| Theme |
The Choice of Blood Purification for the Patients with Renal Failure |
| Title |
Selection of dialysis modalities, HD or PD -- In consideration of residual renal function |
| Author |
Satoru Kuriyama |
Division of Nephrology, Saiseikai Central Hospital |
| Author |
Tosiyuki Imazawa |
Division of Nephrology, Saiseikai Central Hospital |
| Author |
Miwako Numata |
Division of Nephrology, Saiseikai Central Hospital |
| Author |
Haruo Tomonari |
Division of Nephrology, Saiseikai Central Hospital |
| [ Summary ] |
Generally, acceptance rate much higher for HD patients than PD patients. Of note is the fact that residual function (RRF) is well preserved in PD patients. Furthemore, preservation of RRF produces advantageous outcome for PD, which includes better cardiovascular morbidity, better QOL, improvement in renal anemia, and better outcome for renal transplantation. PD should be regarded as a part of integrated renal replacement therapy, in which different techniques are freely accessible and interchangeable. Accordingly, the timing of PD may be between the predialysis period and HD, bridging patients from one mode to another. Careful attention must be paid, however, to the fact that the peritoneum is a biological membrane, which may be impaired by long-term PD therapy, possibly causing loss of ultrafiltration (UF) or sclerosing encapsulating peritonitis. Discontinuation criteria for PD must be based upon changes in peritoneal permeability and/or UF loss, and must be applicable to patients on long-tern PD. |