進歩し続ける透析療法 - asahi-net.or.jp

1 CKD-MBD Ca P 2009 41 8 2009 75 1 /5 2009 2004 7 12 16 1 2004 10 23 16 68 2005 12 22 17 65 2006 1 6 18 2007 7 16 19 15 2010 2 5 60cm 1 51 2009-2010 51 4562 JSDT2008 A B.

2 FAX e-Mail2009-2010 46-66% A 26 B 1 2 29 A 19 8 2 20 6 3 / JSDT2008 0102030405060708090 JSDT2008 NS / 2009-2010 051015202530354045504/204/275/45/115/185 /256/16/86/156/226/297/67/137/207/278/38 /108/178/248/319/79/149/219/2810/510/121 0/1910/2611/211/911/1611/2311/3012/712/1 412/2112/281/41/111/181/252/12/82/152/22 3/13/8 1 2009 1% 14% (1) (1)CKD MBD Ca/P CKD MBD Ca/P Ca P 2006 2006 CKD-MBD Kestenbaum JASN 2007 FGF23 Ca P P) 2006 (Al-P PTH FGF23 Klotho (P) 15 Ravi D, Arch Intern Med.

3 2007;167:879 1mg/dL 01020304050607080902345678 32 (39 CaPCa P 2009 JSDT P D Ca gx3/ gx3/ gx3/ Ca,P(mg/dL)i-PTH(Pg/mL)Al-P(IU/L)CaPMH 70 17 2004 CKD MBD 1981 1985 JSDT CKD-MBD Ca VitD Ca PTH CaxP VitD PTH CaxP 0100200300400500600-8 -4 0 4 8 12 16 20 24 28(Week))

4 IPTH(pg/mL)Al-P IU/L)iPTHAl-PCinacalcet (n=12)Averaged iPTH and Alkaline-phosphataseafter Cinacalcet in my clinic (Pg/mL)iPTH change by cinacalcet(n=12)62y/o, M, CGN, 4500mg Cinacalcet 25mgMaxacalcitol g 510iPTH(pg/mL)CaP(mg/dL)CaP59y/o, M, CGN, Sev 6000mg 50mg LaCa 750mgMaxacalcitol diPTH(pg/mL)CaP(mg/dL)CaPSev 6000mg 58y/o, F, CGN, 25mg50mg (pg/mL)CaP(mg/dL)Maxacalcitol 55y/o, M, CGN (postTx), 25mg Sev 6000mg 1500 Maxacalcitol giPTH(pg/mL)CaP(mg/dL)CaP44y/o,M, PCK, 10 4500mgLaCa 750mgCinacalcet 25mgiPTH(pg/mL)CaP(mg/dL)CaP . JSDT 2006* 60pg/mL intact PTH 180pg/mL( NKF KDOQI)After Sevelamer( ) Cinacalcet( ) LaCa( ) (mg/dL)Ca(mg/dL) Ca P (same cohort in my clinic, n=63)Ca P Ca*P P Ca*P P Ca*P 150-300 Pg/mL (P) ( n=67P(mg/dL)024681012020406080 Na K) (K) (K) 1 2 40 70mg ( ) mg/g ( ) ( 28% ) ( ) ( ) ( 62% )

5 1 52y/o MDM( ) (2) (2) HDF HDF Source: Professional estimates , 20070% 20% 40% 60% 80% 100%ChinaItalyKoreaGermanyEnglandFranceU SA,CanadaJapanHigh-fluxLow-fluxEknoyan, HEMO, 2002 Locatelli, 1999 Bloembergen, 1999 Port, 2001 Hakim,1996 HEMO, (HD > year), 2002 Koda, 1997 Woods, 2000 Hornberger, 1 2 Canaud, 2006 Santoro, 2005 Rabindranath, 2005RR NS High-flux HD HDF/HF vs Low-flux HD,High-flux HD) vs vs (Survey by , personal communication)050100 USAEUAsiaJapan (%) vs CDDS) vs CDDS) Na profiling Cf.

6 Koda Y, Mineshima M.: Advances and advantages in recent central dialysis fluid delivery system. Blood Purif. 2009;27 Suppl 1:23-7 diffusion & convection (ETRF) ETRF HDF/HF HDF (3) (3) (8 12mEq/L 17-% QOL --- --- A 17-% QOL --- --- A 1 6g120 mg 1 110 168 146K mg g 10 1930 10 76 10 84 1 10 OK / 2 3 !)

7 ! H16 59 19 " " (1) (2) (1) Martin,LC. J Bras Nephrol) 14 25% (2) C A 3 C 6 9 1/8 L OTC)

8 H2 D EPA DHA C (AGE) 30% 30% ()