| 特集名 | CAPD療法の新たな展開 | |
|---|---|---|
| 題名 | CAPD療法の今後の展開 (6) 高齢者への適応とシステム作り | |
| 発刊年月 | 2004年 10月 | |
| 著者 | 中野 広文 | かしま病院内科／東京慈恵会医科大学腎臓・高血圧内科 |
| 著者 | 竹口 文博 | かしま病院内科／東京医科大学腎臓科 |
| 【 要旨 】 | 高齢者に対する透析療法は，在宅療法が容易で侵襲の小さい方法が望ましい．こうした視点からPD firstは高齢者にとって利点が多い透析法と考えられる．導入後は残腎機能の低下に応じてPD透析量を段階的に増やす．こうした処方により，過除水を予防し残腎機能を可及的に保護すると，長期にわたり低頻度・低用量のPDが継続されることもある． 要介護状態に陥っても，介護支援が充実していれば在宅PDは継続可能である．介護保険のなかではバッグ交換などのPD医療行為を介助する訪問看護がもっとも重要であるが，高度要介護患者に対しては，さらに手厚い支援が必要となる．このためには在宅介護支援システムの構築による介護支援スタッフ間の連携が重要である． |
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| Theme | New Development in CAPD Therapy | |
|---|---|---|
| Title | Peritoneal dialysis for elderly : adaptation and care support system | |
| Author | Hirofumi Nakano | Department of Internal Medicine, Kashima Hospital / Department of Internal Medicine, Division of Nephrology and Hypertension, Tokyo Jikei University School of Medicine |
| Author | Fumihiro Takeguchi | Department of Internal Medicine, Kashima Hospital / Department of Nephrology, Tokyo Medical University |
| [ Summary ] | In relation to dialysis treatments for the elderly, it is desirable that in-home treatment may be easily carried out and the burden on the body be less invasive. From this viewpoint, peritoneal dialysis as a first form of renal replacement therapy (PD first) yields many advantages for the elderly. After initiation, the dosage of PD fluid should be increased step by step, depending on the reduction of residual renal function. Such a prescription makes it possible to avoid hypovolemia due to over-ultrafiltration, and consequently to preserve residual renal function. Consequently, low frequency and low dose of PD can be continued over the long term. When the patient's ADL is impaired, an in-home PD treatment may be discontinued without a substantial care support system. Since in-home visiting nurses service is the most important form of nursing care for these patients, high levels of nursing support become necessary for extremely frail elderly patients who need more care. Cooperation between the care support staffs is necessary, and construction of a home health care support system is important for that purpose. |
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