| 特集名 | HDF（血液透析濾過）の新しい展開 | |
|---|---|---|
| 題名 | HDFの基礎 (2) 前希釈法と後希釈法の差違 | |
| 発刊年月 | 2011年 05月 | |
| 著者 | 江刺 志穂 | 清永会矢吹嶋クリニック臨床工学技士 |
| 著者 | 政金 生人 | 清永会矢吹嶋クリニック |
| 【 要旨 】 | HDF療法には前希釈法と後希釈法があり，希釈法の違いで尿毒症物質の除去特性が異なり，また改善できる臨床症状にも違いがある．これまでわが国で認められていたHDF療法の適応疾患は血液透析では対処できない透析アミロイド症と透析困難症に限られており，後希釈法を用いたボトル型（バッグ型）が一般的であった．平成22年4月から，診療報酬の改定によりオンラインHDFが保険適用となり大量の置換液を用いた前希釈法が可能となった．それぞれの希釈法の特性を理解したうえで，それぞれの患者に合った希釈法を選択することが大切である． | |
| Theme | Prospects for Hemodiafiltration | |
|---|---|---|
| Title | Choosing pre-dilution or post-dilution HDF for chronic dialysis patients | |
| Author | Shiho Esashi | Yabuki Shima Clinic |
| Author | Ikuto Masakane | Yabuki Shima Clinic |
| [ Summary ] | There are two main dilution methods for hemodiafiltration (HDF) ; pre-dilution and post-dilution. These two methods exhibit different characteristics in terms of removal of uremic substances and clinical advantages. In Japan, HDF is officially recognized for treating dialysis amyloidosis syndrome and intradialytic hypotension, when those conditions are not adequately treated with hemodialysis. Furthermore, bottle or bag type post-dilution HDF is chiefly performed for these indications, because they have been officially recognized for treatment through the medical reimbersment system. Since April 2010, on-line HDF has been covered by medical insurance. As a result, we can provide pre-dilution HDF, which requires a great deal of substitution fluid, for more dialysis patients. We should understand the differences between dilution methods in terms of solute removal and clinical advantages and then choose proper treatment options for individual dialysis patients. |
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