medicina54巻7号

2017年06月発行

特集 外来診療必読エビデンス—日米比較で考える内科Standards of Excellence 各論

米国編　慢性腎臓病

著者： 村上尚加¹ 塚原知樹²

所属機関： ^{1 2}つくばセントラル病院腎臓内科

ページ範囲：P.1108 - P.1112

Point
◎内科外来ではCKDに対して，①血圧・体液量，②血糖，③電解質・酸塩基平衡，④合併症（骨・ミネラル代謝，貧血，食事療法）のチェックを行い，網羅的に管理する（表1）．
◎腎臓内科への紹介が必要なケース（表1）を理解しておく．
◎腎代替療法には，血液・腹膜透析，移植，保存的療法の選択肢がある．血液透析を行う場合は，バスキュラーアクセスを適切に選択する．

参考文献

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16）Pisoni RL, et al：Vascular access use in Europe and the United States；Results from the DOPPS. Kidney Int 61：305-316, 2002

17）Brown RS, et al：The survival benefit of “Fistula First, Catheter Last” in hemodialysis is primarily due to patient factors. J Am Soc Nephrol 28：645-652, 2017

18）DeSilva RN, et al：Fistula first is not always the best strategy for the elderly. J Am Soc Nephrol 24：1297-1304, 2013