HowPDWorksCH腹透原理课件.ppt

* * * * * * * * * * * * * * * What is the message ? * * This slide show patient survival curves for patients with baseline UF 750 mL/24 hr and those with baseline UF 750 mL/24 hr. Baseline UF 750 mL/24 hr was associated with worse patient survival (P=.0048). Worse patient survival was also predicted by baseline age (65 years, P=.001), worse nutritional status (SGA grade, P=.0014), increased comorbidity grade (P=.012), and diabetic status (P=.008). Gender, and baseline body surface area, total peritoneal or residual creatinine clearance, and peritoneal solute transport status did not influence patient, technique, or combined patient and technique survival. Brown EA, Davies SJ, Rutherford P, et al. Survival of functionally anuric patients on automated peritoneal dialysis: the European APD Outcome Study. J Am Soc Nephrol. 2003;14:2948-2957. * * * * * * * * * * * * * Elaborate * Elaborate * * * * * * * * * * * * * The weights at which the weekly Kt/Vurea equals the minimum target of 1.7  每周尿素Kt/V最少达到1.7的患者体重水平 Nolph Kd et al. Perit Dial Int 1994. 14: 261-264 Contents of talk 内容 What is peritoneal membrane ? Physiology of peritoneal dialysis Uremic toxin removal Fluid removal PD prescription Adequacy Membrane transport: PET Indications and contraindications of PD Preparing and performing PD APD Complications related to PD Clinical outcome of PD How to set-up PD center 什么是腹膜？ 腹膜透析(peritoneal dialysis, PD)的生理学 尿毒症毒素的清除 液体的清除 钠的清除 腹膜透析处方 充分性 膜转运：腹膜平衡试验(PET) 腹膜透析的适应症和禁忌症 腹膜透析的准备和实施 自动化腹膜透析（automatic peritoneal dialysis, APD) PD相关并发症 PD的临床预后 怎样建立PD中心? 腹膜透析适应症 大部分病人都适合做腹膜透析1 64％病人既可以腹透也可以血透2 中国维持性腹膜透析专家共识 Jagar KJ et, AJKD2004 Strong medical indication for PD腹膜透析绝对适应症 Difficulties with vascular access Left ventricular hypertrophy Congestive heart failure Prosthetic vascular disease Intolerance of HD Frequent episodes of hypotension Headache and asthenia after HD session Children 血管通路建立困难 左心室肥厚 充血性心衰 人造血管病变 不能耐受血液透析 经常出现低血压事件 血透后头痛和乏力 儿童 PD preferred适合PD Bleeding dia