Nissenson A R
Department of Medicine, University of California, School of Medicine, Los Angeles 90024-6945.
Am J Kidney Dis. 1994 Aug;24(2):368-75. doi: 10.1016/s0272-6386(12)80204-6.
Peritoneal dialysis is now performed as an end-stage renal disease modality in nearly 70,000 patients worldwide. The use of this modality varies widely from less than 5% of all end-stage renal disease patients in Japan to over 95% of patients in Mexico. In addition to medical and psychosocial factors, modality selection involves many other factors, including financial reimbursement, educational deficiencies, resource availability, social mores, and cultural habits. Survival on chronic peritoneal dialysis is similar to that on hemodialysis, although older diabetic patients on peritoneal dialysis may have a higher mortality rate. Hospitalizations and transfer off modality are more common in patients on chronic peritoneal dialysis compared with patients on hemodialysis. The important factors contributing to outcome in patients on chronic peritoneal dialysis are unknown. Results of the Baxter Best-Demonstrated Practice Program suggest that process of care has a strong impact on outcome, at least in retention of patients on chronic peritoneal dialysis. Quality of life is another outcome that has been poorly assessed in chronic peritoneal dialysis patients. Available studies suffer from a lack of standardization of instruments used, no control groups, no random patient allocation to modalities, and short-term, small population groups. When chronic peritoneal dialysis and hemodialysis are compared, subjective quality of life is generally higher with chronic peritoneal dialysis. For objective quality of life, the balance of studies favor hemodialysis. It is clear that there is a dearth of information available on many aspects of delivery of chronic peritoneal dialysis. Future research should target patient factors that are important in morbidity and mortality with chronic peritoneal dialysis, facility factors ("process of care") that are important in morbidity and mortality with chronic peritoneal dialysis, quality of life in chronic peritoneal dialysis patients, and how to measure quality of life accurately and serially. If these issues can be addressed, algorithms could be developed to help the physician to match the end-stage renal disease patient to the treatment modality that will provide the highest quality of life, the least morbidity, and the longest survival.
腹膜透析目前作为一种终末期肾病治疗方式，在全球近70000例患者中应用。这种治疗方式的使用差异很大，在日本终末期肾病患者中占比不到5%，而在墨西哥则超过95%。除了医学和社会心理因素外，治疗方式的选择还涉及许多其他因素，包括医保报销、教育缺陷、资源可用性、社会习俗和文化习惯。慢性腹膜透析患者的生存率与血液透析患者相似，不过接受腹膜透析的老年糖尿病患者死亡率可能更高。与血液透析患者相比，慢性腹膜透析患者住院和更换治疗方式更为常见。导致慢性腹膜透析患者治疗结果的重要因素尚不清楚。百特最佳示范实践项目的结果表明，护理过程对治疗结果有很大影响，至少在慢性腹膜透析患者的留存率方面如此。生活质量是慢性腹膜透析患者中评估较差的另一项治疗结果。现有研究存在所用工具缺乏标准化、无对照组、患者未随机分配治疗方式以及研究为短期、小样本群体等问题。比较慢性腹膜透析和血液透析时，慢性腹膜透析患者的主观生活质量总体较高。对于客观生活质量，多数研究结果更倾向于血液透析。显然，关于慢性腹膜透析治疗的许多方面，现有信息匮乏。未来研究应针对慢性腹膜透析发病和死亡中重要的患者因素、慢性腹膜透析发病和死亡中重要的医疗机构因素（“护理过程”）、慢性腹膜透析患者的生活质量，以及如何准确且连续地测量生活质量。如果这些问题能够得到解决，就可以制定算法，帮助医生为终末期肾病患者匹配能提供最高生活质量、最低发病率和最长生存期的治疗方式。
