血液透析患者の透析中における血糖動態について [in Japanese] The evaluation of blood sugar kinetics during dialysis [in Japanese]
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目的：透析液ブドウ糖濃度と血糖値を考慮すると理論的には血糖値が透析液濃度を下回ることはないが，透析中に低血糖症状を訴える症例を経験する．この原因は生体側の因子が関与すると考え，血糖動態と赤血球の関係について検討した．方法：1．基礎検討：生理食塩水1,000mLを流量100mL/minでダイアライザー血液側に120分再循環し，経時的にブドウ糖濃度を測定した．透析液ブドウ糖濃度は0，100，150mg/dLを用い，ダイアライザーAPS-15Sを使用した．2．臨床検討：対象は慢性維持透析患者42例（NIDDM群18例，IDDM群6例，CGN群18例）で，透析液ブドウ糖濃度150mg/dL，ダイアライザーAPS-15S，血液流量150～200mL/min，透析液流量500mL/minである．1) 開始時と2時間後にダイアライザー入口部より採血した．採血した赤血球成分1mLに0.5％ブドウ糖溶液0.5mL注入した．コントロールとして生理食塩水0.5mLを注入した．37℃で保持し経時的に血糖測定した．2) ダイアライザー内血糖動態観察のため，ダイアライザー出入口の血糖を経時的に測定した．結果：1．透析液ブドウ糖濃度0mg/dLで血液側への拡散はなく，100，150mg/dLでは30分後から血液側と透析液側のブドウ糖濃度は一致した．2-1) 開始10分後の赤血球に0.5％ブドウ糖溶液添加時の血糖値はNIDDM群1.8％，IDDM群－4.5％，CGN群4.1％で，生理食塩水添加時は3群で異なった変動を示した．開始2時間後は0.5％ブドウ糖添加時でNIDDM群－3.8％，IDDM群4％，CGN群－4.3％だった．2-2) 3群とも出口部の血糖値は透析液ブドウ糖濃度を下回った．結語：NIDDM群，IDDM群，CGN群では血糖動態は異なり，IDDM群の血糖値低下の機序に赤血球の関与が考えられた．
Theoretically, the blood sugar level will not be less than the dialysate glucose concentration during dialysis. Therefore, evaluation of the relation between blood sugar kinetics and erythrocytes is considered in this study. For 120min, saline 1,000mL was recirculating to the dialyzer blood compartment (100mL/min) and dialysate flow was 500mL/min during evaluation of glucose diffusion in the dialyzer. The measured of glucose concentration in blood and dialysate compartment of the dialyzer. The dialysate glucose concentration showed three values (0, 100, and 150mg/dL), and the dialyzer used was an APS-15. Forty-two CKD (NIDDM group:18, IDDM group:6, and CGN group:18) was used for interaction between glucose and erythrocytes. The dialysate glucose concentration was 150mg/dL, dialysate flow was 500mL/min, blood flow 150~200mL/min, and the dialyzer was an APS-15. Blood samples were serially collected from dialyzer inlet pre-dialysis, and 2 hours after dialysis started. Then 0.5% glucose solution infusion (0.5mL) was centrifuged to collect erythrocytes from whole blood. These samples were incubated at 37°C and blood sugar levels were measured. The blood sugar levels at the dialyzer inlet and outlet were also measured to determine blood sugar kinetics in the dialyzer. At 0mg/dL, dialysate glucose concentration did not diffuse glucose between blood and dialysate compartment. At 100 and 150mg/dL, the glucose concentration in the blood and dialysate compartment were similar 30 minutes after the start of dialysis. Blood sugar levels in 0.5% glucose containing erythrocytes were 1.8% NIDDM, -4.5% IDDM, and 4.1% CGN, showing different changes in glucose levels compared to those pre HD. Two hrs after HD started, 0.5% glucose containing erythrocytes demonstrated values of -3.8% NIDDM, 4% IDDM, and -4.3% CGN. The three groups showed dialyzer outlet blood sugar levels that were less than dialysate glucose concentration. In conclusion, CKD blood sugar kinetics with erythrocytes differed between NIDDM, IDDM, and CGN. Erythrocyte intervention was considered the mechanism that decreased the blood sugar level in CKD.
- Journal of Japanese Society for Dialysis Therapy
Journal of Japanese Society for Dialysis Therapy 41(2), 111-117, 2008-02-28
The Japanese Society for Dialysis Therapy