透析治療：觀念演變及進展

Dialysis Therapy: Concept Evolution and Update

郭依婷(Yi-Ting Kuo) ； 李佳駿(Chia-Chun, Lee) ； 宋俊明(Junne-Ming Sung)

《內科學誌》 30卷2期 (2019/04) Pp. 86-95

https://doi.org/10.6314/JIMT.201904_30(2).05

摘要

末期腎臟病為慢性腎臟病最嚴重的表現；透析治療為腎臟替代療法（Renal replacement therapy）的一環，提供了末期腎臟病病患延續生命的機會。如何以透析治療改善疾病預後及生活品質，一直都是相當重要的議題。近來在血液透析方面的研究，並未支持於特定的時機開始透析；提高透析劑量或是密集透析的初步研究結果亦未能提高透析病患的存活率。至於透析液的處方對心血管系統的影響方面亦無定論。在腹膜透析方面有別於以葡萄糖為基礎的腹膜透析液，愛多尼爾腹膜透析液和生物相容性較佳腹膜透析液的使用，則可能在體液控制及腹膜功能保存上有其好處，且對包囊性腹膜硬化症可能有預防的效果。至於血液與腹膜透析兩者之比較，本土資料研究顯示在校正共病症後，其預期壽命及生活品質並未有差別，但成本效益分析上則顯示腹膜透析治療較為經濟。

關鍵字

血液透析（Hemodialysis） ； 腹膜透析（Peritoneal dialysis） ； 透析液組成（Dialysate composition） ； 體液過多（Fluid overload） ； 腹膜功能（Peritoneal membrane function）

並列摘要

End-stage renal disease (ESRD) is the most severe stage of chronic kidney disease. Dialysis, one of the renal replacement therapy, provides life-saving therapy for the patients with ESRD. It is paramount to improve disease outcome and quality of life while performing dialysis. According to previous studies among hemodialysis (HD) patients, the results didn't support to initiate HD at specific timing (early vs late initiation). In addition, there was no clear evidence to improve survival rate through an increase of HD dose, intensity or frequency. Although dialysate composition carries weight to the cardiovascular system, the relationships between various dialysate compositions and patient outcomes remain to be elucidated. For peritoneal dialysis (PD), peritoneal dialysis solutions other than glucose-based ones, Icodextrin or biocompatible peritoneal dialysis solutions, may be benefit for fluid control and preservation of peritoneal membrane function, and preventing encapsulating peritoneal sclerosis. About the comparison between dialysis modalities (PD vs HD), there is no significant difference between HD and PD in terms of life expectancy, quality of life and quality-adjusted life expectancy when analyzing the Taiwanese National Insurance Database and dialysis-related cohorts; however, PD is more cost-effective than HD.