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终末期肾病肾脏替代治疗替代方案

Authors
Andreas Pierratos, MD, FRCPC
Gihad E Nesrallah, MD, MSc, FRCPC, FACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
刘丽秋, 主任医师

引言

尽管目前透析技术和患者护理水平有所提高，但维持性透析患者的死亡率仍然高得惊人，每年大约为15%-20%[1,2]。为了改善预后，曾认为给予高于常规透析中常用的透析量可提高接受肾脏替代治疗患者的生存率[3]。

然而，这一假说被两项大型的设计良好的研究推翻，这些研究纳入了血液透析和腹膜透析患者：

●血液透析(Hemodialysis, HEMO)研究显示，每次血液透析的透析量高于当前肾脏病预后质量倡议(Kidney Disease Outcomes Quality Initiative, K/DOQI)推荐量对患者的生存率并无积极影响[4]。 (参见“开具血液透析处方和评估血液透析的充分性”)

●墨西哥腹膜透析充分性(Adequacy of Peritoneal Dialysis in Mexico, ADEMEX)研究显示，当腹膜透析剂量使每周Kt/V大于1.7，未见死亡率降低[5]。 (参见“腹膜透析的充分性”)

由于这些阴性研究结果的出现，人们已极大地关注替代性透析方案，例如长期间歇性血液透析、每日短时血液透析及夜间血液透析。这些方法都将单独详细讨论。 (参见“夜间血液透析技术方面的问题”和“Short daily hemodialysis”)

                                      

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Literature review current through: 2017-06 . | This topic last updated: 2016-01-28.
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