臨牀透析 Vol.35 No.2(5)


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
題名 透析液の適正なナトリウム濃度とは―低ナトリウム透析液を勧める立場から
発刊年月 2019年 02月
著者 花房 規男 東京女子医科大学血液浄化療法科
【 要旨 】 ナトリウム(Na)イオンは細胞外液・血管内容量を規定する重要な溶質で,透析液のNa濃度に影響を受ける.透析液のNa濃度は血圧・循環動態に影響するだけではなく,浸透圧を介して口喝にも影響する.低Na透析液では,高血圧・透析間体重増加の抑制効果だけではなく,炎症・内皮機能にも良い効果をもつ可能性が示されている.透析中の血圧低下を増加させるとする報告もあるが,とくに食塩摂取量が多い若年透析患者では,長期的な予後改善のため,低Na透析液が有効である可能性がある.本稿では,低Na透析液を勧める立場から透析液Na濃度について考察した.
Theme Electrolyte and acid-base disorders in dialysis patients
Title What is an adequate dialysate sodium concentration during hemodialysis? -- for recommendations of lower sodium concentrations in the dialysate
Author Norio Hanafusa Department of Blood Purification, Tokyo Women's Medical University
[ Summary ] Sodium is a major electrolyte in the plasma that determines the tonicity and osmolarity of plasma. Thus, sodium concentration plays a major role in hemodynamics in the body. Because hemodialysis eliminates excessive sodium through the mechanisms of convection and diffusion, dialysis sodium concentration is crucial in determining hemodynamics. Low-sodium dialysis fluid has been extensively investigated for its effects on hemodynamics in patients. Many studies demonstrated that the low-sodium dialysate was associated with the amelioration of hypertension and lower interdialytic weight gain compared with the conventional dialysis fluid due to the reduction of thirst. Moreover, several studies demonstrated that the dialysis fluids with low sodium concentrations were associated with the reduction of inflammation or oxidative stress. On the other hand, the dialysis fluid can be associated with increased incidence of hypotensive episodes or muscle cramps. The characteristics of the population on dialysis are becoming diverse. Low-sodium dialysis fluid has a maximal efficacy and is applied to the patients who are young and robust. In this article, the efficacies or advantages of low-sodium dialysis fluid have been discussed in favor of the dialysis fluid.
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