透析療法を受ける人の基本 - asahi-net.or.jp

1 140/90mmHg 50 55% 45kg ~ / 2 2013 6% (2% 6% (%) *smoothing method=loess (local polynomial regression fitting)(%)mmHgAverage: % Systolic BP difference(preHD-postHD) ( )( )Hui Zhang: KI 81:1108, 2012 10 B,C A (B) (A) < 500 IL-6 TNF- 2m D PTH - -lightchain >500>15,000 p- OL-HDF Kt/V,nPCR CanaudB,1998) 2m 32 24mg/dL ESHOL 2013 P (LornoyW, 2006 P HD:972 mg HDF:1159mg ESA Hb (Vaslaki, 2006) CONTRAST 2012 Locateli,2010) catch-upgrowth Fishbach,2010 QOL CONTRAST RCT, 2012 RCT,ESHOL,2013 , 30% CONTRAST RCT, 2012 ,Turkish(RCT, 2012) Catch-upgrowth I-HDFvsHD)DMDM PermeatePlugged poresMembraneProtein cake Concentration polarization layer(Boundary layer)Bulk(cross-flow blood)DialysteBackwashGuyton and Hall.

2 Textbook of Physiology, acidwasteuremictoxinplasma proteinsaltcarbondioxide CKD-MBD Ca P 2006 2006 CKD-MBD D VitD Ca D DOPPS 0123456 DNR (Klotho) Ca FGF VitD Trade-off 2. Klotho 3. P 25(OH)2D3 7. P 8. Ca 9. CaR VDR Klotho/FGFR1 10. 46:519,2013 Ca P P) 2006 (Al-P PTH FGF23 Klotho Kestenbaum JASN 2007 y = + = (g/kg/day)predialysis P (mg/dL) g/kg/ mg/dL) Ravi D, Arch Intern Med.

3 2007;167:879 1mg/dL P (Ca) (P) ~ ~ PTH60~240pg/mLP>Ca> 2mg CKD MBD 1981 1985 1 (2) K, 44y/o,M, PCK, 750mgCinacalcet 25mgiPTH(pg/mL)CaP(mg/dL)CaP0%10%20%30%4 0%50%60%70%80%90%100%VitDPBC inacalcet D 0200400600800100012001400159131721252933 374145495357616569 PatientsiPTH(Pg/mL)200320062009 iPTH 2011 (Pg/mL)iPTHchange by cinacalcet(n=12)

4 After Sevelamer( ) Cinacalcet( ) LaCa( ) (mg/dL)Ca(mg/dL) Ca P (cohort, n=63)CaPCa* * * of Ca/P adequate group strike zone 0102030405060708090100 CaCO3 SevelamarCinacalcetLanthanPresent(%) 1 2014,Vol 20(1),p12 1 700mg 300mg 20-25g 2g 130mg 1 1000mg 40-60% 20-50 100% 020406080100 1 90 100g 93mg1 1860mg) (1)700mg 0200400600 ( ) ( ) ( ) ( ) ( ) ( ) (1)100g 0100200300400500600 ( ) ( ) ( ) ( ) (2)100g 0200400600 ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) (3)100g X 100mg 100mg 01002003004005006007008009001000 100g (mg) 100mg Na K) (K) (K) 1 2 40 70mg (1) NSC (2) 1 600-750kcal 300mg 20-25 2g 700mg NSC (3)

5 NSC (4) NSC 100mg 100mL340mgX 1 6g120mg 1 110 168 146K mg g 10 1930 10 10 1 10 OK / (1) (2) A 3 C 6 9 1 2-4kg 2025