臨牀透析 Vol.30 No.2(8)


特集名 バスキュラーアクセスの作製・管理・修復―標準化をふまえた個別化
題名 血液透析から腹膜透析への転換
発刊年月 2014年 02月
著者 横田 成司 川島会川島病院
著者 土田 健司 川島会川島病院
【 要旨 】 血液透析を要する患者背景が経年的に変貌してきており高齢化,糖尿病性腎不全,腎硬化症の患者が増加してきている.このことは血液透析用VA(バスキュラーアクセス)の作製あるいは修復が著しく困難でリスクを伴う可能性を増大させると推定される.その場合,血液透析(HD)から腹膜透析(PD)への転換(移行)を選択する症例がある.PDへ移行した場合,HDと比較して循環動態の安定性などの緩徐な透析が確保できる利点がある一方で,除水不良や腹膜炎の発症などの問題も生じてくる.本稿では当院においてVAトラブルを含めてHD→PDへ移行した症例を検討しながら,PDという大事な選択肢があることとその問題点を述べた.
Theme Vascular access -- Creation, management, repair : the individualization based on the standardization
Title Conversion from hemodialysis to peritoneal dialysis
Author Narushi Yokota Department of Kidney Disease, Kawashima Hospital
Author Kenji Tsuchida Department of Kidney Disease, Kawashima Hospital
[ Summary ] The background of patients who require hemodialysis has changed over time. This is because the number of patients with underlying conditions such as aging, diabetic renal failure, and renal sclerosis has increased. Accordingly, preparing hemodialysis vascular access (VA) or performing reconstruction will increase in difficulty along with the number of associated risk factors. In these cases, some patients may choose to convert from hemodialysis (HD) to peritoneal dialysis (PD). Such conversion offers the benefit of securing more gradual dialysis to attain stable hemodynamics as compared to HD. However, PD may also lead to dehydration and peritonitis. In this study, we examine PD as an important choice and discuss related difficulties by investigating cases of conversion from HD, including those with VA problems as experienced at our clinic.
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