臨牀透析 Vol.31 No.8(10)


特集名 CKDにおけるサルコペニア・フレイル対策
題名 CKD患者のサルコペニアに対する治療薬
発刊年月 2015年 07月
著者 加藤 明彦 浜松医科大学医学部附属病院血液浄化療法部
【 要旨 】 日常診療において,透析患者のサルコペニアに対して使用できる薬剤は限られる.唯一,蛋白同化ステロイド薬が“慢性腎疾患による著しい消耗状態”に対して適応がある.しかし,本薬には男性化,肝機能障害,心血管病の進展,前立腺がんの増悪などの副作用があり,European Best Practice Guideline(EBPG)の栄養ガイドラインでは投薬期間は3~6カ月を推奨している(エビデンスレベルII).L-カルニチンは,進行期の膵がん患者のサルコペニアに有効と報告されているが,透析患者における有用性は明らかでない.最近,ミオスタチン受容体中和抗体,選択的アンドロゲン受容体モジュレーター,グレリン受容体作動薬などの新規薬剤が開発されており,臨床試験では高齢者やがん悪液質のサルコペニアに対して有効なことが報告されている.現在,血液透析患者を対象とし,抗ミオスタチン受容体抗体(PINTA 745)のランダム化比較試験が行われており,その結果に注目される.
Theme Approach for sarcopenia and frailty in chronic kidney disease
Title Therapeutic medications for sarcopenia in patients with chronic kidney disease
Author Akihiko Kato Blood Purification Unit, Hamamatsu University Hospital
[ Summary ] In clinical practice, there are few drugs available for the treatment of sarcopenia in patients receiving regular dialysis. Anabolic steroids are the only drugs which are applicable to patients with chronic kidney disease and whom exhibit severe wasting conditions. However, these agents have many serious adverse effects including virilism, liver dysfunction, progression of cardiovascular disease and worsening of prostate cancer. As a result, the European Best Practice Guidelines (EBPG) on nutrition recommend that a course of androgens should be considered for three to six months in malnourished hemodialysis (HD) patients at evidence level II. Although L-carnitine supplementation is reported to be useful for sarcopenia in patients with advanced pancreatic cancer, its effectiveness is still unknown for dialysis patients. Recently, new agents have been developed such as an anti―myostatin receptor peptibodies. These are non-steroidal selective androgen receptor modulators, or oral ghrelin-receptor agonists. Preclinical studies have demonstrated that these agents could provide favorable levels of safety and beneficial effects on muscle wasting in the elderly and in patients with cancer induced cachexia. A randomized, double-blind pilot study is being conducted to examine the effects of anti-myostatin peptibodies (PINTA 745) on muscle composition in HD patients who experience protein-energy wasting. The results of this trial are anticipated.
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