ISSN: 1305-385X
Hakkında: Özel sayılar şeklinde yayınlanır.
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Integrated Therapy Approach And Combination Of Peritoneal Dialysis And Hemodialysis
Dr. Saime PAYDAŞa
aNefroloji BD, Çukurova Üniversitesi Tıp Fakültesi, ADANA
Renal transplantation remains the preferred mode of renal replacement therapy (RRT) for outcomes and cost effectiveness but we can not give up dialysis therapy. Initial selection of RRT is controversial because of a lack of conclusive guidelines. Major RRT’ies, PD and HD were compared in a lot of studies. With integrated care strategy, patients initially treated with PD who subsequently switched to HD, had improved survival and quality of life. Patient preference is most important factor for selection of therapy modality. Most patients are not educated about PD benefits. PD is preferable in early treatment, given the better quality of life, the better psychosocial adaptation, the higher levels of subjective wellbeing, the sparing of vascular access, and the better preservation of RRF. PD is especially effective for transplant candidates. Used in an integrated PD-HD program, PD can be followed by a timely transfer to HD once complications arise. In this manuscript in addition to integrated care strategy, PD+HD combination therarpy which is used especially in Japanese, will summarised. Loos of RRF during the therapy of PD leads to failure in solute and insufficient water elimination. The most frequently used criteria for initiation of this therapy were weekly creatinine clearances of 50 ml/week/1.73m2 or less and weekly KT/V values of 2.0 or less. The mode of this therapy applied widely was 5 or 6 days of PD per week followed by HD once a week. The treatment of each HD frequently used was 4-5 hours and high flux membranes were widely used for HD therapy. PD+HD combination theray was contraindicated in patients who require HD two or more times a week, were high transporters in the PET category or had a marked peritoneal membrane dysfunction which is likely to progress to encapsulating peritoneal sclerosis in the future. PD and HD combination therapy will only ever be a bridge between full-time PD and full-time HD.Keywords: Peritoneal therapy, hemodialysis, integrated therapyTurkiye Klinikleri J Int Med Sci 2007, 3(38):94-99
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