| 特集名 | 透析医療における臨床研究の現状と課題 | |
|---|---|---|
| 題名 | 透析療法 (2) 療法選択 -- 各種療法の長所を生かした選択を目指して | |
| 発刊年月 | 2008年 04月 | |
| 著者 | 中元 秀友 | 埼玉医科大学総合診療内科 |
| 【 要旨 】 | 近年，慢性腎臓病 (CKD) が多くの合併症の誘因となることが明らかとなり，CKDの治療の重要性がいわれている．とくに末期腎不全 (ESRD) であるステージ5のCKD患者では，急激に死亡率も上昇し，適切な時期に適切な透析療法への導入の重要性が議論されている．では透析療法の選択は，どのように行うべきなのであろうか． これまでの透析医療は血液透析 (HD) の患者は一生HDを，腹膜透析 (CAPD) の患者はできるかぎりCAPDを行うとの考え方であったが，近年CAPDとHDは腎代替療法として互いに支え合い，腎不全患者の生活状況をできるかぎり良好に保とうとする考え方が一般的となっている．したがってCAPDからHDへ移行し，時には併用を行うといった，臨機応変に個々の療法の長所を生かしていこうとの考え方へと変化している (包括的腎代替療法)． しかしながら，CAPDは腹膜という生体膜を用いているために長期的には腹膜劣化が生じてくる．したがって，CAPDの継続期間には限界がある．われわれはその限界をきちんと把握し，CAPDの中止時期を患者に明確に示すことが必要となる．現在の透析療法は選択肢が増えた分，われわれ医療者サイドがきちんとその適応を患者に示し，的確なアドバイスを行っていく必要がある． |
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| Theme | Current Problem of Clinical Studies in Dialysis Therapy | |
|---|---|---|
| Title | Selection of dialysis therapy for patients with end-stage renal disease | |
| Author | Hidetomo Nakamoto | Department of General Internal Medicine, Saitama Medical University |
| [ Summary ] | In recent years, important advances have been made in the treatment of patients with end-stage renal disease (ESRD). Patients with ESRD and their physicians must consider many factors, including complications, length of life, and quality of life when choosing a treatment modality. Because of the limited number of donor organs, most patients should continue dialysis for their entire life. It is expected that more than 250,000 patients will undergo maintenance dialysis in Japan by the year 2005. The distribution of patients with ESRD among those receiving transplantation, hemodialysis (HD) and peritoneal dialysis (PD) therapy, differs dramatically in Japan and other countries. A very small number of patients are treated with continuous ambulatory (CAPD), or automated peritoneal dialysis (APD). The selection of dialysis therapy, including hemodialysis or peritoneal dialysis, is an important factor determining the prognosis and quality of life for patients with ESRD. Recently the efficacy of PD therapy in maintaining residual renal function (RRF) has been reported. ADEMEX study in Mexico clearly demonstrated that there was no correlation between peritoneal small-solution clearance (Ccr) and clinical outcome. This data demonstrated the importance of RRF as a predictor of mortality in patients on CAPD where as peritoneal Ccr may lose its efficacy. Furthermore, the usefulness of PD to maintain quality of life (QOL) is known especially in elderly patients with ESRD. From this Japanese data, PD therapy was recommended for patients with RRF (PD first). |
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