HD患者のPADに対するLDLアフェレシス(<特集>腎疾患とアフェレシス-最近の知見-)

概要

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Peripheral arterial disease (PAD) is more common among patients with end-stage renal disease (ESRD) than in the general population. The number of HD patients with PAD is increasing because about forty percent of new HD patients are diabetic and the life span of diabetic HD patients is longer than before. HD patients often are not good candidates for percutaneous transluminal angioplasty (PTA), which is a preferred method with lesser risk for severe PAD compared to bypass surgery in the general population because of distal disease and vascular calcifications. Low-density lipoprotein apheresis (LDL-A) is established as an effective treatment for familial hypercholesterolemia. Based on the findings that blood flow to the lower limbs is enhanced on LDL-A, LDL-A has also been applied to the treatment of PAD and the results of salvaging limbs and the complete recovery of gangrene in the lower limbs have been reported even in HD patients. The cost-benefit of LDL-A in HD patients must now be measured because LDL-A is expensive and the establishment of a guideline or consensus regarding the initiation of LDL-A and the number of times it should be performed to be most effective is also necessary.
2011-05-31