吸着式人工腎"REDY"による糖尿病性腎症患者の血液透析

Abstract

Two patients with terminal renal failure resulting from diabetic nephropathy were treated by hemodialysis with the "REDY" dialysate delivery system. Blood sugar levels are easily regulated by this dialysis (144.5-158.0-127.7 mg/dl). Hemodialysis was performed with the REDY system using a DC-7 Coil. Blood flow through the dialyser averaged 200 ml/min and the average length of dialysis was 6 hours. The patients were dialyzed at the hospital three times per week. The mean pre-dialysis values for BUN, creatinine and uric acid were 84.3mg/dl, 11. 6mg/dl and 8.9mg/dl respectively during 30 dialyses. Similarly, post-dialysis averages for BUN, creatinine and uric acid were 49.9 mg/dl, 7.3 mg/dl and 4.6 mg/dl. Case 1. A 43-year-old man had diabetes for 16 years and had taken 20 units of Lente Insulin per day. He had proteinuria for 4 years, and edema, pulmonary congestion, nausea and vomiting for one year. He was hospitalized elsewhere and treated with salt restriction, bedrest, and diuretics. There was little improvement, however, he began dialysis on Jan. 25, 1973, in another city hospital using a general Kolff-type artificial kidney two times per week. In our clinic, the patient was started on RDT by REDY system on Oct. 20, 1973. Values for blood chemistry studies were: BUN 106 mg/dl, creatinine 9.5 mg/dl, uric acid 17.3mg/dl, Na 139mEq/L, K 4.5mEq/L, and fasting blood sugar 229 mg/dl. Case 2. A 50-year-old man, diabetic since age 37 had well controlled diabetes using Diabinese (200 mg/day) and diet therapy. In July, 1973 there was a rapid onset of increasing BUN and creatinine levels. He was admitted to the hospital on Oct. 1973. The BUN was 154 mg/dl, creatinine 16.2 mg/dl, uric acid 13.9 mg/dl, and fasting blood sugar 150 mg/dl. Intermittent peritoneal dialysis with intraperitoneal insulin administration was performed immediately upon hospitalization. The REDY dialysis was started on Oct. 23, 1973. Patients with terminal diabetic nephropathy will be readily accepted in the future for regular dialysis treatment using the REDY system.