| Theme | The Choice of Blood Purification for the Patients with Renal Failure | |
|---|---|---|
| Title | Sensory organ disorders | |
| Publish Date | 2000/01 | |
| Author | Teruhiko Maeba | Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine |
| Author | Takashi Yasuda | Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine |
| Author | Hiroshi Yamakawa | Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine |
| Author | Syusuke Sekiya | Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine |
| [ Summary ] | In association with the increase in the number of patients with advanced age and diabetes in dialysis patients, management of the patients with sensory disturbance has become an important issue. Here, I describe appropriate modification of hemopurification methods in patients with sensory disturbances including glaucoma, retinopathy, and sudden deafness. Hemofiltration or hemodiafiltration is generally offered to patients with glaucoma or elevated intraocular pressure in order to avoid significant change in plasma osmotic pressure during dialysis therapy. A decrease in plasma osmotic pressure during hemodialysis induces an increase in intracellular water volume causal to dialysis-disequilibrium symptoms, leading to attenuation of fluid outflow from eye. Therefore, the application of normal hemodialysis in patients with acute glaucoma should be avoided. The modality of anticoagulants is important in patients with retinal hemorrhage. Nafamostat mesilate is the most suitable anticoagulant for the patients with acute retinal hemorrhage. Low molecular heparin is also available for patients in the absorption phase of retinal hemorrhage and severe diabetic retinopathy. CAPD is another option for such patients, as its effect are independent of anticoagulant. In addition, acetate free biofiltration may be beneficial for its advantage on significant hemodynamic stability. The concept involved in the management of patients with acute sudden deafness is identical to that described above; that is, minimizing the instability of hemodynamics as well as sigtlificant changes in plasma osmotic pressure during hemopurification. |
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