| 特集名 | 創造する透析医療―新たなmodalityへの期待と課題 | |
|---|---|---|
| 題名 | 新たなmodality（4）PD＋HD併用療法の課題は何か？ | |
| 発刊年月 | 2017年 06月 | |
| 著者 | 本多 佑 | 東京慈恵会医科大学腎臓・高血圧内科 |
| 著者 | 丸山 之雄 | 東京慈恵会医科大学腎臓・高血圧内科 |
| 【 要旨 】 | 末期腎不全に対する最初の腎代替療法（renal replacement therapy ; RRT）として血液透析（hemodialysis ; HD）でなく腹膜透析（peritoneal dialysis ; PD）を選択する，いわゆるPDファーストは残存腎機能が保たれ，不均衡症状が少なく，在宅医療であり社会復帰が容易であるなどの利点から推奨されている．しかし腹膜機能が経年的に劣化し，また残存腎機能も低下するため，長期間のPD単独治療継続は困難である．PD＋HD併用療法はPD単独では透析不足や体液貯留傾向を是正できないときに行われる，わが国特有の治療法である．併用療法の臨床的有用性と課題について評価した． | |
| Theme | Creation of hemodialysis modalities for new goals | |
|---|---|---|
| Title | Issues concerning combination therapy | |
| Author | Yu Honda | Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine |
| Author | Yukio Maruyama | Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine |
| [ Summary ] | Peritoneal dialysis (PD) is recommended as a first-line renal replacement therapy (RRT) for end-stage renal disease (ESRD). The reasons to support this notion are that residual renal function (RRF), a potent predictor of patient survival, is better preserved, there is an absence of disequilibrium symptoms, and higher quality of life (QOL) is provided for PD patients as compared to patients receiving hemodialysis (HD). However, PD alone is not always successful in correcting inadequate dialysis and overhydration after the loss of RRF. Additionally, it is widely recognized that peritoneal membranes gradually deteriorate with PD therapy. As a result, the efficiency of dialysis cannot be maintained. Combined therapy with PD and HD is a treatment option for PD patients who cannot control inadequate dialysis and/or overhydration after the loss of RRF. 20 % of all PD patients are estimated to be on this combination therapy in Japan. The clinical utility and issues related to this modality are examined. |
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