medicina49巻13号

2012年12月発行

今月の主題 急性心不全への挑戦 急性心不全の治療 【非薬物療法の適応】

腎代替療法―限外濾過を中心に

著者： 佐々木彰¹ 柴垣有吾¹

所属機関： ¹聖マリアンナ医科大学病院腎臓高血圧内科

ページ範囲：P.2130 - P.2134

ポイント

★急性心不全の治療において，利尿薬抵抗性の存在がしばしば問題となる．

★利尿薬抵抗性の急性心不全の治療オプションの1つとして，腎代替療法がある．

★限外濾過をはじめとする腎代替療法は，現状では十分なエビデンスが不足しているという点で治療の第1選択とはならない．

参考文献

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2）Felker GM:Diuretic management in heart failure. Congest Heart Fail 16:S68-72, 2010

3）Peacock WF, et al:Impact of intravenous loop diuretics on outcomes of patients hospitalized with acute decompensated heart failure；Insights from the ADHERE registry. Cardiology 113:12-19, 2009

4）Hasselblad V, et al:Relation between dose of loop diuretics and outcomes in a heart failure population；Results of the ESCAPE trial. Euro J HF 9:1064-1069, 2007

5）Felker GM, et al:Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364:797-805, 2011

6）Jentzer JC, et al:Combination of loop diuretics with thiazide-type diuretics in heart failure. J Am Coll Cardiol 56:1527-1534, 2010

7）Patera S, et al:Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as a bolus, in refractory congestive heart failure. Eur J Heart Fail 2:305-313, 2000

8）Patera S, et al:Short-term effects of hypertonic saline solution in acute heart failure and long-term effects of moderate sodium restriction in patients with compensated heart failure with New York Heart Association class Ⅲ（Class C）（SMAC-HF study）. Am J Med Sci 342:27-37, 2011

9）Basal S, et al:Sodium retension in heart failure and cirrhosis；Potential role of natriuretic dose of mineralcorticoid antagonist? Circ Heart Fail 2:370-376, 2009

10）Giamouzis G, et al:Impact of dopamine infusion on renal function in hospitalized heart failure patients；Results of the Dopamine in Acute Decompensated Heart Failure（DAD-HF）Trial. J Card Fail 16:922-930, 2010

11）Bart BA, et al:Ultrafiltration versus usual care for hospitalized patients with heart failure；The Relief for Acutely Fluid-Overloaded Patients With Decompansated Congestive Heart Failure（RAPID-CHF）trial. J Am Coll Cardiol 46:2043-2046, 2005

12）Costanzo MR, et al:Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 49:675-683, 2007

13）McMurray JJ, et al:ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Euro Heart J 33:1787-1847, 2012

14）2009 Focused Update:ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. J Am Coll Cadiol 53:1343-1382, 2009

15）Gheorghiade M, et al:Characterization and prognostic value of persistent hyponatremia in patient with severe heart failure in the ESCAPE Trial. Arch Intern Med 167:1998-2005, 2007