Peritoneal dialysis in acute renal failure.

Given the discussion so far, it might be apparent that factors beyond efficacy have dictated the decline in the use of PD for ARF. The importance of these factors should not be underestimated. They might be related to the perceived "labor intensive" aspect of PD, fear of a malfunctioning catheter (which in some instances may be real), insufficient exposure to PD during nephrology training, and, last, the comfort offered by the technology used for HD. Such psychological barriers are difficult to overcome, much more so than technical barriers (which can be and have been overcome). Only a concentrated effort by the PD community in educating the general nephrologist concerning the feasibility of PD in ARF, better clinical trials that harness the full potential of PD, and careful patient selection for the use of PD will bring PD back to the mainstream in the treatment of ARF.     

腹膜透析在小儿心脏术后急性肾功能衰竭治疗中的应用

目的探讨心脏直视术后急性肾功能衰竭的治疗方法。方法1995年4月～2000年5月,应用腹膜透析治疗小儿急性肾功能衰竭6例,急性肾功能衰竭均发生于低温体外循环下复杂先天性心脏病矫正术后,原因包括心跳骤停1例,低心排出量综合征4例,诱因不明1例。结果死亡1例。存活5例腹膜透析3～4日尿量恢复正常,透析出液体(42±18)ml     

脑出血并急性肾功能衰竭的腹膜透析治疗

目的观察腹膜透析治疗脑出血合并急性肾功能衰竭的疗效。方法将40例脑出血合并急性肾功能衰竭患者随机分成两组,腹膜透析组与无肝素血液透析组,对疗效进行观察。结果两种透析方法对溶质的清除和酸碱平衡的影响差异无统计学意义,但腹膜透析组的存活率明显高于无肝素血液透析组,且腹膜透析组的日平均透析费也明显低于无肝素血液透析组。结论脑出血合并急性肾功能衰竭采用腹膜透析治疗是一种安全有效经济的方法。     

Peritoneal dialysis for management of pediatric acute renal failure.

BACKGROUND: While the use of continuous renal replacement therapies in the management of children with acute renal failure (ARF) has increased, the role of peritoneal dialysis (PD) in the treatment of pediatric ARF has received less attention. DESIGN: Retrospective database review of children requiring PD for ARF over a 10-year period. SETTING: Pediatric intensive care unit at a tertiary-care referral center. PATIENTS: Sixty-three children without previously known underlying renal disease who required PD for treatment of ARF. RESULTS: Causes of ARF were congestive heart failure (27), hemolytic-uremic syndrome (13), sepsis (10), nonrenal organ transplant (7), malignancy (3), and other (3). Mean duration of PD was 11 +/- 13 days. Children with ARF were younger (30 +/- 48 months vs 88 +/- 68 months old, p < 0.0001) and smaller (11.9 +/- 15.9 kg vs 28 +/- 22 kg, p < 0.0001) than children with known underlying renal disease who began PD during the same time period. Percutaneously placed PD catheters were used in 62% of children with ARF, compared to 4% of children with known renal disease (p < 0.0001). Hypotension was common in patients with ARF (46%), which correlated with a high frequency of vasopressor use (78%) at the time of initiation of PD. Complications of PD occurred in 25% of patients, the most common being catheter malfunction. Recovery of renal function occurred in 38% of patients; patient survival was 51%. CONCLUSIONS: Peritoneal dialysis remains an appropriate therapy for pediatric ARF from many causes, even in severely ill children requiring vasopressor support. Such children can be cared for without the use of more expensive and technology-dependent forms of renal replacement therapies.     

