HIV感染者における透析医療の推進に関する研究-拠点医院でのアンケート調査-  [in Japanese] Research for the facilitation of dialysis therapy in HIV-infected patients : questionnaire on base hospitals for HIV infection  [in Japanese]

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    • 秋葉 隆 AKIBA Takashi
    • 東京女子医科大学腎臓病総合医療センター血液浄化療法科 Department of Blood Purification, Kidney Center, Tokyo Women's Medical University
    • 今村 顕史 IMAMURA Akifumi
    • がん・感染症センター都立駒込病院感染症科 Department of Infectious Disease, Tokyo Metropolitan Center and Infectious Disease Center, Komagome Hospital


平成24年度われわれは,エイズ感染者の透析医療の確保に関して調査し,公的な援助なしに民間施設がHIV感染者を受け入れるには多くの難関があることを明らかにした.その結果を踏まえて,全国の拠点病院に,透析患者の透析の確保の状況と,透析施設への支援活動についてアンケート調査を行った.全国のブロック拠点病院・中核拠点病院・拠点病院380施設にアンケートを発送,回答190通(回答率は50.0%)を得た.回答施設はブロック拠点11,中核拠点35,拠点121,いずれでもない4病院で平均入院病床数542床,記載のあった172施設には腎臓内科医平均3.05名,泌尿器科医3.79名が在籍し,透析装置は155施設,平均17.2台保有されていた.HIV感染者で透析導入が必要だったのは28施設で血液透析28名,腹膜透析16名の計44名で,(1) 自院で導入・自院で慢性透析19例,(2) 自院で導入・他院で慢性透析11例,(3) 紹介の上,他院で導入・慢性透析7例,の37例だった.透析患者の入院依頼では,(1) 入院受け入れ12例,(2) 入院断り11例の計33例,他院で管理中のHIV透析患者の外来診療依頼は外来受け入れ12例が経験されていた.「針刺し事故についての対応」は,(1) 対応しない23.6%,(2) 通常時間内のみ対応4.5%,(3) 夜間・休日とも対応61.9%,と3/4の施設が対応していたものの,祝日や夜間対応のため透析施設にHIV暴露後予防内服薬をあらかじめ貸与していない施設は69.7%と高率だった.また地域の医療施設に対してHIV感染症についての啓発活動を定期的に行っていない施設が63%と過半数で,さらに透析スタッフ向けに行っている施設は全体の6%にすぎなかった.慢性腎不全患者の透析医療は約半数が拠点病院で,残りの半数が地域の透析施設と連携して行われているものの,拠点病院からの透析施設へのサポート体制が不十分な状況が明らかとなった.

In 2012, we conducted a survey for the facilitation of dialysis therapy for HIV-infected CKD patients, and found that there must be many obstacles for private dialysis facilities to accept HIV-infected dialysis patients without public assistance. From these results, we conducted a survey of the base hospitals for AIDS across the country for activities to support dialysis facilities. Sending a questionnaire to 380 base hospitals, core base hospitals, and block base hospitals, 190 responses (response rate 50.0%) were analyzed. Their average bed number was 542. They had 3.79 urologists and 3.05 nephrologists, with 17.2 dialysis machines. A total of 44 patients needed substitution therapy, 28 were treated with hemodialysis, and 16 with peritoneal dialysis. Initiation and chronic therapy was supplied in 19 cases at their own hospital, initiation at their own hospital but chronic therapy at other dialysis facilities in 11 cases, and initiation and chronic therapy at other dialysis facilities in 7 cases. Although the facilities of 3/4 support medical care for “needle-stick injuries” of dialysis staff, 69.7% of base hospitals do not supply HIV post-exposure prophylaxis medicine to dialysis facilities for accidents at night and during holidays. Educational activities for the neighborhood by base hospitals were not done regularly in 63%. Educational activities for dialysis staff were done in only 6% of base hospitals. We found that the relationships between the base hospital and satellite dialysis facilities were not close. We must enhance the closeness of cooperation between base hospitals and neighborhood dialysis facilities.


  • Nihon Toseki Igakkai Zasshi

    Nihon Toseki Igakkai Zasshi 46(9), 931-936, 2013-09-28

    The Japanese Society for Dialysis Therapy

References:  14


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