臨牀透析 Vol.25 No.5(1-1)


特集名 血液透析処方をどのように選択するか
題名 治療法,操作条件の選択基準 (1) 治療法の選択
発刊年月 2009年 05月
著者 政金 生人 清永会矢吹嶋クリニック
【 要旨 】 慢性維持透析患者の血液透析療法選択を行う際には,透析困難症,アミロイドによる骨関節痛だけでなく,いらいらやかゆみなどの不定愁訴もターゲットにする.拡散,濾過,吸着の三つのメカニズムをうまく利用し,HDFと蛋白吸着型ダイアライザを組み合わせた治療条件を設定する.ターゲットとした患者の愁訴がとれるまで,ダイアライザ選択や血流量,置換方法,置換液量,透析時間,透析スケジュールを一つずつ変えていく.治療効果の判定は除去効率やBeta2MG値だけでなく,臨床症状の改善を最重要視し,さまざまな治療モードにおけるアルブミン損失量を把握して条件設定を行う.
Theme Achieving Adequate Dialysis Prescription for Individual Patients
Title How to choose the modality for chronic dialysis
Author Ikuto Masakane Yabukishima Clinic
[ Summary ] Therapeutic modalities for chronic dialysis should be decided on not only based on the existence of dialysis hypotension or dialysis related amyloidosis, but also in relation to multiple patient complaints, such as itching and irritability. It is important to balance the diffusion, convection and adsorption of uremic toxins to establish adequate therapeutic modalities. On-line HDF and protein adsorptive dialysis membranes are useful tools in achieving treatment goals. Changes in therapeutic conditions must be initiated to improve treatment. These changes include control of blood flow rates and substitution fluid flow rates improved dialysis membranes, improved dialysis schedules and adapting to patient complaints. Improvement of symptom is the most important parameter used to assess the quality of modalities. The efficacy of any modality should be analyzed not only by the level of serum beta2 microglobulin and reduction rates, but also by the total amount of albumin leakage through dialysis sessions.
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