Serviço de Nefrologia, Centro Hospitalar Universitário Do Algarve, Faro, Portugal.
Imperial College Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK.
J Nephrol. 2023 Dec;36(9):2549-2557. doi: 10.1007/s40620-023-01765-y. Epub 2023 Oct 19.
Peritoneal dialysis provides several benefits for patients and should be offered as first line kidney replacement therapy, particularly for fragile patients. Limitation to self-care drove assisted peritoneal dialysis to evolve from family-based care to institutional programs, with specialized care givers. Some European countries have mastered this, while others are still bound by the availability of a volunteer to become responsible for treatment.
A group of leading nephrologists from 13 European countries integrated real-life application of such therapy, highlighting barriers, lessons learned and practical solutions. The objective of this work is to share and summarize several different approaches, with their intrinsic difficulties and solutions, which might helpperitoneal dialysis units to develop and offer assisted peritoneal dialysis.
Assisted peritoneal dialysis does not mean 4 continuous ambulatory peritoneal dialysis exchanges, 7 days/week, nor does it exclude cycler. Many different prescriptions might work for our patients. Tailoring PD prescription to residual kidney function, thereby maintaining small solute clearance, reduces dialysis burden and is associated with higher technique survival. Assisted peritoneal dialysis does not mean assistance will be needed permanently, it can be a transitional stage towards individual or caregiver autonomy. Private care agencies can be used to provide assistance; other options may involve implementing PD training programs for the staff of nursing homes or convalescence units. Social partners may be interested in participating in smaller initiatives or for limited time periods.
Assisted peritoneal dialysis is a valid technique, which should be expanded. In countries without structural models of assisted peritoneal dialysis, active involvement by the nephrologist is needed in order for it to become a reality.
腹膜透析为患者带来了诸多益处，应作为一线肾脏替代治疗方案，尤其适用于体弱患者。由于自我护理受限，辅助腹膜透析逐渐从家庭护理演变为机构化项目，由专业护理人员提供支持。一些欧洲国家已经掌握了这一模式，而其他国家仍受制于志愿者的可用性，以确保有人负责治疗。
来自 13 个欧洲国家的一组领先肾病学家整合了该疗法的实际应用，强调了其中的障碍、经验教训和实际解决方案。这项工作的目的是分享和总结几种不同的方法，以及它们固有的困难和解决方案，这可能有助于腹膜透析单位发展和提供辅助腹膜透析。
辅助腹膜透析并不意味着每周 7 天、每天进行 4 次持续非卧床腹膜透析交换，也不排除使用自动化腹膜透析机。许多不同的处方可能对我们的患者有效。根据残余肾功能调整 PD 处方，从而维持小分子清除率，可以减轻透析负担，并与更高的技术生存率相关。辅助腹膜透析并不意味着需要永久性的协助，可以作为向个人或护理人员自主管理的过渡阶段。私人护理机构可用于提供协助；其他选择可能涉及为疗养院或康复病房的工作人员实施 PD 培训计划。社会合作伙伴可能有兴趣参与较小的倡议或有限的时间段。
辅助腹膜透析是一种有效的技术，应予以推广。在没有辅助腹膜透析结构性模式的国家，需要肾病学家积极参与，才能使其成为现实。
