臨牀透析 Vol.16 No.9(8)


特集名 ブラッドアクセス
題名 DOQI : Clinical Practice Guidelines for Vascular Accessの解説
発刊年月 2000年 07月
著者 大平 整爾 日鋼記念病院外科・腎センター
著者 辻 寧重 日鋼記念病院外科・腎センター
著者 伊丹 儀友 日鋼記念病院外科・腎センター
【 要旨 】 ブラッドアクセス(BA)は，慢性血液透析療法を受ける患者にとって必要不可欠な「生命線」であり「アキレスの腱」と目される．
前腕末梢の自己動脈・静脈間で作製される動静脈内シャント(arterio-venous fistula ; AVF)が種々の観点からもっとも望ましい形式であるが，患者の脈管の状態によりこのAVFも各種の変法を余儀なくされる．さらに，自己静脈の荒廃のために人工血管の使用が試みられる場合も少なくはない．本邦における人工血管使用のAVFは現在，全BAの約5%に止まっているが，アメリカでは70%にも達するとの報告もある．
BA作製・維持においてできうるかぎり客観的な指針の望まれるところであったが，1997年，NKF(National Kidney Foundation)がDOQI : Clinical Practice Guidelines for Vascular Accessを発表した．本論では，このガイドラインの概要を紹介する．
Theme Blood Access for Chronic Hemodialysis Therapy -- The Present Problems and New Developments
Title Explanation of DOQI : Clinical Practice Guidelines for Vascular Access
Author Seiji Ohira Department of Surgery and Kidney Center, Nikko Memorial Hospital
Author Yasushige Tsuji Department of Surgery and Kidney Center, Nikko Memorial Hospital
Author Noritomo Itami Department of Surgery and Kidney Center, Nikko Memorial Hospital
[ Summary ] Blood or vascular access is essential for chronic hemodialysis and is considered to be both a life line and an Achilles' heel.
The most desirable method is to create blood access between the Radial artery and Cephalic vein (arteriovenous fistula; AVF) at the wrist. Howevere, modified methods are often applied.
Furthermore, artificaial vessels must often be used in cases in which the patient's veins have sustained damage.
In Japan, AVFs using artificial vessels account for about 5% of all blood access, while in the USA they account for approximately 70%, as seen in some reports.
Guidelines, which are as objective as possible, for creating and maintaining blood access have been anticipated. In 1997, the National Kidney Foundation in the USA presented the Dialysis Outcomes Quality Initiative (DOQITM) Clinical Practice Guidelines for Vascular Access, which was introduced and explained briefly in this paper.
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