| 特集名 | CKDステージG3以降の診療と看護・生活支援 | |
|---|---|---|
| 題名 | CKD薬物療法の実際 (1) 血圧・脂質・貧血の管理 | |
| 発刊年月 | 2013年 06月 | |
| 著者 | 森脇 久美子 | 香川大学医学部循環器・腎臓・脳卒中内科 |
| 著者 | 清元 秀泰 | 東北メディカル・メガバンク機構地域医療支援部門 |
| 【 要旨 】 | 高血圧，脂質代謝異常，貧血は，慢性腎臓病（CKD）および心血管病（CVD）の増悪因子であり，きめこまかな管理によってCKDの進行を抑制できる．CKDにおける降圧目標は，130/80mmHg以下である．尿蛋白0.15g/gCr以上または糖尿病合併CKD患者においてはRAS阻害薬を第一選択薬とするが，高カリウム血症や腎機能低下に注意する．蛋白尿がないCKDの第一選択薬の種類は問わない．CKDにおける脂質異常症の治療目標は，CVD予防の観点から，LDL―C120mg/dL未満，HDL―C40mg/dL以上，中性脂肪150mg/dL未満とする．スタチンによる横紋筋融解症に留意する．CKDステージG3～G5では腎性貧血をきたす．Hb10g/dL以下で，赤血球造血刺激因子投与や鉄補充を開始する．治療目標は，Hb11～13 g/dL，血清フェリチン値100～250ng/mLまたはTSAT20％以上である． | |
| Theme | Medical treatment, nursing care, and life support for patients with advanced CKD stages | |
|---|---|---|
| Title | Pharmacotherapies for chronic kidney disease (CKD) : managements of haypertension, dyslipidemia, and anemia | |
| Author | Kumiko Moriwaki | Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University |
| Author | Hideyasu Kiyomoto | Department of Community Medical Supports, Tohoku Medical Megabank Organization |
| [ Summary ] | Chronic kidney disease (CKD) is associated with an increased incidence of cardiovascular disease. Hypertension, dyslipidemia and anemia respectively are risk factors for progression of CKD and cardiovascular disease. Ideal blood pressure（BP）levels should be 130/80 mmHg for patients with CKD. Angiotensin II type 1 receptor blockers (ARB) and angiotensin-converting-enzyme (ACE) inhibitors are the first choice of antihypertensive drugs for CKD patients with proteinuria or diabetes. The major adverse effects of ARB are hyperkalemia and temporal decreases in glomerular filtration rates (GFR). Japan atherosclerosis society guidelines for prevention of atherosclerotic cardiovascular disease recommend LDL-C treatment goals of < 100 mg/dL, HDL-C > 40 mg/dL, triglycerides levels of <150 mg/dL for CKD patients. Statins may reduce proteinuria as observed in large clinical studies. For patients with GFR lower than 60 mL/min per 1.73 m2, statins and/or fibrates may increase the incidence of rhabdomyolysis in some cases. Anemia is a major complication of CKD. Treating anemia by administering erythropoiesis stimulating agents (ESA) and/or suitable iron supplementation should be implemented when hemoglobin (Hb) levels are <10 g/dL. Hb levels should be 11-13 g/dL. Targeting Hb levels in excess of 13 g/dL may increase the rate of adverse events. |
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