臨牀透析 Vol.29 No.5(1-5)


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 (5) 連日透析(在宅血液透析)
発刊年月 2013年 05月
著者 坂井 瑠実 芦屋坂井瑠実クリニック
【 要旨 】 当院の在宅血液透析(HHD)患者45名のうち24名が連日透析を行っている.連日透析群は尿素窒素,クレアチニン,カリウム,リン,β2-MG 値は低く,アルブミン,ヘモグロビンは高かった.連日オーバーナイトの患者5名にリンを補給している.血圧は収縮期・拡張期ともに正常で,皮膚の色素沈着,かゆみ,むずむず足症候など腎不全に起因する不快な症状はまったくみられない.服薬量はわずかで,少量の活性型ビタミンD3が主で,降圧薬は4名のみの服用であった.連日透析の患者は食生活も家族と変わらず,透析患者とは思えない顔色,行動力で,活力ある生活を送っている.PD患者は「透析は“毎日”“ゆっくり”するもの」であることを体で知っているので,連日透析の候補生であり,PD→HD併用→HHDはこれからの優れたプログラムになると思っている.
Theme Diversity of hemodialysis therapies
Title Daily in home hemodialysis
Author Rumi Sakai Ashiya Sakai Rumi Clinic
[ Summary ] There are 45 home hemodialysis (HHD) patients in our clinic. Twenty-four HHD patients receive daily hemodialysis. Advantages, disadvantages and problems patients experience with daily hemodialysis in our clinic compared to the current state of conventional hemodialysis and HHD in Japan are examined. Laboratory data concerning patients receiving daily hemodialysis exhibited levels of lower urea, creatinine, potassium and phosphorus, but higher albumin and hemoglobin levels. Dialysates for five patients receiving daily nocturnal HHD were given increased levels of phosphates. Both systolic blood pressure and diastolic blood pressure were lowered. Unpleasant symptoms caused by renal failure such as skin pigmentation, itching, restless leg syndrome, abnormal sweating, and insomnia were not observed. The quantities of medications were low. The primary medication was active vitamin D3. Antihypertensive drugs were used by only four patients. The diets of daily hemodialysis patients were the same as those of their families. Their complexions were good and their energy levels increased when they received daily hemodialysis. Patients receiving peritoneal dialysis may be good candidates for this type of treatment because they were informed that dialysis must be performed daily and slowly. HHD combination therapy using peritoneal dialysis and hemodialysis may provide new treatment options.
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