臨牀透析 Vol.16 No.6(9)


特集名 再検証:ダイアライザ
題名 ダイアライザの今後の動向は?
発刊年月 2000年 05月
著者 斎藤 明 東海大学医学部腎・代謝内科
【 要旨 】 今日,わが国の透析療法では,標準型透析器が減り,ハイパフォーマンス膜透析器が9割を超えていると思われる.また,透過性の高い透析器,濾過器の開発が進み,透析濾過器として用いられるべきものが,透析器として使用されている.高透過性の血液浄化膜は高透水性でもあり,逆濾過も起きやすいことより,透析濾過器を用いる場合,透析液純度が高いことが要求される.透析器と透析濾過器,濾過器の性能を明確化させ,その機能に見合った透析液エンドトキシン濃度基準を設定する必要があることより,日本透析医学会は新たな血液浄化器の機能分類と透析液水質を明らかにした.一方,厚生省は透析医療費を抑制するために,透析液,血液回路,ヘパリンなどとともに,透析器も含めた包括化を検討しているが,それが実施されれば透析の質の低下は避けられないであろう.包括化の進んでいる米国では,透析器の再使用も行われ,患者の死亡率も高く,約60%が毎年1回以上入院している.包括化された部分は低コストだが,入院費,診察料などを合わせると決して低コストではない.わが国では,高透過性膜,高純度透析液を用いた高効率透析を行い,合併症の少ない低コスト治療を実現させたいものである.
Theme Current Topics in Hemodialyzers
Title Future trend of hemodialyzers
Author Akira Saito Division of Nephrology, Department of Medicine, Tokai University School of Medicine
[ Summary ] Recently the number of standard dialyzers in use has been decreasing. High performance membrane dialyzers are thought to be used in over 80% of all cases in Japan. Hemodiafilters, which are highly permeable, have frequently been used as hemodialyzers. When highly-permeable filters are used as hemodiafilters or hemodialyzers, a pure dialysate must be used, since endotoxin is easily transported into the blood across highly permeable membranes from the dialysate. The Sicentific Committee of Japanese Society for Dialysis Therapy classified hemodialyzers into the categories of hemodiafilters and hemofilters, each having functional properties and specified standard levels of endotoxin content in the dialysate, for each type of treatment. The Japanese Ministry of Health and Welfare, on the other hand, intends to make an inclusive charge for dialyzers as well as the dialysate, blood lines, heparin, etc. In order to hold down total dialysis costs. The quality of dialysis treatment in Japan will be reduced if these inclusive charges are authorized. In the United States, where inclusive charges for dialysis exist, a dialyzer is reused 25-30 times, and the one year mortality rate is as high as 24%. Also 60% of dialysis patients were hospitalized at least once a year, according to the USRDS for 1998. The total dialysis cost in the United States including hospitalized fee and doctor's fee, was not low, although the inclusive charges for dialysis were indeed low. In Japan, dialysis treatment at a low cost should be realized by eliminating dialysis-related complications by using hemodialysis and hemodiafiltration with ultrapure dialysate and highly permeable filters.
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