CAPD guide line 透析的开始时机.PPT

CAPD guide line VS 施孟甫 醫師 CAPD麗華 CR 蔡智生 醫師 透析的 開始時機 每週 KT/V 2 GFR 10.5/min/1.73m2 DOQUI guideline 2 Before peritoneal dialysis 1. PD start 10 days to 2 weeks after catheter placement. 2. If PD started in 10 days following catheter placement, ?do low-volume, supine dialysis. 3. Obtain baseline 24-hour urine collection for urea and creatinine clearance Before peritoneal dialysis 4. Explain to patient/parents/caregivers that : The prescription will be individualized. Instilled volume almost increase over time. Their total solute clearance will be monitored IF RRF or peritoneal transport changes, their prescription may need to change as well. Initial prescription (1) Full dose to meet minimal total solute clearance goal (2) Pt with a significant RRF, but Kt/V 2.0 ?Incremental dosage of PD. (3) Based on BSA and residual renal function (4) During training, transporter type can be predicted from drain volume during a timed (4- hr) dwell with 2.5% glucose Residual renal function Renal GFR =1/2 (renal CCr + renal UreaCr) BSA =0.007184xBW(Kg)0.425xBH(cm)0.725 透析型態的選擇 CAPD = 白天由人力換透析液3-4次 晚上滯留 CCPD= 白天last bag滯留9小時,或CAPD換液1-2次 晚上由機器換透析液4-6次 NIDP = 晚上由機器換透析液4-6次 白天dry GFR 2 ml/min A. If patients lifestyle choice is CAPD: BSA1.7 m2 ?4 x 1.5 L exchanges/day BSA 1.7 to 2 m2 ?4 x 2.0 L exchanges/day BSA2.0 m2 ? 4 x 2.5 L exchanges/day GFR 2 ml/min B. If patients lifestyle choice is CCPD: BSA1.7 m2 ?6 x 1.5 L (9hours/night) +1 L/d(last bag) BSA 1.7 to 2.0 m2 ?4 x 2.0 L (9 hours/night)+1.5-2.0 L/day (last bag) BSA2.0 m2 ? 4 x 2.0 L (9 hours/night)+2. L/day (last bag)