| 特集名 | 腹膜透析療法―ポストガイドラインの方向性 | |
|---|---|---|
| 題名 | 課題と対策 (4) 併用療法―EARTH研究 | |
| 発刊年月 | 2012年 05月 | |
| 著者 | 丸山 之雄 | 東京慈恵会医科大学腎臓・高血圧内科 |
| 著者 | 横山 啓太郎 | 東京慈恵会医科大学腎臓・高血圧内科 |
| 【 要旨 】 | 末期腎不全に対する最初の腎代替療法（renal replacement therapy；RRT）として血液透析（hemodialysis；HD）でなく腹膜透析（peritoneal dialysis；PD）を選択するいわゆるPDファーストは，残存腎機能が保たれる，不均衡症状が少ない，在宅医療であり社会復帰が容易であるなどの利点から推奨されている．しかし，腹膜機能が経年的に劣化し，また，残存腎機能も低下するため，長期間のPD単独治療継続は困難である．PD＋HD併用療法は，PD単独では透析不足や体液貯留傾向を是正できないときに行われる，わが国特有の治療法である．われわれEARTH研究会は多施設共同の後ろ向き研究を行い，その臨床的有用性を評価した． | |
| Theme | Trend in Peritoneal Dialysis Therapy After Implementation of Japanese Society for Dialysis Therapy (JSDT) Peritoneal Dialysis Guideline | |
|---|---|---|
| Title | The combined therapy with peritoneal dialysis and hemodialysis | |
| Author | Yukio Maruyama | Division of Kidney and Hypertension, The Jikei University School of Medicine |
| Author | Keitaro Yokoyama | Division of Kidney and Hypertension, The Jikei University School of Medicine |
| [ Summary ] | Peritoneal dialysis (PD) is recommended as a firstline renal replacement therapy (RRT) for end-stage renal disease (ESRD). The factors to support this notion include the fact that residual renal function (RRF), a potent predictor of patient sur vival, is better preserved, as well as an absence of disequilibrium symptoms, and provision of a high quality of life (QOL) for PD patients as compared to patients receiving hemodialysis (HD). However, PD alone is not always successful in correcting inadequate dialysis and/or overhydration after the loss of RRF. Additionally, it is widely recognized that peritoneal membranes gradually deteriorate over the duration of PD therapy. As a result, the efficiency of dialysis cannot be maintained. Combined therapy with PD and HD is a treatment option for PD patients who cannot control inadequate dialysis and/or overhydration after the loss of RRF. In Japan, 20 % of all PD patients are estimated to be on this therapy. We established the Evaluation on the Adequacy of Renal Replacement Therapy (EARTH) Study Group, and demonstrated the clinical utility of this modality in a retrospective multicenter study. |
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