臨牀透析 Vol.32 No.6(7)


特集名 高齢化のなかでのCKD-MBDにどう対応するか?
題名 二次性副甲状腺機能亢進症への対策
発刊年月 2016年 06月
著者 石田 真理 東海大学医学部付属八王子病院腎内分泌代謝内科
著者 角田 隆俊 東海大学医学部付属八王子病院腎内分泌代謝内科
【 要旨 】 二次性副甲状腺機能亢進症(SHPT)対策とガイドラインの管理目標値は,治療薬の開発と研究成果により変遷してきた.日本では,VDRA治療と同時に経皮的エタノール注入をする選択的副甲状腺PEITが開発された.シナカルセト塩酸塩の発売後,国内外でもPTxの件数は減少したものの,PTxは高度のSHPTに対する最終治療手段であり,PTH値を劇的に低下させ血清P,Ca値を改善するとともに,骨折リスク低減や生命予後改善の可能性を示す.内科的治療に抵抗する高度のSHPTに対してPTxは高齢者においても意義のある治療である.高齢だからこそ早期介入による合併症予防とADL低下予防が,医療費抑制にもつながる重要な治療方針であると考える.
Theme The appropriate management for CKD-MBD in the elderly patients
Title Approach to secondary hyperparathyroidism
Author Mari Ishida Division of Nephrology, Endocrinology and Metabolism, Tokai University Hachioji Hospital
Author Takatoshi Kakuta Division of Nephrology, Endocrinology and Metabolism, Tokai University Hachioji Hospital
[ Summary ] Modified treat-to-target and target range guidelines for secondary hyperparathyroidism (SHPT) have been developed by the Kidney Disease Outcomes Quality Initiative (KDOQI), Kidney Disease:Improving Global Outcomes (KDIGO), and the Japanese Society for Dialysis Therapy (JSDT). Vitamin D receptor activators (VDRA) and cinacalcet hydrochloride have also changed the targets of interventional therapy for SHPT patients.
In Japan, percutaneous ethanol injection therapy (PEIT) has developed as an intervention for isolated parathyroid hyperplasia.
The number of parathyroidectomies has been decreasing since the introduction of cinacalcet.
However, not only decreased parathyroid hormone (PTH) levels but also parathyroidectomies have reduced the number of hip bone fractures and mortality of end-stage renal disease (ESRD) patients on hemodialysis.
Therefore, parathyroidectomy is the ultimate weapon against SHPT and makes it easier to achieve targets for calcium and phosphorus as well as significant reduction of PTH levels.
More than 70 % of ESRD patients receiving hemodialysis are over 65 years old, and must receive intensive treatment to avoid comorbidities and frailty, as well as to reduce mortality and medical costs.
戻る