Canaud B, Mion C
Service de néphrologie, Hôpital Lapeyronie, Montpellier.
Nephrologie. 1995;16(1):129-35.
Continuous ambulatory peritoneal dialysis (CPAD) is a fully recognized method for treating end stage renal disease patients. However, literature data in agreement indicating that CAPD is a treatment modality for short to mid-term period. Largest series show that technical survival for CAPD averaged 50% at 3 years. Transplantation, curing temporarily ESRD patients, represents a success exit for CAPD in only 25 to 30% of patients. CAPD does not impair long term success of renal graft. Post-operative morbidity related to peritoneal catheter (exit skin infection and peritonitis) and abdominal problems represents a significant risk that should be prevented by appropriate measures. Hemodialysis transfer, failure of the method, represents an exit modality in 50 to 60% of patients. Whatever causes of CAPD failure, psycho-social difficulties, inadequacy of dialysis, edema due to fluid excess, malnutrition, severe peritonitis, transfer to hemodialysis must be considered as soon as possible to prevent deleterious effects on patient survival. Such facts indicate that CAPD program must be associated with large and appropriate withdrawal hemodialysis facilities. CAPD may be also a waiting modality for hemodialysis patients faced with temporary or repeated vascular access problems. In this last case it must be emphasized that hemodialysis to CAPD transfer will reduce "dialysis dose" efficiency (e.g., urea Kt/V) by 50%. We conclude that rationale use of CAPD would provide an excellent treatment modality for end stage renal disease patients for a short or mid-term period of time.
持续性非卧床腹膜透析（CPAD）是一种被充分认可的治疗终末期肾病患者的方法。然而，文献数据一致表明，持续性非卧床腹膜透析是一种短期至中期的治疗方式。最大规模的系列研究表明，持续性非卧床腹膜透析的技术生存率在3年时平均为50%。移植可暂时治愈终末期肾病患者，但仅25%至30%的持续性非卧床腹膜透析患者能通过移植成功摆脱该治疗。持续性非卧床腹膜透析不会影响肾移植的长期成功率。与腹膜导管相关的术后并发症（出口皮肤感染和腹膜炎）以及腹部问题是重大风险，应通过适当措施加以预防。血液透析转换，即该方法失败，是50%至60%患者的一种退出方式。无论持续性非卧床腹膜透析失败的原因是什么，心理社会困难、透析不充分、液体过多导致的水肿、营养不良、严重腹膜炎，一旦出现都必须尽快考虑转为血液透析，以防止对患者生存产生有害影响。这些事实表明，持续性非卧床腹膜透析项目必须与大型且合适的备用血液透析设施相结合。持续性非卧床腹膜透析也可能是面临临时或反复血管通路问题的血液透析患者的一种过渡方式。在最后这种情况下，必须强调从血液透析转为持续性非卧床腹膜透析会使“透析剂量”效率（如尿素Kt/V）降低50%。我们得出结论，合理使用持续性非卧床腹膜透析将为终末期肾病患者在短期或中期提供一种极佳的治疗方式。