腹膜透析治疗小儿先心病术后急性肾功能衰竭

目的 探讨腹膜透析(PD)对小儿先天性心脏病术后急性肾功能衰竭(ARF)的治疗效果。方法 对36例先心病术后ARF行腹膜透析治疗患儿的临床资料进行透析效果、转归合并症进行回顾性分析。结果 单纯ARF的死亡率12.5％,显著低于合并其它系统器官衰竭组的45％(P<0.05),腹膜透析3～30天内肾功能恢复,其中1～2天内血钾[K~ ]恢复正常,2～5天内血碳酸氢根[HCO_3~-]恢复正常,4～6天内血尿素氮(BUN)下降49.2％,血肌酐(Cr)下降42.6％。结论 对小儿先心病术后ARF,及早进行腹膜透析具有较好的治疗效果。     

Peritoneal dialysis for acute renal failure: overfeeding resulting from dextrose absorbed during dialysis

Peritoneal dialysis is a relatively safe and effective form of therapy for acute renal failure (ARF). As dextrose in the dialysate provides the osmotic gradient to achieve fluid removal, frequent exchanges with dialysate containing high dextrose is occasionally used to achieve negative balance in fluid overloaded patients. It has previously been shown that dextrose absorption from the peritoneal cavity is significant. Using indirect calorimetry and analyzing the dialysate effluent for its dextrose concentration, we studied the effects of high dextrose-containing dialysate in five patients with ARF. Despite minimal intake of calories, all patients had an RQ greater than 1.0 consistent with net lipogenesis resulting from dextrose absorbed from the peritoneal cavity. Four of five patients absorbed greater than 500 g of dextrose over 24 h. As overfeeding could lead to hepatic steatosis, increased CO2 production with worsening of respiratory failure, and hyperglycemia, the risks of using high dextrose-containing dialysate fluids should be weighed carefully against potential benefits. When nutritional support is indicated in such patients, contribution of dextrose calories from dialysate fluid should be taken into account.     

儿童急性肾功能衰竭行腹膜透析的护理

急性肾功能衰竭(acute renal failure,ARF)为儿童常见急危重症,病势凶险,病死率极高,腹膜透析(peritoneal dialysis,PD)是治疗小儿急性肾功能衰竭的重要手段之一.置管后的早期透析操作主要由护士完成,从透析前的准备,透析时注意防止渗漏,防止感染,密切观察病情变化以及后期指导、培训家长进行操作,护士在不同阶段采取不同的对策,起着关键的作用.我科2007年收治了4例ARF行腹膜透析治疗的患儿,经过精心护理,预后较好,现报道如下.     

床边插管腹膜透析治疗慢性肾脏病急性肾衰56例效果分析

目的 探讨床边插管腹膜透析(PD)治疗慢性肾脏病急性肾衰(A/C)的疗效及安全性.方法 回顾性分析我科在综合治疗基础上联合床边插管PD治疗56例A/C患者的疗效与转归,观察患者PD治疗前后血肌酐(Scr)、尿素氮( BUN)、钾(K+)、二氧化碳结合力(CO2CP)水平的变化以及床边插管PD的并发症.结果 45例A/C患者经PD治行后短期内血Scr 、BUN、K+、CO2CP下降非常明显(P<0.001).其中31例患者肾功能恢复到基础水平,脱离透析;11例患者肾功能无明显改变,其中1例进入维持性透析.无一例因插管出现严重并发症.结论 床边插管PD治疗A/C是一种安全、简单、经济、有效的治疗方法,早期、持续地行PD治行有利于改善A/C的预后.     

Peritoneal dialysis retardation of progression of advanced renal failure.

OBJECTIVES: The rate of decline of residual renal function is slower in peritoneal dialysis (PD) than in hemodialysis. However, it is unclear which and whether either of the two techniques modifies the natural course of renal failure. We tested whether PD influences the natural course of the progression of chronic renal failure in humans. DESIGN: Retrospective review of clinical charts. SETTING: Tertiary-care center. PATIENTS: Fourteen patients were selected from the 36 patients that were treated with PD in our center from January 1997 to June 2000, applying the following criteria: predialysis follow-up longer than 12 months, renal creatinine clearance 20 mL/minute or more at the start of predialysis follow-up, follow-up while on PD longer than 6 months, and renal creatinine clearance above 0 mL/minute at the start of PD. MAIN OUTCOME MEASURE: Residual renal function calculated as renal creatinine clearance obtained from 24-hour urine samples. RESULTS: A lower mean rate of decline of residual renal function was observed during PD than during the predialysis period (-0.06 +/- 0.16 vs -0.94 +/- 0.74 mL/min/month, p < 0.0005). The rate of decline in renal creatinine clearance was faster in every patient during the predialysis period than during his or her time on PD. CONCLUSIONS: These preliminary data support the hypothesis that PD may contribute to the slowing of the natural progression of renal disease in humans, as it does in rodents. Prospective studies involving a larger number of patients are needed to settle the question.     

