循環器ジャーナル66巻4号

2018年10月発行

特集 循環器救急の最前線—初期診療と循環管理を極める Ⅳ．循環管理を極める

体液管理における血液浄化療法

著者： 吉本広平¹ 土井研人¹

所属機関： ¹東京大学医学部附属病院集中治療部

ページ範囲：P.589 - P.595

Point
・心不全に対しては，機械的除水手段として体外限外濾過法と持続的血液濾過が用いられる．
・早期の限外濾過施行により短期・長期予後が改善する可能性があるが，結論は出ていない．
・限外濾過を行う際は，患者状態に応じ血管内脱水を避けるよう施行することが重要である．

参考文献

1) Damman K, Valente MA, Voors AA, et al:Renal impairment, worsening renal function, and outcome in patients with heart failure:an updated meta-analysis. Eur Heart J 35:455-469, 2014

2) Iwagami M, Yasunaga H, Noiri E, et al:Current state of continuous renal replacement therapy for acute kidney injury in Japanese intensive care units in 2011:analysis of a national administrative database. Nephrol Dial Transplant 30:988-995, 2015

3) 急性・慢性心不全診療ガイドライン（2017年改訂版）

4) Ronco C, Ricci Z, Bellomo R, Bedogni F:Extracorporeal ultrafiltration for the treatment of overhydration and congestive heart failure. Cardiology 96:155-168, 2001

5) Marenzi G, Lauri G, Grazi M, et al:Circulatory response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive heart failure. J Am Coll Cardiol 38:963-968, 2001

6) Bart BA, Boyle A, Bank AJ, et al:Ultrafiltration versus usual care for hospitalized patients with heart failure:the Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure（RAPID-CHF）trial. J Am Coll Cardiol 46:2043-2046, 2005

7) Costanzo MR, Guglin ME, Saltzberg MT, et al;UNLOAD trial investigators:Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. J Am Coll Cardiol 49:675-683, 2007

8) Giglioli C, Landi D, Cecchi E, et al:Effects of ULTRAfiltration vs. DIureticS on clinical, biohumoral and haemodynamic variables in patients with deCOmpensated heart failure:the ULTRADISCO study. Eur J Heart Fail 13:337-346, 2011

9) Marenzi G, Muratori M, Cosentino ER, et al:Continuous ultrafiltration for congestive heart failure:the CUORE trial. J Card Fail 20:9-17, 2014

10) Costanzo MR, Negoianu D, Jaski BE, et al:Aquapheresis versus intravenous diuretics and hospitalizations for heart failure. J Am Coll Cardiol HF 4:95-105, 2016

11) Bart BA, Goldsmith SR, Lee KL, et al;Heart Failure Clinical Research Network:Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 367:2296-2304, 2012

12) Jain A, Agrawal N, Kazory A, et al:Defining the role of ultrafiltration therapy in acute heart failure:a systematic review and meta-analysis. Heart Fail Rev 21:611-619, 2016

13) Costanzo MR, Ronco C, Abraham WT, et al:Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure:Current Status and Prospects for Further Research. J Am Coll Cardiol 69:2428-2445, 2017

14) AKI（急性腎障害）診療ガイドライン作成委員会編：AKI（急性腎障害）診療ガイドライン2016，CQ7-1；AKIに対して血液浄化療法を早期に開始すべきか？

15) Gaudry S, Hajage D, Schortgen F, et al:Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit. N Engl J Med 375:122-133, 2016

16) Zarbock A, Kellum JA, Schmidt C, et al:Effect of Early vs Delayed Initiation of Renal Replacement Therapy on Mortality in Critically Ⅲ Patients With Acute Kidney Injury:The ELAIN Randomized Clinical Trial. JAMA 315:2190-2199, 2016

17) Meersch M, Küllmar M, Schmidt C, et al:Long-Term Clinical Outcomes after Early Initiation of RRT in Critically Ⅲ Patients with AKI. J Am Soc Nephrol 29:1011-1019, 2018