臨牀透析 Vol.19 No.1(9)


特集名 カルシウム・リン調整薬の使い分け
題名 透析液の適正カルシウム濃度 -- 各種薬剤との関連
発刊年月 2003年 01月
著者 伊達 敏行 腎愛会だてクリニック
著者 重松 隆 東京慈恵会医科大学腎臓・高血圧内科
【 要旨 】 透析液カルシウム(Ca)濃度の議論は長年なされてきた話題だが,理想的な透析液Ca濃度の結論は出ていない.逆に活性型ビタミンDの臨床応用により透析患者は大いなる負のCaバランスから正のCaバランスに転換した.この正のCaバランスはリン(P)吸着薬がアルミニウム(AI)製剤からCa製剤に大きく切り替わった段階で一気に,よりいっそう推進されてしまった.こうした状況に伴い,HD透析液濃度は高Ca透析液(Ca3.5~4.0mEq/l)から低Ca透析液(Ca2.5mEq/l)へと大きく変動したが,変更が追いつかない状況では高Ca血症や異所性石灰化という不幸な結果も生じた.現在では新規ビタミンD静注製剤が使用可能となり,高Ca血症の危険性はより高まり,より低めの低Ca透析液すら検討課題に上っている.しかし,今後はCa-freeの新規P吸着薬やcalcimimeticsなどのようにCaバランスを再び負にする薬剤が登場予定であり,今後,Caバランスと透析液Ca濃度が検討課題となるであろう.
Theme Selection of New Drug for Calcium and Phosphate Disorder
Title Optimal dialysate calcium concentration-in combination with vitamin D3 metabolites and phosphate binders
Author Toshiyuki Date Jin-ai-kai Date Clinic
Author Takashi Shigematsu Department of Nephrology and Hypertension, Tokyo Jikeikai Medical School
[ Summary ] Optimal dialysate calcium concentrations have been discussed in long term duration. However, conclusions about the ideal dialysate calcium concentration have not yet been reached. Through the clinical use of active vitamin D3 metabolites many chronic hemodialysis patients' levels changed from negative to positive calcium balances. These positive calcium balances were accelerated by a change in phosphate binder from aluminium to calcium compounds. Under such circumstances, in many dialysis centers, dialysate calcium concentrations changed from a high of (Ca 3.5 to 4.0mEq/l) to a low of (Ca 2.5mEq/l). However, in several dialysis centers the change of dialysate calcium concentration was not performed, so hypercalcemia and ectopic calcification were frequently observed. Now we can use new vitamin D3 metabolites intravenously, so the risk of hypercalcemia has increased and we may have to consider the use of even lower levels of calcium dialysate. However, it will soon be possible to use new calcium free phosphate binders and calcimimetics, having the potential to create negative calcium balances, so we will again have to investigate concerns related to calcium balance and dialysate calcium concentrations.
戻る