臨牀透析 Vol.26 No.2(2)


特集名 血液透析方法を再考する
題名 [総論]透析施設における長時間透析の現状と問題点 -- 「長時間透析+限定自由食」の取組み
発刊年月 2010年 02月
著者 金田 浩 かもめクリニック
【 要旨 】 1998年から12年間,透析患者の「高血圧と栄養障害」を同時に解決する治療法として「長時間透析と限定自由食」を考案し実践した.(1) 方法:透析時間は6~8時間,食事はカリウム以外制限なく食塩摂取量は8~12g/day,血液流量は100~180 ml/min.(2) 結果:高血圧と栄養および貧血の改善に伴う高いQOLが得られた.10年間に1,764名に実施し74名が死亡.年間平均粗死亡率は4.2%(9.6%:2008年のJSDT)で,心不全と感染症がJSDTよりも著明に減少.(3) 問題点:経済的理由より普及は困難.
Theme Re-consideration for the Modification of Hemodialysis Therapy
Title Long hemodialysis without salt restriction ; methods, outcomes and problems
Author Hiroshi Kaneda Kamome Clinic
[ Summary ] 1. Method : A 3x6-8hr/week hemodialysis without salt restricted diet(8-12 g/day of salt intake)without potassium control was carried out over a 12 year period. 2. Outcomes: 1) Adequate blood pressure and nutrition control were achieved. 2) The average yearly mortality rate was 4.2% compared to the 9.6% rate observed by the JSDT (2008) in 74 out of 1,764 patients treated over the 10 year period (1999-2008). 3) As a cause of death, heart failure accounted for 1.4% of cases (24.0% in JSDT), infection 6.8% (20.0%), CVD 6.8% (8.6%) and malignancy 16.2% (9.2%). 3. Problems:This dialysis modality is not popular in Japan but it may become accepted world-wide in the future because of high QOL, low mortality rates and the fact that dialysis costs are very low. However, in Japan it may not easily become accepted because of economic reason.
戻る