臨床外科72巻2号

2017年02月発行

特集 ビッグデータにもとづいた—術前リスクの評価と対処法 機能障害別　評価と対処法

慢性腎不全

著者： 西田正人¹ 瀬戸泰之¹

所属機関： ¹東京大学医学部附属病院胃食道外科

ページ範囲：P.158 - P.161

【ポイント】
◆慢性腎不全患者では，循環器系，免疫系，凝固系に病態生理学的変化が起こり，栄養障害も生じている．
◆ビッグデータの解析で慢性腎不全は手術リスクであり，NCDの術前評価にも，腎機能が組み込まれている．
◆慢性腎不全患者の周術期管理では，残存腎機能を障害せず，細心の注意で術後合併症を未然に防ぐことが重要である．

参考文献

1）Karopadi AN, Mason G, Rettore E, et al：Cost of peritoneal dialysis and haemodialysis across the world. Nephrol Dial Transplant 28：2553-2569, 2013

2）Masakane I, Nakai S, Ogata S, et al：An Overview of Regular Dialysis Treatment in Japan（As of 31 December 2013）. Ther Apher Dial 19：540-574, 2015

3）Kalantar-Zadeh K, Ikizler TA, Block G, et al：Malnutrition-inflammation complex syndrome in dialysis patients：causes and consequences. Am J Kidney Dis 42：864-881, 2003

4）Abe H, Mafune K：Risk factors for maintenance hemodialysis patients undergoing elective and emergency abdominal surgery. Surg Today 44：1906-1911, 2014

5）Yasuda K, Tahara K, Kume M, et al：Risk factors for morbidity and mortality following abdominal surgery in patients on maintenance hemodialysis. Hepatogastroenterology 54：2282-2284, 2007

6）Wind P, Douard R, Rouzier R, et al：Abdominal surgery in chronic hemodialysis patients. Am Surg 65：347-351, 1999

7）Drolet S, Maclean AR, Myers RP, et al：Morbidity and mortality following colorectal surgery in patients with end-stage renal failure：a population-based study. Dis Colon Rectum 53：1508-1516, 2010

8）Gajdos C, Hawn MT, Kile D, et al：Risk of major nonemergent inpatient general surgical procedures in patients on long-term dialysis. JAMA Surg 148：137-143, 2013

9）Brakoniecki K, Tam S, Chung P, et al：Mortality in patients with end-stage renal disease and the risk of returning to the operating room after common General Surgery procedures. Am J Surg, 2016［Epub ahead of print］

10）Sirany AM, Chow CJ, Kunitake H, et al：Colorectal Surgery Outcomes in Chronic Dialysis Patients：An American College of Surgeons National Surgical Quality Improvement Program Study. Dis Colon Rectum 59：662-669, 2016

11）Hu WH, Cajas-Monson LC, Eisenstein S, et al：Association of dialysis with adverse postoperative outcomes in colorectal cancer-an analysis of ACS-NSQIP. Int J Colorectal Dis 30：1557-1562, 2015

12）Gajdos C, Hawn MT, Kile D, et al：The risk of major elective vascular surgical procedures in patients with end-stage renal disease. Ann Surg 257：766-773, 2013

13）Tam SF, Au JT, Sako W, et al：How sick are dialysis patients undergoing cholecystectomy? Analysis of 92,672 patients from the American College of Surgeons National Surgical Quality Improvement Program database. Am J Surg 210：864-870, 2015

14）Mozer AB, Pender JR 4th, Chapman WH, et al：Bariatric Surgery in Patients with Dialysis-Dependent Renal Failure. Obes Surg 25：2088-2092, 2015

15）Tam SF, Au JT, Chung PJ, et al：Is it time to rethink our management of dialysis patients undergoing elective ventral hernia repair? Analysis of the ACS NSQIP database. Hernia 19：827-833, 2015

16）Matsumoto S, Takayama T, Wakatsuki K, et al：Short-term and long-term outcomes after gastrectomy for gastric cancer in patients with chronic kidney disease. World J Surg 38：1453-1460, 2014

17）Sirany AM, Chow CJ, Kunitake H, et al：Colorectal Surgery Outcomes in Chronic Dialysis Patients：An American College of Surgeons National Surgical Quality Improvement Program Study. Dis Colon Rectum 59：662-669, 2016

18）Takeuchi H, Miyata H, Gotoh M, et al：A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg 260：259-266, 2014

19）Kunisaki C, Miyata H, Konno H, et al：Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer. Gastric Cancer, 2016［Epub ahead of print］

20）Kurita N, Miyata H, Gotoh M, et al：Risk Model for Distal Gastrectomy When Treating Gastric Cancer on the Basis of Data From 33,917 Japanese Patients Collected Using a Nationwide Web-based Data Entry System. Ann Surg 262：295-303, 2015

21）Watanabe M, Miyata H, Gotoh M, et al：Total gastrectomy risk model：data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg 260：1034-1039, 2014

22）Kimura W, Miyata H, Gotoh M, et al：A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population（Japanese）using a web-based data entry system：the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 259：773-780, 2014

23）Matsubara N, Miyata H, Gotoh M, et al：Mortality after common rectal surgery in Japan：a study on low anterior resection from a newly established nationwide large-scale clinical database. Dis Colon Rectum 57：1075-1081, 2014

24）Kobayashi H, Miyata H, Gotoh M, et al：Risk model for right hemicolectomy based on 19,070 Japanese patients in the National Clinical Database. J Gastroenterol 49：1047-1055, 2014

25）Kenjo A, Miyata H, Gotoh M, et al：Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan. J Am Coll Surg 218：412-422, 2014

26）日本腎臓学会：薬剤性腎障害の診療ガイドライン　〔http://www.jsn.or.jp/academicinfo/report/CKD-guideline2016.pdf〕

27）Pierson DJ：Respiratory considerations in the patient with renal failure. Respir Care 51：413-422, 2006

28）河野　崇，横山正尚：【慢性腎臓病（CKD）と麻酔管理】CKD患者の疼痛管理．麻酔62：1344-1350，2013