臨牀透析 Vol.23 No.8(11)


特集名 高齢社会における透析医療 -- 現況と課題
題名 高齢維持透析患者における薬物療法上の留意点
発刊年月 2007年 07月
著者 平田 純生 熊本大学薬学部臨床薬理学分野
【 要旨 】 高齢透析患者では一般の高齢者よりもさまざまな合併症により,多剤併用されることが多く,相互作用の発現,コンプライアンスの低下が懸念される.また高齢透析患者では分布および代謝の変化が起こりやすく,血中薬物濃度の上昇に伴う中毒性副作用の発現率が高くなる.さらに高齢化に伴う生理機能の低下も薬物療法に影響を及ぼす.たとえば,胃内pH上昇は炭酸カルシウムのリン吸着能力低下が懸念され,腸管蠕動力低下は便秘の悪化をもたらす.また,免疫能低下による抗菌薬投与は腸内細菌叢を乱すため,適切な下剤投与,あるいは乳酸菌,食物繊維の投与あるいはサプリメントの摂取が望まれる.
Theme Dialysis Therapy in Aging Society -- Current Status and Involved Problems
Title Essential points of pharmacotherapy for elderly dialysis patients
Author Sumio Hirata Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Kumamoto University
[ Summary ] Elderly dialysis patients are frequently prescribed multiple drugs, because they have a variety of complications compared to the general elderly population. Hence, concerns arise as to drug interactions and a lack of compliance. In addition, elderly dialysis patients may be influenced by changes in drug distribution and drug metabolism. The incidence of adverse effects may also be high with high serum drug concentrations.
A decrease in physiological functions with increasing age also affects pharmacotherapy for the elderly. For example, an increase in gastric pH causes a decrease in the phosphate binding ability of calcium carbonate, and decreased peristalsis in the colon causes deterioration, leading to constipation. Furthermore, the frequent administration of antimicrobial agents because of lowered immunity destroys their bacterial flora. Therefore, taking an appropriate laxative, or acidophilus in conjunction with dietary fiber is highly recommended.
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