腹膜透析充分性的国际指南解读

《腹膜透析充分性的国际指南解读》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、腹膜透析充分性的国际指南Shijunbao腹膜透析充分性的国际指南ISPDGUIDELINEONTARGETSFORSOLUTEANDFLUIDREMOVALINADULTPATIENTSONCHRONICPERITONEALDIALYSISKDOQICLINICALPRACTICEGUIDELINESANDCLINICALPRACTICERECOMMENDATIONS2006UPDATESERA-EDTAEUROPEANBESTPRACTICEGUIDELINESFORPERITONEALDIALYSISGUIDELINEONTARGETSFORSOLUTEANDFLU

2、IDREMOVALINADULTPATIENTSONCHRONICPERITONEALDIALYSISISPDGUIDELINES/RECOMMENDATIONSRECOMMENDATIONS1Adequacyofdialysisshouldbeinterpretedclinicallyratherthanbytargetingonlysoluteandfluidremoval.ClinicalAssessmentClinicalandlaboratoryresultsPeritonealandrenalclearancesHydrationstatusAppetitea

3、ndnutritionalstatusEnergylevelHemoglobinconcentrationResponsivenesstoerythropoietintherapyElectrolytesandacid–basebalanceCalciumphosphatehomeostasisBloodpressurecontrolRECOMMENDATIONS2Inordertoemphasizethatthereismoretoadequatedialysisthanafocusonsmallsolutekineticsandultrafiltrationtarge

4、ts,theCommitteedecidedtonamethisguidelineGuidelineonTargetsforSoluteandFluidRemovalinAdultPatientsonChronicPeritonealDialysisinsteadofGuidelineonAdequacyofPeritonealDialysis.RECOMMENDATIONS3Forsmallsoluteremoval,thetotal(renal+peritoneal)Kt/Vureashouldnotbelessthan1.7atanytime(Evidencelev

5、elA).Thatmeans,inanuricpatients,peritonealKt/Vureahastobeabove1.7.RECOMMENDATIONS3Inthepresenceofresidualrenalfunction,thecontributionsofrenalandperitonealclearancesmaybeaddedforpracticalpurposes,although,asmentionedpreviously,renalandperitonealclearancesmaynotbetrulyadditive(Opinion).Sol

6、uteremovalabovethislevelshouldnotbeequatedwith“adequatedialysis.”RECOMMENDATIONS3Knowledgeofthetransportcharacteristicsofthepatient’speritonealmembranebyperitonealequilibrationtestorothertestsmayhelptooptimizetheprescriptiontomeetthistarget.RECOMMENDATIONS4Aseparatetargetforcreatinineclea

7、ranceisnotrequiredinCAPD.InAPD,duetoamorevariablerelationshipbetweenureaandcreatinineclearanceanadditionaltargetof45L/week/1.73m2forcreatinineclearanceisrecommended(EvidencelevelC).RECOMMENDATIONS5Forpatientswhorelysignificantlyonresidualrenalfunctiontoachievethemin