特集名 | 透析療法における様々なガイドラインを考える | |
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題名 | 血糖管理・高脂血症 | |
発刊年月 | 2004年 01月 | |
著者 | 普天間 新生 | 愛知医科大学腎臓・膠原病内科 |
著者 | 今井 裕一 | 愛知医科大学腎臓・膠原病内科 |
【 要旨 】 | 糖尿病透析患者は透析導入後も良好な血糖コントロールを維持することは,糖尿病性血管症の進展抑制のために重要である.血糖コントロールの指標は血糖の測定とHbA1c,グリコアルブミン (GA) が有用である.血糖管理目標は空腹時血糖120mg/dl未満,食後2時間180mg/dl,HbA1cを7.0%未満,GAを20%以下へもっていく.低血糖や不安定な血糖変動を示す場合はもう少し緩くするが,HbA1cは8%未満にするのが望ましい. 透析患者の高脂血症についても,動脈硬化症進展防止に重要である.その管理目標はLDL-C100mg/dl未満,中性脂肪150mg/dl未満,non HDL-Cを130mg/dl未満,HDL-Cは40mg/dl以上を目指すようにする. |
Theme | Diagnostic and Therapeutic Guidelines in End-stage Renal Failure | |
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Title | Guidelines for managing glycemia and hyperlipidemia in hemodialysis patients | |
Author | Arao Futenma | Division of Nephrology and Rheumatology, Aichi Medical University School of Medicine |
Author | Hirokazu Imai | Division of Nephrology and Rheumatology, Aichi Medical University School of Medicine |
[ Summary ] | Maintenance of good glycemic control in diabetic patients receiving hemodialysis is important in preveting the development of diabetic angiopathy and other complications. Reliable indices of glycemic states in diabetic dialysis patients were blood glucose (BS), HbA1c and glycated albumin (GA) levels. The practical guidelines for managing good glycemic states were as follows; fasting BS < 120mg/dl, post pradial (2 hrs) BS < 180mg/dl, HbA1c < 7.0% and GA < 20%. In patients with hypoglycemia or with rapidly fluctuating glucose levels there is a need for more flexable control, but HbA1c levels should be maintained below 8.0%. Maniging of hyperlipidemia in dialysis patients is important in preventing the progression of arteriosclerosis. Expected control levels of serum lipids were as follows; LDL-C < 100mg/dl, TG < 150mg/dl, non HDL-C < 130mg/dl and HDL-C => 40mg/dl. |