腹膜透析充分性的国际指南解读.pptx

腹膜透析充分性的国际指南
Shijunbao
腹膜透析充分性的国际指南
ISPD
GUIDELINE ON TARGETS FOR SOLUTE AND FLUID REMOVAL IN ADULT PATIENTS ON CHRONIC PERITONEAL DIALYSIS
KDOQI
CLINICAL PRACTICE GUIDELINES AND CLINICAL PRACTICE MENDATIONS 2006 UPDATES
ERA-EDTA
EUROPEAN BEST PRACTICE GUIDELINES FOR PERITONEAL DIALYSIS
GUIDELINE ON TARGETS FOR SOLUTE AND FLUID REMOVAL IN ADULT PATIENTS ON CHRONIC PERITONEAL DIALYSIS
ISPD GUIDELINES/MENDATIONS
MENDATIONS 1
Adequacy of dialysis should be interpreted clinically
rather than by targeting only solute and fluid removal.
Clinical Assessment
Clinical and laboratory results
Peritoneal and renal clearances
Hydration status
Appetite and nutritional status
Energy level
Hemoglobin concentration
Responsiveness to erythropoietin therapy
Electrolytes and acid–base balance
Calcium phosphate homeostasis
Blood pressure control
MENDATIONS 2
In order to emphasize that there is more to adequate dialysis than a focus on small solute ics and ultrafiltration targets, mittee decided to name this guideline
Guideline on Targets for Solute and Fluid Removal in Adult Patients on Chronic Peritoneal Dialysis instead of Guideline on Adequacy of Peritoneal Dialysis.
MENDATIONS 3
For small solute removal, the total (renal + peritoneal) Kt/V urea should not be less than at any time (Evidence level A).
That means, in anuric patients, peritoneal Kt/V urea has to be above .
MENDATIONS 3
In the presence of residual renal function, the contributions of renal and peritoneal clearances may be added for practical purposes, although,
as mentioned previously, renal and peritoneal clearances may not be truly additive (Opinion).
Solute removal above this level should not be equated with “adequate dialysis.”
MENDATIONS 3
Knowledge of the transport characteristics of the patient’s peritoneal membrane by peritoneal equilibration test or other tests
may help to optimize the prescription to meet this target.
MENDATIONS 4
A separate target for creatinine clearance is not req