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首页> 外文期刊>Peritoneal dialysis international: Journal of the International Society for Peritoneal Dialysis >Incremental initiation of dialysis: one center's experience over a two-year period.
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Incremental initiation of dialysis: one center's experience over a two-year period.

机译：逐步开始透析：一个中心两年的经验。

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OBJECTIVE: This pilot study describes our center's experience with peritoneal dialysis (PD) over the past 2 years using a "healthy start" dialysis protocol with an incremental approach to prescription management. DESIGN: Nonrandomized, prospective pilot study. SETTING: Single PD unit of a university teaching hospital. PATIENTS: Thirteen PD patients who initiated dialysis at our center from April 1997 to June 1999. METHODS: Patients initiating PD with residual renal Kt/V of 1.0 - 2.0/week were invited to participate. They were given an initial dialysis prescription so that total (residual renal + dialysis) weekly Kt/V exceeded 2.0. The dialysis prescription was "incrementally" increased as residual renal function (RRF) declined. Data collected for all patients included monthly serum chemistries, residual renal weekly Kt/V and creatinine clearance (CCr) at 1- to 2-month intervals, and peritoneal weekly Kt/V and CCr at 3-month intervals and 1 month after each prescription change. RESULTS: To date, we have followed 13 patients on our incremental PD protocol for a total of 159.3 patient-months. Mean serum albumin concentration and mean normalized protein equivalent of nitrogen appearance (nPNA) were stable throughout the study. Mean total Kt/V and CCr remained above the recommended targets of 2.0/wk and 60 L/wk, respectively. Residual renal function declined rather slowly in our PD patients. One patient died from complications of aortic valve surgery and a second died from pneumonia. A third patient died from peritonitis. One patient required a new Tenckhoff catheter after catheter migration. Three patients were temporarily switched to hemodialysis after a hernia repair, a pleural leak, and elective native/transplant nephrectomies, respectively. Two patients were permanently switched to hemodialysis: one after an episode of peritonitis, the second after accidentally damaging his PD catheter. CONCLUSIONS: Providing incremental dialysis to maintain adequate total small solute clearance has been technically feasible in our patient population. However, a larger than expected number of complications was seen in our study. Fortunately, complications were easier to manage due to the presence of RRF. Because this study was not designed to compare outcome with that observed after traditional initiation of dialysis, further large-scale studies are needed.
机译：目的：这项初步研究描述了我们中心在过去两年中使用“健康开始”透析方案和渐进式处方管理方法进行腹膜透析（PD）的经验。设计：非随机前瞻性研究。地点：大学教学医院的单一PD单元。患者：1997年4月至1999年6月在我们中心进行透析的13名PD患者。方法：邀请残余肾Kt / V为1.0-2.0 /周的PD患者入选。给他们一个初始的透析处方，以使每周总（残余肾脏+透析）Kt / V超过2.0。随着残余肾功能（RRF）下降，透析处方“逐渐”增加。所有患者收集的数据包括每月血清化学指标，每隔1-2个月间隔一次的残余肾脏每周Kt / V和肌酐清除率（CCr），每隔一次处方后每3个月和1个月一次的腹膜每周Kt / V和CCr更改。结果：到目前为止，我们已经按照递增PD方案对13例患者进行了随访，总共159.3个月。在整个研究过程中，平均血清白蛋白浓度和平均氮素表观标准化蛋白质当量（nPNA）稳定。平均总Kt / V和CCr分别高于建议的目标2.0 / wk和60 L / wk。在我们的PD患者中，残余肾功能的下降相当缓慢。一名患者死于主动脉瓣手术并发症，另一例死于肺炎。第三名患者死于腹膜炎。一名患者在导管迁移后需要使用新的Tenckhoff导管。三名患者分别在疝气修复，胸膜渗漏和选择性自然/移植肾摘除术后暂时转为血液透析。两名患者被永久性地进行血液透析：一例发生腹膜炎，第二例意外损坏了他的PD导管。结论：在我们的患者人群中，提供增量透析以维持足够的总小溶质清除率在技术上是可行的。但是，在我们的研究中发现的并发症数量超过了预期。幸运的是，由于存在RRF，并发症更容易处理。由于本研究的目的不是将结局与传统透析开始后的结局进行比较，因此需要进一步的大规模研究。

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