007/s40620-023-01759-w. Epub 2023 Sep 25.
As the global burden of chronic kidney disease continues to increase, the use of peritoneal dialysis is often advocated as the preferred initial dialysis modality. Observational studies suggest a survival advantage for peritoneal dialysis over hemodialysis for the initial 2-3 years of dialysis. Peritoneal dialysis has been associated with better graft survival after kidney transplantation and has a reduced cost burden compared to hemodialysis. However, several medical and non-medical reasons may limit access to peritoneal dialysis, and less than 20% of patients with end-stage kidney disease are treated with peritoneal dialysis worldwide. In this narrative review, we sought to summarize the recent medical literature on risk factors for peritoneal dialysis discontinuation, distinguishing the early and the late phase after peritoneal dialysis initiation. Although the definition of clinically relevant outcomes varies among studies, we observed that center size, older age, and the presence of many comorbidities are risk factors associated with peritoneal dialysis discontinuation, regardless of the phase after peritoneal dialysis initiation. On the contrary, poor technique training and late referral to nephrology care, as opposed to the need for a caregiver, patient burnout and frequent hospitalizations, are related to early and late peritoneal dialysis drop-out, respectively. The aim of the review is to provide an overview of the most relevant parameters to be considered when advising patients in the selection of the most appropriate dialysis modality and in the clinical management of peritoneal dialysis patients. In addition, we wish to provide the readers with a critical appraisal of current literature and a call for a consensus on the definition of clinically relevant outcomes in peritoneal dialysis to better address patients' needs.
随着全球慢性肾脏病负担的不断增加，腹膜透析常被推荐作为首选的初始透析方式。观察性研究表明，在透析的最初 2-3 年内，腹膜透析的生存率优于血液透析。腹膜透析与肾移植后移植物存活率的提高有关，与血液透析相比，其成本负担也较低。然而，由于多种医学和非医学原因，腹膜透析的应用可能会受到限制，全世界只有不到 20%的终末期肾病患者接受腹膜透析治疗。在本综述中，我们试图总结腹膜透析停止的近期医学文献，区分腹膜透析开始后的早期和晚期阶段。尽管不同研究中临床相关结局的定义不同，但我们观察到中心规模、年龄较大以及存在多种合并症是与腹膜透析停止相关的危险因素，而与腹膜透析开始后的阶段无关。相反，技术培训不良和晚期转至肾病科治疗，而非需要护理人员、患者倦怠和频繁住院，分别与腹膜透析的早期和晚期停止相关。本综述的目的是提供一个概述，介绍在为患者选择最合适的透析方式和腹膜透析患者的临床管理中应考虑的最重要参数。此外，我们希望对当前文献进行批判性评估，并呼吁就腹膜透析中临床相关结局的定义达成共识，以更好地满足患者的需求。
