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Hybriddialyse

Hybriddialyse. NordiaTrans 2006 København. Hybriddialyse. En kombination af Hæmo + Peritoneal dialyse (complimentary dialysis therapy eller Peritoneal and Haemodialysis combination therapy ) med Peritoneal dialyse som basis behandling. Hybriddialyse. Baggrund:

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Hybriddialyse

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  1. Hybriddialyse NordiaTrans 2006 København

  2. Hybriddialyse • En kombination af Hæmo + Peritoneal dialyse (complimentary dialysis therapy eller Peritoneal and Haemodialysis combination therapy ) med Peritoneal dialyse som basis behandling. emh2006

  3. Hybriddialyse • Baggrund: • Siden introduktion for 25 år siden har peritonealdialyse (PD) udviklet sig til et komplementært – ikke kompetitivt - alternativ til hæmodialyse (HD) for patienter med nyresvigt • Da PD er kritisk afhængig af restfunktionen, som bevares bedst hos PD patienter, og da peritoneum ikke holder evigt til dialyse, er modaliteten bedst egnet til patienter, der starter på kroniske renal erstatningsterapi • Mange patienter vælger PD pga. livsstil og -kvalitet emh2006

  4. Hybriddialyse • Baggrund • PD er hjemmedialyse • Hovedparten af patienterne varetager behand-lingen selv, men der kan ydes hjælp fra pårørende eller hjemmesygeplejerske / hjemmeplejen • PD + HD kombineret er et ønske fra patienter der vil gerne fortsætter med deres daglige gøremål og sociale aktiviteter emh2006

  5. The PD + HD Combination therapy Study Group : Fukui et al : International Society for Apheresis 2004. The name ’PD + HD combination therapy’ was proposed in 1996 by Kimura and Watanabe. Though the original idea was born in Japan, an ad hoc committee meeting of International Society of Peritoneal Dialysis ( ISPD ) was held in March 2003 to discuss combination therapy used in Japan. At the meeting the name ’ Complementary Dialysis therapy’ was proposed. PD + HD Combination Therapy’ was given as an alternative name emh2006

  6. The PD + HD combination Therapy Study Group / Fukui H, Hara S, et al 2003 PD + HD is a treatment option that is psychologically more acceptable to patients than complete transfer to HD, it enables a smooth modality switch. Moreover, this therapy provides a beneficial peritoneal resting, improvement of QOL, and reduction in medical costs. In Japan there are 600 patients currently treated under combination therapy. emh2006

  7. Hashimoto et al. Adv Perit Dial 2000;16:108-12 Combined peritoneal dialysis and hæmodialysis therapy improves quality of life in end stage renal disease patients Hashimoto et al added HD once a week to a 5 day a week CAPD in six patients who had differculties continuing CAPD alone and compared their QOL scores before and after the combination therapy, all patients obtained improvement emh2006

  8. Hybriddialyse • Anvendelse: • Patienter som er i behandling med CAPD eller APD som har: • Problemer ultrafiltration • Mistet rest-nyrefunktion (loss of residual renal function) • Utilstrækkelig dialyseeffektivitet klinisk og eller laboratoriemæsigt • Overstående kombineret med social forhold emh2006

  9. Hybriddialyse • Problemer med ultrafiltration emh2006

  10. Hybriddialyse • Utilstrækkelig dialyseeffektivitet: • Kt/V mindre end 1.8 • Uræmiske symptomer: • Anæmi, hyperkaliæmi, overhydrering, hyperfostatæmi, tæthed og appetitløshed emh2006

  11. Hybriddialyse Anvendt siden 2001 på i alt 23 patienter i Rigshospitalets p-dialyse ambulatorium September 2005 / HÆ emh2006

  12. Hybriddialyser Danmark 1999 - 2004 Dansk Nefrologisk Selskab 2005 emh2006

  13. Hybriddialyser RH2001 - 2005 September 2005 / HÆ emh2006

  14. Hybriddialyser RH 2005 September 2005 / HÆ emh2006

  15. Hybriddialyser RH 2005 emh2006

  16. Hybriddialyser RH 2005 September 2005 / HÆ emh2006

  17. Hybriddialyser RH 2005 September 2005 / HÆ emh2006

  18. Hybriddialyser RH 2005 emh2006

  19. Hybriddialyser RH 2005 emh2006 September 2005 / HÆ

  20. Hybriddialyse Fremtidige anvendelse af hybriddialyse Patienter der ønsker af fortsætte med PD trods: 1: Problemer med ultrafiltration 2: Utilstrækkelig p-dialyseeffektivitet, laboratoriemæssigt og/eller klinisk (f. eks. neuropati) 3: Ovenstående kombineret med sociale forhold 4: Stor afstand fra HD centre eks. Færøerne September 2005 / HÆ emh2006

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  25. Agarwal M, Clinard P, Burkart JM./Peri Dial Int 2003 Mar-Apr ; 23(2) : 157- 61 Patients not doing well on PD alone were put on a ’combined – mode therapy’. Winston-Salem, North Carolina 27 patients were included between 1992 –1998 Main outcome measures: Clinical improvement in the indication for which the participant was started on combined therapy Conclusion PD + HD can be used to achieve targeted solute clearances, improve clinical conditionsand to control volume and blood pressure emh2006

  26. Hybriddialyse • Konklusion • PD + HD som kombineret behandling bliver mere almindelig i fremtiden • Blød overgang til evt. Hjemme-hæmodialyse eller HD • PD patienter som har stor afstand til HD- centre og som ønsker at være i hjemmedialyse regi • Standarder til udregning af Kt/V på PD/HD emh2006

  27. References : 1.Review of Combination of Peritoneal Dialysis and hæmodialysis as a Modality of Treatment for End stage Renal Disease. Therapeutic and Apheresis and Dialysis. 2004 Fukui et al 2.Five years experience of combination therapy: peritoneal dialysis and hæmodialysis..Kawanishi.H. Moriishi M. Tsuchiya S. Adv.Perit.Dial.2002;18:62-7 3. Combined peritoneal dialysis and hæmodialysis our experience compared to others. Agarwal M. Clinard P. Burkarrt JM. Perit Dial Int. 2003 Mar – Apr; 23(2):157-61 4.Combined peritoneal dialysis and hæmodialysis therapy improves quality of life in end stage renal disease patients. Hashimoto Y. Matsubara T. Adv. Peritoneal Dial.2000;16:108-12 emh2006

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