腎不全合併難治性腹水患者に対する腹水濾過還元血液透析療法(AFRHD)の有用性(<特集>アフェレシス療法における技術的進歩 : 最近のトピックスから)

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During the last decade great advances have been achieved in the treatment of massive refractory ascites in cirrhosis. However, refractory ascites complicated with hepatorenal syndrome is still difficult to cure. We therefore have developed a new technique of ascite filtration and re-infusion with hemodialysis (AFRHD) for the treatment of massive refractory ascites with renal insufficiency in hepatic cirrhosis. We have performed AFRHD and ECUM of ascites on 4 cases and a case who suffered from ovarian cancer, respectively. In order to prevent the contamination of endotoxins and cytokines, reverse filtration was used for purification of ascites in AFRHD. Purified ascites were directly infused into blood circulation prior to dialysis pump. No fever was observed in any case, and severe abdominal fluids were diminished by a couple of AFRHD. On the other hand, ECUM of ascites caused a severe rise in fever and appetite loss in the patient with ovarian cancer. Finally she died from septic shock 10 days after a treatment of ECUM of ascites. Compared with ECUM of ascites, the AFRHD is a much more beneficial and safe treatment to reduce the massive ascites and to protect re-generation of ascites. It is concluded therefore that AFRHD is an effective and safe therapy for patients having renal insufficiency and hepatorenal syndrome complicated with massive or refractory ascites by hepatic cirrhosis.
2006-05-31