長期血液透析患者の臨床的検討 -第1編- 10年間の患者統計およびBlood Access

Abstract

Hemodialysis has been carried out at Kyoto University Hospital since 1960. Before the opening of Artificial Kidney Unit, most of the patients died in a short term. The establishment of the above unit made regular dialysis treatment possible, and 98 patients have been treated from 1968 to 1977. 1) Age, sex and basic diseases have gradually changed for these ten years. At the present time, indication of hemodialysis is expanded to almost all of chronic renal failures. 2) Cumulative survival rate of 98 patients was calculated as follows: 77.2% at 5 years, 56% at 8 years, and 40.9% at 10 years. 3) As to causes of death, uremia due to the under-dialysis was frequently seen in the beginning, but cerebro-vascular accident and infection has become the main causes since adoption of adequate dialysis in which BUN is maintained below 80 mg% and creatinine below15mg%. 4) Some of chronic renal failures are of postrenal origin. Urological examinations are required to rule out these causes. 5) As to blood access, the external A-V shunt was constructed mainly. Average cannula survival was 34.6 months on the artery side and 16.4 months on the venous side. The most frequent complication with the external A-V shunt was clotting. We had experiences of serious accident at the time of declotting. Recently, the internal A-V fistula is taking place of the external shunt.