Extending the role of peritoneal dialysis: can we win hearts and minds?

Extending the role of peritoneal dialysis: can we win hearts and minds?
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扩大腹膜透析的作用：我们能赢得人心吗？

DOI：
10.1093/ndt/gfu001
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发表时间：
2014
期刊：
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
影响因子：
--
通讯作者：
C. Roffe
C. Roffe
中科院分区：
--
文献类型：
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作者：
S. Davies;F. Lally;D. Satchithananda;U. Kadam;C. Roffe

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背景 腹膜透析（PD）能够以较低的血液动力学成本实现低分子量溶质清除和超滤，这使得它在由于脑、冠状动脉或肾血流量突然减少而可能不需要更积极治疗的情况下成为一种有吸引力的治疗方法。 方法 我们对文献进行了回顾，以检查两个具体例子中的最新证据：急性卒中后谷氨酸的清除和超滤治疗利尿剂抵抗性心力衰竭。 结果 在急性中风中，当谷氨酸被释放到细胞外组织中时，由于其兴奋性毒性特性而导致神经元细胞死亡。来自动物模型的实验证据表明，它的去除，包括通过PD，可以减少梗死面积和恢复功能性脑组织。PD可有效清除肾衰竭患者的谷氨酸。在心力衰竭中，PD对于延长治疗具有许多理论和实践优势，特别是作为一种既定的家庭治疗。最近的几项队列研究描述了其在近300例利尿剂抵抗患者中的使用，显示出在住院和严重程度方面的一致获益。 结论 这两种应用都需要大量的进一步临床评估，然后才能证明更广泛的采用，但它们在大规模和潜在的高成本效益规模上减轻发病率的潜力需要进一步研究。
BACKGROUND The ability of peritoneal dialysis (PD) to achieve low-molecular weight solute clearance and ultrafiltration at low haemodynamic cost makes it an attractive therapy in situations where more aggressive therapy may be undesirable due to sudden reductions in cerebral, coronary or renal blood flow. METHODS We undertook a review of the literature to examine the recent evidence for this in two specific examples: the removal of glutamate following acute stroke and ultrafiltration for the treatment of diuretic resistant heart failure. RESULTS In acute stroke, glutamate, when released into the extracellular tissues, causes neuronal cell death due to its excitotoxic properties. Experimental evidence from animal models indicates that its removal, including via PD, can reduce infarct size and restore functional brain tissue. PD is effective in removing glutamate in patients treated for renal failure. In heart failure, PD has a number of both theoretical and practical advantages for extending treatment, especially as an established home therapy. Several recent cohort studies describing its use in approaching 300 patients with diuretic resistance show consistent benefits in hospitalization and severity. CONCLUSION Both these applications require substantial further clinical evaluation before they can justify wider adoption but their potential to alleviate morbidity on a large and potentially highly cost-effective scale demands further study.