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特集 血液透析―カレントトピックス
文献概要
要旨 リン代謝障害は，副甲状腺機能亢進症（以下，HPT）の惹起因子であり，骨代謝障害・異所性石灰化（CKD-MBD）を通し生命予後の悪化に至る。内科的治療にはリン管理と活性型ビタミン（VD）に加えcalcimimeticsが登場した。活性型VDによる長期管理には限界がある。現在頻用されている炭酸Caを中心としたリン吸着や透析液Ca濃度は過剰なCa負荷になる。Calcimimeticsは有効であるが，10～20年の長期使用は新たなコストを必要とする。他方，副甲状腺切除（PTx）は生命予後の改善につながりそのコストも低い。移植後のHPTの頻度は高くないものの，10～15年の長期透析後移植へ移行する患者においては移植後のHPTは相当数存在する。移植前PTxの必要性が痛感される。HPTの発症機序・治療・ガイドラインについて概括し，PTxに関するわれわれの経験を述べた。
参考文献
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