臨牀透析 Vol.33 No.13(4-1)


特集名 透析スタッフにとっての腎移植―直面する臨床的課題
題名 腎移植前後の患者管理(1)移植待機患者の長期透析管理
発刊年月 2017年 12月
著者 上條 祐司 信州大学医学部附属病院腎臓内科
【 要旨 】 腎移植待機患者は良好な全身状態を維持する必要がある.腎移植待機患者における長期管理として重要なのは,感染症の評価・予防・治療,悪性腫瘍の早期発見・治療,心血管病の発症予防である.透析施設においては,通常の感染予防対策に加え,ワクチン接種や無症候性感染症の治療,悪性腫瘍のスクリーニング,体液過剰・高血圧・貧血・血糖・CKD-MBD(慢性腎臓病に伴う骨ミネラル代謝異常)・肥満に対する治療,禁煙指導が重要である.腎移植が円滑に行われるように,腎移植待機患者は移植登録施設での受診が義務づけられた.今後,腎移植待機患者の医療情報を移植施設と透析施設で共有できる連携体制の構築が必要である.
Theme Kidney transplantation for dialysis room staff -- Recent clinical issues
Title Long-term management of patients waiting for kidney transplantation
Author Yuji Kamijo Department of Nephrology, Shinshu University School of Medicine
[ Summary ] Patients who are waiting for kidney transplantation should maintain a good general condition. The evaluation, prevention, and treatment of infectious diseases, early detection and treatment of malignant tumors, and prevention of cardiovascular diseases (CVDs) are very important for long-term management. In dialysis facilities, in addition to usual infection prevention measures, vaccination and treatment against asymptomatic infection, screening for malignant tumor, adequate treatment for systemic pathogenic conditions, including excess body fluid volume, hypertension, renal anemia, impaired glucose tolerance, chronic kidney disease-mineral bone disorder (CKD-MBD), and obesity, and nonsmoking guidance are necessary. Today, patients who are waiting for kidney transplant must be checked and evaluated by health professionals in the transplant registration facility. A collaborative system that can enable sharing of the patient's medical information among transplant and dialysis facilities must be established.
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