337 Ch 336. Dialysis — Hemodialysis and Peritoneal Dialysis

Dialysis 是 ESKD (end-stage kidney disease, eGFR < 15 or symptoms) 的兩大替代療法之一（另一為 transplant）；modalities：(1) hemodialysis (HD) — in-center 3x/week 4h or home HD daily/nocturnal；(2) peritoneal dialysis (PD) — CAPD (continuous ambulatory) + APD (automated, nocturnal)；indications for initiation：traditional eGFR < 10-15 + uremic symptoms；IDEAL trial 2010: early start (10-14) vs late (5-7) — no mortality benefit, defer until symptomatic；HD access：AV fistula (gold standard) > AV graft > tunneled catheter；KDOQI 2019：“fistula first” + “catheter last” + vein preservation；PD vs HD outcomes：similar survival; PD more flexibility + preserved residual function + first 1-2 yr; HD better for refractory volume; modality choice ↑ patient autonomy；complications：(1) HD intradialytic (hypotension, cramps, nausea, headache, disequilibrium)；(2) HD vascular access (thrombosis, infection, stenosis, aneurysm); (3) PD peritonitis (cardinal complication — cloudy effluent + abdominal pain)；2024 wearable artificial kidney (WAK) + portable HD systems + xenotransplantation considerations for future。