| 特集名 | 透析患者の糖尿病管理の新展開 | |
|---|---|---|
| 題名 | 合併症 (3) 大血管合併症 a．スクリーニング | |
| 発刊年月 | 2019年 01月 | |
| 著者 | 岩﨑 昌樹 | 東邦大学医療センター大橋病院腎臓内科 |
| 著者 | 長谷 弘記 | 東邦大学医療センター大橋病院腎臓内科 |
| 【 要旨 】 | 糖尿病を合併した透析患者においては心血管疾患の合併頻度が高く，また予後不良が知られているにもかかわらず，典型的な症状を示しにくいことから，診断が難しく重症化してからようやく顕在化する患者をしばしば経験する．胸部症状がなくてもドライウエイト調整に反応しないうっ血症状や透析中の血圧低下は虚血性心疾患の関与を疑うべき所見である．冠動脈狭窄のみならず，貧血，内シャントなど心筋酸素需要と供給のバランスを破綻させる他の要因に留意する必要がある． | |
| Theme | New perspectives in the management of patients with diabetes undergoing dialysis | |
|---|---|---|
| Title | Heart disease in end stage kidney disease patients with diabetes mellitus | |
| Author | Masaki Iwasaki | Department of Nephrology (Ohashi), Toho University |
| Author | Hiroki Hase | Department of Nephrology (Ohashi), Toho University |
| [ Summary ] | An imbalance between myocardial oxygen demand and supply is attributable not only to coronary artery stenosis but also to other factors including anemia, arteriovenous fistula, left ventricular hypertrophy, and tachycardia. Anemia, and arteriovenous fistula among other such conditions can precipitate myocardial ischemia even without significant stenosis of the coronary arteries. It is difficult to diagnose ischemic heart disease (IHD) among end stage kidney disease patients with diabetes mellitus because these patients often do not present with typical symptoms. Congestion (refractory to adjustment of dry weight), intradialytic hypotension, and nocturnal paroxysmal dyspnea are findings suggestive of IHD, even if patients do not show typical chest symptoms. In patients with a suspicion of IHD, depending on the patient's condition, the examination of following in order must be performed. 1. electrocardiogram and ultrasound cardiogram 2. stress electrocardiogram and/or stress myocardial perfusion single-photon emission computed tomography 3. coronary angiography |
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