| 特集名 | 老年医学からみた透析医療 | |
|---|---|---|
| 題名 | 高齢末期腎不全患者に対する透析療法導入の適否並びに透析開始後の継続中止の問題点 | |
| 発刊年月 | 2015年 09月 | |
| 著者 | 大平 整爾 | 札幌北クリニック |
| 【 要旨 】 | 近年，腎不全のために透析に導入される患者の70％弱が，65歳以上の高齢者で占められてきている．高齢者は腎不全以外にも合併障害をもつことが多く，透析への導入については，透析の開始が対象患者の残腎機能の推移とADL，QOLにどのような変化をもたらすかが医療側と患者側とで慎重に検討されなければならない．心肺機能などに重度の障害が存在する場合には，当該患者が透析療法から優れた効用を得られる可能性は低い．透析非開始が決断された後には，当然ながら，十分な保存療法が即時に開始されなければならない． 透析がいったん開始された後であっても患者の負担が受益を上回れば，継続の中止を検討せざるをえない病態が生ずることを熟知したい． |
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| Theme | Geriatric nephrology and dialysis | |
|---|---|---|
| Title | Problems in determining suitability for introducing dialysis therapy and its continuation or withdrawal once dialysis has been started in elderly end stage renal failure patients | |
| Author | Seiji Ohira | Sapporo Kita Clinic |
| [ Summary ] | In recent years, approximately 70 % of the patients being introduced to dialysis for renal failure consist of elderly people 65 years old or older. In many cases, these elderly people have other co-morbid conditions in addition to renal failure. The affects of dialysis on the patient's residual kidney function, ADL and QOL will need to be considered carefully by care providers as well as the patient and family when contemplating introduction to dialysis. In cases where severe conditions in cardiopulmonary function, etc. exist, the chances of the patient getting the full benefits of dialysis therapy are limited. After a decision not to initiate dialysis (dialysis withholding), naturally, adequate conservative therapy must be undertaken immediately. Even after starting dialysis, if the burden on the patient outweighs any benefits they receive, we need to be aware that conditions can occur for which withdrawal of treatment must be considered. |
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