8 how pd works 2 ch腹透原理2.pptVIP

How PD works 2 腹透原理 2 Min Sun PARK, M.D., Ph. D., Medical Director Baxter Asia Renal Contents of talk 内容 What is peritoneal membrane ? Physiology of peritoneal dialysis Uremic toxin removal Fluid removal Sodium 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 Goal of Dialysis 透析目标 Maintains symptom-free by replacing some of the functions performed by the healthy kidneys. To removes uremic toxins accumulated in the blood Water Electrolytes Urea, creatinine, phosphate, PTH, etc. H+ Minimizes mortality and morbidity Prevents short- and long-term complications 通过替代正常肾脏的部分功能减轻肾衰时机体相关症状 清除积聚在血液中的尿毒症毒素 水分 电解质 尿素、肌酐、磷、甲状旁腺激素等等 氢离子 发病率和死亡率最低化 预防短期、长期并发症 How to achieve it ? 如何达到治疗目标？ Sufficient fluid and toxin removal: dose of dialysis It depends on Residual renal function Body size Co-morbid condition 充分清除水分和毒素：透析剂量 有赖于： 残存肾功能 体形大小 合并症情况 How to measure toxin removal ?如何评估毒素清除情况？ Surrogate markers of uremia Creatinine Urea Numeric measurement of uremic toxin removal Removal of urea and creatinine Normalizing factor: Body size Total removal=Peritoneal + Renal Calculation of peritoneal clearance腹透清除率计算 Calculation of renal creatinine clearance for 24 hours: Total urinary creatinine removal divided by serum creatinine level U/Pcreatinine x urine volume Standardized by body surface area Calculation of peritoneal clearance (Urea/Creatinine) for 24 hours Total peritoneal removal divided by serum level D/P x total dialysate volume Standardized by body surface area (creatinine)-Peritoneal creatinine clearance Standardized by body water content (urea): Kt/Vurea Important factors determining peritoneal clearance决定腹膜清除率的重要因素 Dialysate to plasma concentration ratio (D/P) : Peritoneal transport characteristics Diffusion Convection : Mainly depends on ultrafiltration Dialysate volume Total infusion volume Ultrafiltration vol