| Theme | Current Problem of Clinical Studies in Dialysis Therapy | |
|---|---|---|
| Title | Selection of dialysis therapy for patients with end-stage renal disease | |
| Publish Date | 2008/04 | |
| Author | Hidetomo Nakamoto | Department of General Internal Medicine, Saitama Medical University |
| [ Summary ] | In recent years, important advances have been made in the treatment of patients with end-stage renal disease (ESRD). Patients with ESRD and their physicians must consider many factors, including complications, length of life, and quality of life when choosing a treatment modality. Because of the limited number of donor organs, most patients should continue dialysis for their entire life. It is expected that more than 250,000 patients will undergo maintenance dialysis in Japan by the year 2005. The distribution of patients with ESRD among those receiving transplantation, hemodialysis (HD) and peritoneal dialysis (PD) therapy, differs dramatically in Japan and other countries. A very small number of patients are treated with continuous ambulatory (CAPD), or automated peritoneal dialysis (APD). The selection of dialysis therapy, including hemodialysis or peritoneal dialysis, is an important factor determining the prognosis and quality of life for patients with ESRD. Recently the efficacy of PD therapy in maintaining residual renal function (RRF) has been reported. ADEMEX study in Mexico clearly demonstrated that there was no correlation between peritoneal small-solution clearance (Ccr) and clinical outcome. This data demonstrated the importance of RRF as a predictor of mortality in patients on CAPD where as peritoneal Ccr may lose its efficacy. Furthermore, the usefulness of PD to maintain quality of life (QOL) is known especially in elderly patients with ESRD. From this Japanese data, PD therapy was recommended for patients with RRF (PD first). |
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