急性肾功能衰竭的透析治疗

急性肾功能衰竭(ARF)是以肾小球滤过率(GFR)迅速下降(几小时到几周)和代谢紊乱(含蛋白质、水、电解质、酸碱)为特征的临床危重综合征,涉及临床多个科室,发病率相当高,近几年来,外科和创伤后ARF的发生率下降,而内科性ARF的比例升高。产科源性ARF尤其是流产后败血症所致者,在西方国家几乎已消失,但在发展中国家数据仍很可观,肾毒性ARF接近20％,且有上升趋势。     

Peritoneal dialysis in chronic renal insufficiency

The author reviews a possibility of the use of peritoneal dialysis in the treatment of patients with chronic renal failure. Demonstrates that this procedure compares very favourably with chronic hemodialysis (less economic losses, simplicity, no burden of the heart). Recommends the performance of the automatized procedure 3 to 5 times a week, with each session lasting 10 to 12 h.     

高龄肾功能衰竭患者腹膜透析疗效分析

目的 评价腹膜透析(PD)在高龄肾功能衰竭患者治疗中的作用。方法 观察35例高龄肾衰患者PD治疗前及PD治疗后肾功能、肝功能、血红蛋白等评价指标的动态变化,并发症的发生情况及生存率的变化。结果 大多数高龄患者在行腹透治疗后血浆白蛋白、血清前白蛋白和血红蛋白等全身营养状况指标均较治疗前有明显降低,常见并发症有:低血钾、腹膜炎、呼吸道感染、心力衰竭、皮肤和肢体末端溃疡和腹壁疝。结论 腹膜透析治疗并非是高龄肾衰患者最合适的治疗手段,应综合考虑患者病情,选择适合的透析方式。     

High volume peritoneal dialysis for acute renal failure.

BACKGROUND: Peritoneal dialysis (PD) is still widely used for acute renal failure (ARF) in developing countries despite concerns about its inadequacy. Continuous PD has been evaluated in ARF by analyzing the resolution of metabolic abnormality and normalization of plasma pH, bicarbonate, and potassium. Methodology: A prospective study was performed on 30 ARF patients who were assigned to high-dose continuous PD (Kt/V = 0.65 per session) via a flexible catheter (Tenckhoff) and automated PD with a cycler. Fluid removal, pH and metabolic control, protein loss, and patient outcome were evaluated. RESULTS: Patients received 236 continuous PD sessions; 76% were admitted to ICUs. APACHE II score was 32.2+/-8.65. BUN concentrations stabilized after 3 sessions, creatinine after 4, and bicarbonate and pH after 2. Fluid removal was 2.1+/-0.62 L/day. Creatinine and urea clearances were 15.8+/-4.16 and 17.3+/-5.01 mL/minute respectively. Normalized creatinine clearance and urea Kt/V values were 110.6+/-22.5 L/week/1.73 m(2) body surface area and 3.8+/-0.6 respectively. Solute reduction index was 41%+/-6.5% per session. Serum albumin values remained stable in spite of considerable protein losses (median 21.7 g/day, interquartile range 9.1-29.8 g/day). Regarding ARF outcome, 23% of patients presented renal function recovery, 13% remained on dialysis after 30 days of follow-up, and 57% died. CONCLUSION: High-dose continuous PD by flexible catheter and cycler was an effective treatment for ARF. It provided high solute removal, allowing appropriate metabolic and pH control, and adequate dialysis dose and fluid removal. Continuous PD can therefore be considered an alternative to other forms of renal replacement therapy in ARF.