| 特集名 | CKD-MBDガイドラインを再考する─KDIGOガイドライン改訂を受けて | |
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| 題名 | JSDTガイドラインとKDIGOガイドライン | |
| 発刊年月 | 2018年 06月 | |
| 著者 | 濱野 高行 | 大阪大学大学院医学系研究科腎疾患臓器連関制御学 |
| 【 要旨 】 | CKD-MBDの検査値異常は感染症や腎予後アウトカムと関連する．最近，鉄やEPO投与とFGF23との関連や，鉄の血管石灰化抑制作用も明らかになり，MBDは腎性貧血とも密接な関わり合いがあり，MBD概念が拡充しつつある．FGF23と心不全の関連やcinacalcetによる心不全抑制を考えると，MBD関連臓器のなかに，血管に加え心臓を入れるのは自然である．ただ，心肥大といった器質的なものではなく，機能的なものを概念に取り入れたほうが賢明だろう． 日本と欧米の食事の違いは，保存期における高リン血症の頻度の違いを説明する．25位水酸化ビタミンDの測定が保険償還されるか，ビタミンD強化食の有無，天然型ビタミンDを処方できるかなどの文化的違いを，二つのガイドラインの違いを理解する際に忘れてはならない．日本人のPTH抵抗性は欧米人のそれより低いことが予想され，両ガイドラインのPTH目標管理域の違いに??がっているのだろう．日本では長期透析例が多いことからアミロイドーシスがJSDTガイドラインで取り上げられている． |
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| Theme | Chronic kidney disease-mineral and bone disorder (CKD-MBD) guidelines: Endorsement of the Kidney Disease Improving Global Outcomes (KDIGO) 2017 CKD-MBD Guidelines Update | |
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| Title | JSDT and KDIGO guidelines for CKD-MBD | |
| Author | Takayuki Hamano | Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine |
| [ Summary ] | Abnormalities in FGF23 and 25-hydroxyvitamin D (25 (OH) D) levels predict infection and renal outcomes. Recent findings concerning the effect of iron/ESA administration on FGF23 and inhibition of vascular calcification with iron treatment suggest a close link between CKDMBD and renal anemia. Thus, the concept of CKD-MBD is expanding. Given the association between FGF23 and congestive heart failure and its prevention with cinacalcet therapy, it is reasonable to include the heart as well as vessels into MBD-related organs as being associated. Functions of the heart rather than organic alterations of the heart such as left ventricular hypertrophy should be taken into account. Dietary differences between Japan and western countries may explain the difference in the prevalence of hyperphosphatemia in predialysis stages. Reimbursement policies for the measurement of 25 (OH) D, availability of vitamin D-fortified food, and doctors' prescription right of native vitamin D vary from country to country. These medical and cultural issues should be considered to understand the differences between the JSDT and KDIGO guidelines. The skeletal resistance to PTH in Japanese hemodialysis patients is expected to be lower than that of western patients. This may explain the lower target range of PTH in the JSDT guidelines. The high prevalence of patients having received long term dialysis in Japan has led to the inclusion of the management of amyloidosis into the JSDT guidelines. |
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