腹膜透析充分性的国际指南解读.pptVIP

GUIDELINE 4. 4.4 The patients record of PD effluent volume should be reviewed monthly, with particular attention to the drain volume from the overnight dwell(s) of CAPD and the daytime dwell(s) of APD. GUIDELINE 4. 4.5 A number of techniques can be used to optimize volume and blood pressure control. GUIDELINE 4. 4.5.1 To achieve the desired volume status, the lowest possible dialysate dextrose concentration should be used. 4.5.2 When appropriate, implement dietary sodium and fluid restriction. GUIDELINE 4. 4.5.3 In patients with RKF, to achieve dry weight, diuretics may be preferred to increasing dialysate dextrose concentration. 4.5.4 Drain volume should be optimized during the overnight dwell(s) of CAPD and the daytime dwell(s) of APD to maximize solute clearance and ultrafiltration volume. GUIDELINE 4. 4.5.5 In patients who are hypertensive or who show evidence of volume overload, ultrafiltration generally should not be negative (ie, no absorption) for any daytime or nighttime exchanges. EUROPEAN BEST PRACTICE GUIDELINES FOR PERITONEAL DIALYSIS Adequacy of peritoneal dialysis GUIDELINE A Adequacy targets for dialysis should include both urea removal and ?uid removal. (Evidence level C) GUIDELINE B These targets should be based on those achieved by peritoneal dialysis only. Urine production and renal urea clearance can be subtracted from the targets. (Evidence level C) GUIDELINE C The minimum peritoneal target for Kt/Vurea in anuric patients is a weekly value of 1.7; (Evidence level A) The minimum peritoneal target for net ultra?ltration in anuric patients is 1.0 l/day. (Evidence level B) The presence of residual renal function can compensate when these peritoneal targets are not achieved.(Evidence level C) GUIDELINE D When the targets are not achieved, patients should be monitored carefully for signs of overhydration, uraemic complaints and malnutrition. Appropriate therapy changes might be considered. (Evidence level C) GUIDELINE E Some APD patients who u