臨牀透析 Vol.29 No.5(1-1)


特集名 透析modalityの多様化
題名 HD療法の多様化:透析スケジュールの見直し (1) 長時間透析
発刊年月 2013年 05月
著者 前田 兼徳 兼愛会前田医院
著者 鶴田 耕一郎 兼愛会前田医院臨床工学課・臨床工学技士
著者 前田 由紀 兼愛会前田医院
著者 望月 保志 長崎大学大学院医歯薬学総合研究科医療科学専攻展開医療科学講座腎泌尿器病態学
【 要旨 】 先人たちの努力により,装置や水処理技術,透析液の清浄化,ダイアライザの品質改良,デバイスの生体適合性向上など,透析医療を取り巻く環境は日進月歩である.薬物療法を含む合併症対策や対症療法は確実に前進し,腎不全治療は実績を積み重ねてきた.しかし「拡散」「吸着」で過剰な尿毒素を除去し,「濾過」で除水を行うというごく単純な原理は,血液透析の黎明期から現在に至るまでの50年間でまったく変化をみていない.血液透析がまだまだ発展途上の医療であり,それゆえにこの治療法にはさらなる改善の余地や伸びしろが多く存在することを,われわれ医療従事者は改めて自覚する必要がある.透析量の上限が示されていない現段階では,少なくとも透析不足には注意を払うべきである.長時間透析のもつ臨床的意義は大きい.
Theme Diversity of hemodialysis therapies
Title Long hemodialysis
Author Kanenori Maeda Department of Nephrology, Maeda Clinic
Author Koichiro Tsuruta Department of Clinical Engineering, Maeda Clinic
Author Yuki Maeda Department of Nephrology, Maeda Clinic
Author Yasushi Mochizuki Department of Nephro-Urology, Nagasaki University Graduated School of Biomedical Sciences
[ Summary ] The environment surrounding dialysis-treatment, in terms of improved equipment and water treatment technology, dialyzer quality, dialysate purification and the biocompatibility of devises has steady progressed due to current efforts and those of our predecessors. Prevention of complications involving drug therapy has certainly advanced as have symptomatic treatments, and renal failure treatments. However, the very simple principles of removing excess uremic toxins by "diffusion" and "adsorption", and removing body fluids by "filtration" have not changed in the 50 years since the introduction of hemodialysis therapy.Hemodialysis therapy is still in the developmental stages. Therefore, medical personel, need to recognize there is much room for improvement in this field. Currently the upper limits of dialysis dosage are not known. We must recognize there is a shortage of dialysis available. It is thought that long-term hemodialysis is an effective treatment.
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