| 特集名 | よりよい透析療法のために -- 保存期腎不全治療の重要性 | |
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| 題名 | 保存期腎不全の病態と治療・予後 (5) 腎性貧血 | |
| 発刊年月 | 2004年 06月 | |
| 著者 | 藤井 正満 | 大阪厚生年金病院内科 |
| 【 要旨 】 | 腎機能の低下とともに腎性貧血の発現頻度は増加する．腎性貧血の主因はエリスロポエチン (EPO) の欠乏である．保存期からrecombinant human erythropoietin (rHuEPO) を使用し貧血を是正すれば，腎性貧血が惹き起こす種々の症状，身体機能低下，心循環器系合併症，中枢神経障害などが改善し，QOLが向上し，生命予後が改善する．血圧を適正に管理すれば，腎機能の温存効果も期待できる．貧血改善の目標は，最低でもヘモグロビン (Hb) 10g /dl [ヘマトクリット (Ht) 30％] 以上，できればHb11g/dl (Ht33％) 以上とする．rHuEPOの効果が不十分であるおもな原因は鉄欠乏である．鉄補充は経口投与を第一選択とし，必要に応じ静脈内投与する． 貧血改善目標の上限値，鉄の静脈内投与の適応，鉄欠乏状態を評価する至適な指標については明確にはされておらず，今後の検討を要す． |
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| Theme | Importance of Preservative Management in Chronic Renal Failure -- for a Better Dialysis | |
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| Title | Renal anemia | |
| Author | Masamitsu Fujii | Department of Internal Medicine, Osaka Kousei-Nenkin Hospital |
| [ Summary ] | As renal function declines, the incidence of anemia increases. Anemia associated with chronic renal failure is mainly caused by reduced renal erythropoietin (EPO) production. Successful treatment of anemia with recombinant human EPO (rHuEPO) before the initiation of dialysis improves anemia-induced symptoms, exercise capacity, cardiovascular morbidity, central nerve system dysfunction, quality of life, and patient survival. rHuEPO treatment in predialysis patients may slow the rate of progression of renal failure as long as blood pressure is well controlled. Target hemoglobin concentration (hematocrit) is>10 to 11 g/dl (30 to 33%). The most common cause of an incomplete response to rHuEPO is iron deficiency. In iron deficient patients, oral iron should be tried as the first mode of treatment. Iron must be administered intravenously as needed. The upper limits of optimal hemoglobin concentration (hematocrit), indications for intravenous iron administration and the ideal markers for iron deficiency are unclear and more studies will be required. |
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