臨牀透析 Vol.16 No.14(9)


特集名 今日のCAPD療法
題名 小児CAPDの特殊性
発刊年月 2000年 12月
著者 星井 桜子 国立療養所西札幌病院小児科
著者 荒木 義則 国立療養所西札幌病院小児科
【 要旨 】 小児の末期腎不全治療の最終目標は心身両面での正常な成長発達である.小児の透析法の主流は腹膜透析(PD)で,小児PD研究会の全国登録データでは15歳以下の小児の新規PD導入数は毎年50~60例である.その1/3は6歳未満が占め,乳幼児のPD選択率は高い.生存率,PD継続率,腹膜炎罹患率,カテーテル継続率などの成績は向上しているが,6歳未満では年長児に比べ劣り,その管理に注意を要する.成長促進には鼻腔チューブによる積極的な栄養管理を行う.腎不全保存期から精神心理的,社会的な問題が起きやすく,患者と家族へのサポートは重要である.わが国では献腎移植低迷から諸外国に類をみない長期透析となり,被嚢性腹膜硬化症の頻度も増加している.
Theme CAPD Up-to-date 2000
Title Special problem with children on peritoneal dialysis
Author Sakurako Hoshii Department of Pediatrics, Nishi-Sapporo National Hospital
Author Yoshinori Araki Department of Pediatrics, Nishi-Sapporo National Hospital
[ Summary ] The ultimate goal for treatment or children with end stage-renal disease is the achievement of normal growth and development. Peritoneal dialysis (PD) is the main dialytic modality for children. According to the national registry data on children undergoing PD in Japan, 50 to 60 new patients under 16 years of age are enrolled each year. One third of patients were under 6 years old, indicating that PD is the treatment of choice in younger children. Patient survival rates, technique survival rates, peritonitis rates and catheter survival rates have improved recently. However, these rates were worse for children under 6 years of age. Careful management is needed for this age group. Also, intensive nutritional therapy with nasogastric feeding is recommended for normal growth. Because chronic renal disease results in severe psychological and social stresses, supportive care for both the patient and the family is very important. The proportion of patients requiring longterm PD has increased because of a severe national shortage of cadaver donors for renal transplantation in Japan. The incidence of encapsulating peritoneal sclerosis tends to increase in relation to the duration of PD.
戻る