Krediet R T
Department of Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
Blood Purif. 1998;16(1):1-14. doi: 10.1159/000014307.
The success of peritoneal dialysis on the short-term is mainly dependent on the prevention of infectious and technical complications. The mid-term results will to a large extent be determined by the ability to remove enough uraemic toxins to prevent uraemic complications and malnutrition. The long-term challenge is the prevention of the development of structural abnormalities of the peritoneum leading to ultrafiltration failure and sometimes peritoneal sclerosis.
A review of the literature on the possibilities to increase the removal of uraemic waste products from the body, and on strategies to detect and prevent deteriorations of the peritoneal membrane during long-term dialysis treatment.
Improved efficacy and safety of peritoneal dialysis on the midterm can be achieved by individualization of the dialysis prescription taking residual renal function especially into account. Early start of dialysis might reduce the progression rate of renal function deterioration, but exposes the peritoneum to bio-incompatible dialysis solutions for a longer time. The long-term alterations in the peritoneal membrane are probably mainly caused by the continuous exposure to dialysis fluids, especially glucose, and perhaps the combination of low pH with lactate. The implications of long-term continuous ambulatory peritoneal dialysis using only more biocompatible dialysis fluids are not clear. To improve the efficacy and safety of peritoneal dialysis, careful monitoring of patients and dialysis is mandatory. This should include 24-hour urine collections and 24-hour dialysate collections to calculate the residual glomerular filtration rate and adequacy parameters. A peritoneal membrane function test should be done regularly with 3.86% glucose dialysate, including determinations of dialysate Na+ and cancer antigen 125 to detect patients who are at risk for the development of structural abnormalities of the peritoneum.
腹膜透析短期的成功主要取决于感染和技术并发症的预防。中期结果在很大程度上取决于清除足够尿毒症毒素以预防尿毒症并发症和营养不良的能力。长期面临的挑战是预防腹膜结构异常的发展，这种异常会导致超滤失败，有时还会引起腹膜硬化。
综述关于增加从体内清除尿毒症废物的可能性，以及长期透析治疗期间检测和预防腹膜功能恶化策略的文献。
通过个体化透析处方，尤其考虑残余肾功能，可在中期提高腹膜透析的疗效和安全性。早期开始透析可能会降低肾功能恶化的进展速度，但会使腹膜更长时间暴露于生物不相容的透析液中。腹膜的长期改变可能主要是由于持续接触透析液，尤其是葡萄糖，也可能是低pH值与乳酸的联合作用。仅使用生物相容性更高的透析液进行长期持续性非卧床腹膜透析的影响尚不清楚。为提高腹膜透析的疗效和安全性，必须对患者和透析进行仔细监测。这应包括收集24小时尿液和24小时透析液，以计算残余肾小球滤过率和充分性参数。应定期使用3.86%葡萄糖透析液进行腹膜功能测试，包括测定透析液钠和癌抗原125，以检测有腹膜结构异常发展风险的患者。
