Remise en cause de la prescription d'hémodialyse standard : adaptation de la prescription de dialyse à la fonction rénale résiduelle.
DOI :
https://doi.org/10.25796/bdd.v6i1.74683Mots-clés :
hémodialyse, dialyse incrémentale, dialyse à domicile, fonction rénale résiduelleRésumé
La prise de conscience récente de la viabilité et des avantages de l’hémodialyse incrémentale est l’occasion de revoir les pratiques cliniques et d’améliorer le processus d’initiation de la dialyse. La dialyse incrémentale est une approche standard dans la prescription de la dialyse péritonéale, avec un accent mis sur la qualité de la néphro-protection. Il devrait en être de même pour l’hémodialyse, avec une individualisation de la prescription : la fréquence, la durée et l’intensité, que ce soit en hémodialyse à domicile ou en centre, sont des variables de prescription à ajuster selon la fonction rénale résiduelle du patient, de son état de santé et de ses priorités psychosociales. Étant donné que l’équilibre hydrique et l’ultrafiltration régulière ont un impact critique sur la survie du patient, les programmes de dialyse incrémentale doivent être soigneusement adaptés, sur la base des mesures de routine de la fonction rénale résiduelle. Cet article soulève la question des avantages de la dialyse incrémentale, mais aussi de ses effets néfastes présumés, qui dépendent principalement de la qualité de la prescription de l’hémodialyse et des contraintes économiques externes. En comparaison, la dialyse péritonéale incrémentale est un modèle scientifiquement fondé à poursuivre, quelle que soit la modalité, basé sur des concepts actualisés de prescriptions d’adéquation des thérapies d’épuration extra-rénale centrées sur le patient.
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(c) Tous droits réservés João Fernandes, Anabela Soares Rodrigues 2023
Ce travail est disponible sous la licence Creative Commons Attribution 4.0 International .
