Durand P Y, Kessler M, Chanliau J
ALTIR, CHU de Nancy.
Nephrologie. 1998;19(5):239-44.
Recent epidemiological studies show a slowing down of the global growth of CAPD which is not compensated by the considerable development of APD. These modifications are the result of the arrival of technologies which allow new strategies as well as an improved knowledge of the adequate dialysis dose for PD. The re-evaluation of the adequate clearance targets show that CAPD does not deliver an adequate dialysis dose for anuric patients but it remains an excellent technique for patients with residual renal function. APD and mixed techniques (APD with automated diurnal exchange(s), CAPD with automated nocturnal exchange) can deliver an adequate dialysis dose if the peritoneal permeability is not too low and if the prescription is adapted to each patient. The growth of CAPD seems to be slowing down due to a better knowledge of its limitations. However the development of APD does not seem to be related to the increasing knowledge of its possibilities. The development of automated techniques, prescribed as substitute treatments, depends on a precise evaluation of the cost/efficiency/quality of life index, compared to the reference treatment which is iterative hemodialysis.
近期的流行病学研究表明，持续性非卧床腹膜透析（CAPD）的全球增长速度正在放缓，而间歇性腹膜透析（APD）的显著发展并不能弥补这一趋势。这些变化是新技术出现的结果，新技术带来了新的策略，也使人们对腹膜透析（PD）的适当透析剂量有了更好的认识。对适当清除目标的重新评估表明，CAPD不能为无尿患者提供足够的透析剂量，但对于仍有残余肾功能的患者而言，它仍是一种出色的技术。如果腹膜通透性不过低且处方适合每位患者，APD和混合技术（日间自动交换的APD、夜间自动交换的CAPD）可以提供足够的透析剂量。由于对CAPD局限性的更深入了解，其增长似乎正在放缓。然而，APD的发展似乎与对其可能性的认识增加无关。作为替代治疗方式的自动化技术的发展，取决于与作为参考治疗的间歇性血液透析相比，对成本/效率/生活质量指数的精确评估。
