| 特集名 | 透析患者の長期予後とリスクファクター | |
|---|---|---|
| 題名 | 骨・異所性石灰化 | |
| 発刊年月 | 2000年 06月 | |
| 著者 | 栗原 怜 | 春日部秀和病院腎臓内科 |
| 著者 | 須賀 優 | 春日部秀和病院腎臓内科 |
| 【 要旨 】 | 透析患者においてはカルシウム(Ca)，リン(P)，ビタミンDの代謝異常，副甲状腺ホルモン(PTH)の分泌異常，アルミニウム(Al)の蓄積などが加わり，種々のタイプの腎性骨異栄養症(ROD)や異所性石灰化が発症する．RODでは骨・関節痛，病的骨折が，また心血管系における異所性石灰化は心不全や種々の臓器障害を引き起こし，透析患者の生命予後を悪化させる．最近増加の傾向にある無形成骨(ABD)症の患者では，Caホメオスターシスの異常から心血管系の石灰化が起こりやすく，また血清PTH値の低い患者では生命予後が悪いことも指摘されている． 発症を予防するためには，血清Ca,P，PTHの濃度を適当な範囲に維持するように，P吸着剤やビタミンD製剤の量，あるいは透析液Ca濃度などを適宜，調節していく必要がある． |
|
| Theme | Risk Factors and Outcome on Long-term Dialysis | |
|---|---|---|
| Title | Risk factors on renal osteodystrophy and metastatic calcification in patients with long-term dialysis | |
| Author | Satoshi Kurihara | Division of Nephrology, Kasukabe-Shuwa Hospital |
| Author | Masaru Suga | Division of Nephrology, Kasukabe-Shuwa Hospital |
| [ Summary ] | In dialysis patients, various types of renal osteodystrophy (ROD) and metastatic calcifications frequently develop because of abnormalities in parathyroid hormone (PTH) levels, aluminum accumulation, metabolism of calcium (Ca), phosphate (P) and vitamin D, and many other processes. Bone and joint pain are frequently seen in patients with ROD, and pathological fractures are also often noticed. These conditions affect the quality of life and worsen the prognosis for dialysis patients. Aplastic bone disease (ABD), a group of disorders now increasing in prevalence, is characterized by abnormal Ca homeostasis, with increased risk of calcification in the cardiovas cular system. It has also been shown that patients with low serum PTH levels have higher mortality rates than patients with adequate PTH levels. To prevent ABD and extraosseous calcifications in dialysis patients, suitable serum Ca, P and PTH levels should be maintained through proper preparation of phosphate binders, vitamin D derivatives, and Ca concentrations in the dialysate. |
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