腹膜透析超滤衰竭的诊治策略

超滤衰竭是腹膜透析常见的并发症，是导致腹膜透析失败的重要原因之一。超滤衰竭定义为4.25%葡萄糖透析液留腹4 h后超滤量<400 ml。超滤衰竭根据病理生理机制分为4种类型：Ⅰ型超滤衰竭由于有效腹膜表面积增加导致，Ⅱ型超滤衰竭由于葡萄糖渗透转导作用下降导致，Ⅲ型超滤衰竭由于腹膜有效表面积减少导致，Ⅳ型超滤衰竭由于通过腹腔淋巴系统或局部组织间隙吸收大量水分导致。避免过度使用高浓度葡萄糖透析液、有效防治腹膜透析相关腹膜炎、保护残肾功能、选用生物相容性好的透析液、使用改善腹膜损伤和纤维化药物等是防治超滤衰竭的有益方法。

Strategy of diagnosis and treatment for ultrafiltration failure of peritoneal dialysis

Ultrafiltration failure is a common complication and an important cause of peritoneal dialysis failure. Ultrafiltration failure is defined as that the net ultrafiltration volume is less than 400 ml after a 4-hour dwell with 4.25% dextrose dialysis solution. According to its pathophysiological mechanisms, the ultrafiltration failure has been divided into 4 types: type 1 ultrafiltration failure is caused by increase of effective peritoneal surface area; type 2 ultrafiltration failure is caused by decrease of osmotic conductance to glucose; type 3 ultrafiltration failure is caused by decrease of effective peritoneal surface area; and type 4 ultrafiltration failure is caused by absorbance of a lot of water through the peritoneal lymphatic system or local tissue gap. Beneficial methods to prevent and treat ultrafiltration failure include rational use of high glucose dialysate, effective prevention and treatment of peritoneal dialysis-related peritonitis, protection of residual renal function, appropriate use of biocompatible dialysates, and application of drugs to improve peritoneal damage and fibrosis.