長期血液透析患者の臨床的検討 第2編 : 長期血液透析患者の貧血

Abstract

A ferrokinetic study as well as determination of the red blood cell survival and the serum iron were carried out in 20 patients under the long term hemodialysis. Causes of anemia were thus investigated, and managements of anemia were here discussed. 1.As to the ferrokinetic study, plasma iron disappearance rate (PIDT 1/2) was 104±56 min, plasma iron turnover rate (PIT) 0.59±0.26 mg/kg/day, % red cell utilization (%RCU) 39± 12%, and red cell iron turnover rate (RIT) 0.53±0.20 mg/kg/day. These are the values within normal range. The red cell survival was shortened (16.7 ±3.5 days) and the serum iron level was lowered in most of the cases. Three factors; iron deficiency, aplastic and hemolytic are concurrently present but iron deficiency was contributory most frequently. 2. In order to correct iron deficiency anemia, administration per os (210 mg/day) or of intravenous route (80-120 mg/week) of iron was made and both resulted in good response. In administration per os, hematocrit increased from 17.1 to 22.8% in three months whereas in the intravenous route it increased from 17.2% to 26.3% in 7 weeks. The intravenous administration seems to give the prompt and sufficient therapeutic effect. 3. The maintenance dosis of the iron is now 40 to 30 mg per month i.v. 4. As to other adjuvant methods, androgen and anabolic steroid showed certain effects, but elevation of transaminase was found in some of the patients. At the present, epithioandrostanol is recommended because it gives effect on anemia without inducing transaminase elevation. 5. In order to improve anemia, adequate and sufficient dialysis, sufficient intake of protein and the treatments as mentioned above seem to be required. Thus, hematocrit value can be maintained at 25% in average entirely without blood transfusion.