腹膜透析患者容量过多的评估
- Author
- John M Burkart, MD
John M Burkart, MD
- Section Editor — Dialysis
- Professor of Medicine/Nephrology
- Wake Forest University Medical Center
- Section Editor
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
- Deputy Editor
- Alice M Sheridan, MD
Alice M Sheridan, MD
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
- Translators
- 赵慧萍, 副主任医师，副教授
赵慧萍, 副主任医师，副教授
- 北京大学人民医院肾内科
引言
维持血容量正常在慢性肾脏病(chronic kidney disease, CKD)患者的治疗中至关重要，并且是肾脏替代治疗的一个主要目标。这个目标的实现取决于液体摄入与排出之间复杂的相互作用，而这种关系取决于患者及治疗相关的特点。
由于腹膜透析具有连续透析的特点，其有利于避免容量波动和保持状态稳定，所以它一直以来被认为在维持终末期肾病(end-stage renal disease, ESRD)患者充分的容量控制方面优于血液透析[1]。尽管具有这种优势，但许多腹膜透析患者仍出现高血压和容量超负荷[2]。这最常由一些可预防或可治疗的状况引起。
通常根据临床判断评判腹膜透析患者是否达到血容量正常或“目标体重”。然而，由于腹膜透析是一种居家治疗，这种临床判断常由患者决定。由于目标体重通常在腹膜透析培训期间设定，所以不能低估患者实际体重(如，肌肉质量、脂肪质量)动态变化的重要性，因此也不能低估患者的目标体重的重要性。
在标准的临床实践中，由于腹膜透析期间患者的体重可能减少或增加，所以其目标体重不是基于培训期间称重的结果。相反，它是根据临床参数的总体情况来确定，这些临床参数包括血压、外周水肿及体重。每月一次的门诊随访期间，需要根据心血管或营养状况的变化来重新评估目标体重。研究者们正在考虑更为精确的真实体重测量，例如人体阻抗检查，但是这些测量只能在临床随访时使用，比较耗时，而且大多数国家的医疗保险并不对其进行报销。
如果基于临床评估发现患者容量超负荷，则需要考虑其原因是否为下列病理生理过程：钠或水的摄入过多、钠或水的清除太少或出现新的共存疾病。基于这种方法，应该询问患者以下问题：
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- Coles GA. Have we underestimated the importance of fluid balance for the survival of PD patients? Perit Dial Int 1997; 17:321.
- K/DOQI Clinical Practice Guidelines for Peritoneal Dialysis Adequacy. Am J Kidney Dis 2006; 47(Suppl 4):S1.
- Mujais S, Nolph K, Gokal R, et al. Evaluation and management of ultrafiltration problems in peritoneal dialysis. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000; 20 Suppl 4:S5.
- Pannekeet MM, Imholz AL, Struijk DG, et al. The standard peritoneal permeability analysis: a tool for the assessment of peritoneal permeability characteristics in CAPD patients. Kidney Int 1995; 48:866.
- Pride ET, Gustafson J, Graham A, et al. Comparison of a 2.5% and a 4.25% dextrose peritoneal equilibration test. Perit Dial Int 2002; 22:365.
- Lam MF, Lo WK, Chu FS, et al. Retroperitoneal leakage as a cause of ultrafiltration failure. Perit Dial Int 2004; 24:466.
- Abu-Alfa AK, Burkart J, Piraino B, et al. Approach to fluid management in peritoneal dialysis: a practical algorithm. Kidney Int Suppl 2002; :S8.
- Michels WM, Zweers MM, Smit W, et al. Does lymphatic absorption change with the duration of peritoneal dialysis? Perit Dial Int 2004; 24:347.
- Akonur A, Holmes CJ, Leypoldt JK. Peritoneal residual volume induces variability of ultrafiltration with icodextrin. Perit Dial Int 2014; 34:95.
- Posthuma N, ter Wee PM, Verbrugh HA, et al. Icodextrin instead of glucose during the daytime dwell in CCPD increases ultrafiltration and 24-h dialysate creatinine clearance. Nephrol Dial Transplant 1997; 12:550.
- Teitelbaum I, Burkart J. Peritoneal dialysis. Am J Kidney Dis 2003; 42:1082.
- Davison SN, Jhangri GS, Jindal K, Pannu N. Comparison of volume overload with cycler-assisted versus continuous ambulatory peritoneal dialysis. Clin J Am Soc Nephrol 2009; 4:1044.
- Chan PC, Tam SC, Robinson JD, et al. Effect of phosphatidylcholine on ultrafiltration in patients on continuous ambulatory peritoneal dialysis. Nephron 1991; 59:100.
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