血液透析時間短縮化の影響　患者の受け止め方と透析量から検討:患者の受け止め方と透析量からの検討 Shortening of hemodialysis time: Evaluation of patient acceptance and dialysis dose.:Evaluation of patient acceptance and dialysis dose

血液透析時間の短縮 (5時間を4時間) を試験的に施行した. 施行に当たって, これまで得ていた透析量を維持するために以下の諸点を考慮した: 1) 透析液量は変更しない, 2) 血流量を増加した, 3) 透析器の表面積を増大した, 4) 食事内容を個々に再検討した, 5) 患者の不安を軽減するために, 個々の症例が1回の血液透析で耐えられる最大除水量を理解せしめ, これを越える場合には透析時間の延長があり得ることを周知徹底した. 12か月の試行の結果は以下のごとくであった: 1) 患者は概ね, 時間短縮を歓迎したが, 何らかの自覚症の出現や検査値の悪化を懸念する患者も存在した, 2) BUN, 血清Cr, P等に有意な上昇を認めなかった, 3) Kt/V, TAC_BUN, PCR等の検討では大半の症例が短縮後も透析量不足とはならなかった, 4) 少数の水分・塩分管理不良者および心機能不全者では4時間透析では目標の除水量が行い得ない場合が生じた, この中にrestless leg syndromeの悪化を呈した症例が1例認められた, 5) 時間短縮に伴って降圧剤の増量を要した症例は11% (5/47) に止まった, 6) 血流量が増大しその分幾分, 血液透析の効率が高まったことの影響は12か月の試行期間では出ていない.<br>しかし, Kt/Vが同一であっても透析時間の長短によって患者の長期的予後には差異が生ずる可能性は極めて高い. 今後の問題として長期的に注意深く患者を観察していきたい.

Five hours of hemodialysis three times a week was tentatively shortened to 4 hours. This trial was done with the following conditions in order to maintain the same dialysis dose (Kt/V): 1) Dialysate volume was maintained at the same level. 2) Blood flow and the dialyzer surface were increased. 3) Diet content was reevaluated. 4) Patients were notified that dialysis-time might be extended if interdialytic weight-gain exceeded the limit of asymptomatic ultrafiltration volume in each patient. The results of an approximately 1-year trial were as follows: 1) All patients accepted the shortening of dialysis time though some worried about worsening of subjective well-being and laboratory data. 2) BUN, serum creatinine, phosphate, HS-PTH and β₂-MG were essentially unchanged. 3) In most cases, Kt/V, PCR, TAC_BUN showed no significant decrease after the shortening. 4) 4 hours of hemodialysis was associated with difficulty in obtaining the proposed ultrafiltration volume in a few cases who were in cardiac failure or had poorly managed salt and water intake. One case experienced worsening of his restless leg syndrome. 5) Most cases necessitated no additional antihypertensive medications. 6) No undesirable effects were observed over the one year trial period in most cases though higher efficiency hemodialysis was inevitable. Longer observation is mandatory because we can not conclude that Kt/V results or patient survival will be the same with a different dialysis-time.