1．当院の透析患者のQOL調査―十分な透析量を確保したオンラインHDF療法が維持透析患者のQOLに及ぼす影響

Study of quality of life the hemodialysis patients: Influence of on-line hdf pre-dilution, high blood flow, high efficiency

　オンラインHDFは，大量濾過による大分子量物質の高率な除去が可能なことが特徴である．さらに貧血や関節痛，かぶれ，血圧低下などの透析関連合併症に対し有効であり，長期的にはmalnutrition inflammation atherosclerosis syndrome（MIA症候群）の抑制や，透析患者の生命予後を含めた臨床効果が期待されている．当院は開院以来「苦痛のない生活，苦痛のない透析，合併症の予防」を治療目標としている．今回，当院透析患者に行っているオンラインHDF（前補液）で高血流・高効率を目指した治療が，QOLにどのように影響するかを明らかにすることを目的とし，KDQOL-SF^TMを用いてQOL調査を実施した．その結果，当院の患者は代表値よりもQOLが高く，また血液検査結果においても，透析量を十分に確保することで栄養状態や貧血が改善されていることが示された．年齢および透析歴に関係なく十分な透析量を確保することは，透析生活におけるさまざまな制限や身体的・精神的苦痛の緩和につながり，高血流・高効率のオンラインHDFはQOLの向上および長期生存に効果が期待できると考える．

　On-line hdf is known that a high rate removal of large molecular weight substances can be attained by extensive filtration. It is effective for dialysis related complication, such as anemia, joint pain, irritation, dialysis related hypotension etc. In the long run, this treatment may be effective in the prevention of malnutrition inflammation atherosclerosis syndrome and the improvement of general prognoses for dialysis patients. The aim of treatments in our clinic is “Living with less pain, Dialysis with less pain, and Prevention of complications”. We treat our all patients with on-line hdf pre-dilution, high blood flow and high efficiency. And we carried out research to assess the quality of life of the patients in our clinic with KDQOL-SF^TM and the results indicated that the quality of life of our patients is higher than the Japanese average score. In addition, the results showed that enough dialysis dosage improves the nutritional state and anemia in blood tests results. It is important for patients to keep enough dialysis dosage regardless of their age and the length of their dialysis treatment, because we believe that it can ease the patients physical and mental pain. On-line hdf with high blood-flow and high efficiency improves the quality of life of dialysis patients and decreases of mortality.