- 著者
- 栗山 哲 中山 昌明 友成 治夫 沼田 美和子 林 文宏 疋田 美穂 川口 良人 細谷 龍男
- 出版者
- The Japanese Society for Dialysis Therapy
- 雑誌
- 日本透析医学会雑誌 (ISSN:13403451)
- 巻号頁・発行日
- vol.30, no.12, pp.1369-1373, 1997-12-28 (Released:2010-03-16)
- 参考文献数
- 15
- 被引用文献数
- 1 1
現在, 除水不全を呈するCAPD患者に有効に作用する薬剤はない. 本研究では, 除水不全を認めるCAPD患者において, 抗プラスミン剤であるトラネキサム酸 (tranexamic acid: TNA) が改善効果を有するか否かを検討した.限外濾過不全I型の除水不全を認めるCAPD患者5例において, 先行するCAPDスケジュールを変更せずにTNA 1500mg/日を2週間経口投与し, その薬理効果を検討した. その結果, 1) TNA投与で一日総除水量は全例で有意に増加した. また, 体重は5例中3例で有意に減少した. 2) TNAはCAPD排液中の電解質, UN, Cr, アルブミン等の総除去量に影響を与えなかった. また, PETのD/PcrやKT/V, PCRにも影響を与えなかった. 3) TNA投与により血中およびCAPD排液中のブラジキニン濃度, 血中の組織プラスミノーゲンアクティベーター (tPA) 濃度は有意に低下した.以上, TNAは除水不全を呈するCAPD患者で除水量を増加させる. その機序は不明であるが, ブラジキニン, tPAの抑制を介した腹膜透過性の変化が関与している可能性が示唆された.
- 著者
- 栗山 哲 友成 治夫 大塚 泰史 大城戸 一郎 細谷 龍男
- 出版者
- 社団法人 日本腎臓学会
- 雑誌
- 日本腎臓学会誌 (ISSN:03852385)
- 巻号頁・発行日
- vol.45, no.4, pp.367-371, 2003-05-25 (Released:2011-03-01)
- 参考文献数
- 19
Combination therapy with angiotensin receptor antagonist (ARB) plus angiotensin converting enzyme inhibitor (ACE-I) (ARB/ACE-I) was efficacious in reducing proteinuria in patients with progressive renal disease. However, this therapy may be associated with the worsening of anemia and hyperkalemia. The present study addressed whether or not triple therapy with low dose ARB, low-dose diuretic (D) and calcium channel blocker(CCB) (ARB/D/CCB) is as effective as therapy with low-dose ARB/ACE-I in retarding the progression of overt diabetic nephropathy. In the triple therapy, the patients were initially subjected to monotherapy with CCB for 24 weeks. Low-dose ARB and low-dose D were added to the treatment for an additional 24-week period. In parallel, patients undergoing double therapy were initially treated with low-dose ACE-I alone for 24 weeks, and then low-dose ARB was added for an additional 24-week period. The results were as follows: 1) In the triple therapy, blood pressure was reduced by 9 mmHg in systole and 5 mmHg in diastole (not significant) compared to monotherapy with CCB. There was a significant decline in proteinuria (3.3±1.2 g/day in the CCB-treated period vs. 2.1± 1.0 g/day in the ARB/D/CCB-treated period, n=12, p=0.0143) . Furthermore, a significant improvement in the slope of reciprocal serum creatinine concentration (1/Cr) was found in response to triple therapy (l /Cr : -0.0118±0.0009 in the CCB-treated vs. -0.0035±0.0028 (1/mg/dl/month) in the ARB/D/CCB-treated period, n =12, p <0.001) . There was neither a worsening of anemia nor an increase in the serum potassium (K) concentration. 2) In the double therapy, blood pressure was reduced by 12 mmHg in systole(p=0.0079, n=11) and 6 mmHg in diastole(n=11, p=0.0037) compared to the monotherapy with ACE -I . A significant improvement in the slope of 1/Cr was found in the double therapy (1/Cr : -0.00952±0.0052 in the ACE- I treated period vs. -0.0029±.0028(1/mg/dl/month) in the ARB/ACE-I, n=1 I, p<0.001). In addition, there was a substantial reduction in hematocrit and increase in serum K concentration. The present result suggests that triple therapy consisting of ARB/D/CCB is as efficacious as double therapy with ARB/ACE-I in protecting the kidney from the progression in patients with diabetic overt nephropathy. The former may be expected to have less adverse effects.