| 特集名 | HDF（血液透析濾過）の新しい展開 | |
|---|---|---|
| 題名 | HDFの基礎 (1) HDF療法の種類と特徴 | |
| 発刊年月 | 2011年 05月 | |
| 著者 | 武本 佳昭 | 大阪市立大学大学院医学研究科泌尿器病態学 |
| 著者 | 長沼 俊秀 | 大阪市立大学大学院医学研究科泌尿器病態学 |
| 【 要旨 】 | HDF療法の種類は，補充液の注入部位によって三つに分けられる．HDFフィルタ前に補充液を注入する前希釈HDF，HDFフィルタ内部において補充液を注入する内部希釈HDF およびHDFフィルタ後に補充液を注入する後希釈HDFである．また，使用する補充液によりオフラインHDFとオンラインHDFに分けられる．さらに，酢酸を含まない補充液を使用するacetate-free biofiltration（AFBF）などがある．前希釈HDFでは大量の補充液を使用することができ，低分子蛋白質の除去に優れている．内部希釈HDFには内部濾過促進型血液透析があり，特殊な装置を必要とせず簡便にHDFを行うことができる．HDF療法は低分子量物質から低分子量蛋白質までバランスよく溶質を除去できる優れた治療法である． | |
| Theme | Prospects for Hemodiafiltration | |
|---|---|---|
| Title | The classification and characteristics of HDF therapy | |
| Author | Yoshiaki Takemoto | Department of Artificial Kidney, Osaka City University Medical School |
| Author | Toshihide Naganuma | Department of Artificial Kidney, Osaka City University Medical School |
| [ Summary ] | There are three hemodiafiltration methods which are divided into categories employing infused substitution fluids. The first method is predilution HDF in which the substitution fluid is infused before contact with the HDF filter. Predilution HDF employes on-line prepared substitution fluid. Therefore, a large amount of substitution fluid can be used. This method provides high efficacy removal of low molecular weight proteins. The second method is internal-dilution HDF, in which the substitution fluid is infused via the HDF filter. Internal dilution HDF is involved with internal filtration enhanced hemodialysis. With this method we may very easily provide HDF therapy without any additional devices because the dialyzer is designed to be incorporated within the dialysate through the membrane. Another factor concerning HDF therapy is that it may be divided into two categories, those which employ on-line prepared fluids and those which do not. On-line HDF systems employ on-line prepared substitution fluids. Off-line HDF systems use the commercially available substitution fluids. Another type of HDF therapy, termed acetate free biofiltration (AFBF), employs bicarbonate substitution fluids and acetate free dialysates. With AFBF, the harmful effects of acetates are completely eliminated. Therefore, this therapy improves the generally unstable condition of the patients treated. Overall, HDF therapy exhibits excellent characteristics for removal of low molecular weight molecular solutes and low molecular weight proteins. |
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