| 特集名 | 透析患者における電解質・酸塩基平衡異常―透析液を含めて | |
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| 題名 | 血液透析液濃度の歴史と今後の課題 | |
| 発刊年月 | 2019年 02月 | |
| 著者 | 峰島 三千男 | 東京女子医科大学臨床工学科 |
| 【 要旨 】 | 黎明期を除くと，透析液のおおまかな歴史はそのアルカリ化剤の成分による．すなわち1970年代（第1世代）の酢酸透析液，1980年代以降（第2世代）の重炭酸透析液，2007年以降（第3世代）の無酢酸重炭酸透析液の三つに大別される． 透析膜を介した分子拡散による溶質の移動は，血液と透析液間の濃度差を推進力とする．したがって，透析液濃度の設定は除去（補充）速度を規定する意味において重要な意味をもつ．一方，Naのように血液と透析液間の濃度差が小さい場合，分子拡散に比べた限外濾過による移動の割合が大きくなる． 将来の透析医療では，患者の病態に合わせて，複数の承認済み透析液の配合比や希釈率の変更を自動制御によりリアルタイムに行い，適正な病態へナビゲートできる時代が訪れるものと思われる． |
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| Theme | Electrolyte and acid-base disorders in dialysis patients | |
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| Title | The history and future perspectives of the dialysate for hemodialysis therapy | |
| Author | Michio Mineshima | Department of Clinical Engineering, Tokyo Women's Medical University |
| [ Summary ] | For hemodialysis therapy, the dialysate strongly depends on the types of alkaline agents. There are three types of dialysate: acetate dialysate (first generation), bicarbonate dialysate (second generation), and non-acetic bicarbonate dialysate (third generation). The driving force of solute transport through the dialysis membrane based on molecular diffusion is the difference of solute concentration between blood and dialysate sides. Namely, the solute transfer rate through the membrane is dependent of the solute concentration in the dialysate. On the other hand, the transfer rate depends on the ultrafiltration flow rate of solutes, such as Na, having small concentration differences between the blood and dialysate. In the future, real-time monitoring of patient condition and device performance during the hemodialysis treatment will allow for adequate dialysis of patient by changing the compounding and/or diluting ratio of dialysis agents based on an automatic control method. |
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