඲ ᩥ せ ⣙Comparison of the pre-dilution and post-dilution
methods for online hemodiafiltration㸦࢜ࣥࣛ࢖ࣥ⾑ᾮℐ㐣㏱ᯒ࡛ࡢ๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲ
ࡢẚ㍑㸧

ᕝ஭ భඔ
㸦་ṑ⸆ಖ೺Ꮫ◊✲⛉ ་ṑ⸆Ꮫᑓᨷ㸧࠙ᴫせࠚ┠ⓗ㸸࢜ࣥࣛ࢖ࣥ⾑ᾮℐ㐣㏱ᯒ㸦OL-HDF㸧ࡣࠊᣑᩓ࡜㝈እℐ㐣ࢆ⏝࠸ࡓ἞⒪࡛࠶ࡿࠋOL-HDF
ࡢᕼ㔘᪉ἲ࡟ࡣࠊ᪥ᮏ୍࡛⯡ⓗ࡟⾜ࢃࢀ࡚࠸ࡿ๓ᕼ㔘ἲ࡜Ḣᕞ୍࡛⯡ⓗ࡟⾜ࢃࢀ࡚࠸ࡿᚋᕼ㔘ἲࡢ኱ࡁࡃ 2 ✀㢮ࡀ࠶ࡿࠋಶࠎࡢᝈ⪅࡟᭱㐺࡞ OL-HDF ࡢ᪉ἲ࡟ࡘ࠸࡚ࡣ༑ศ࡟᳨ウࡉࢀ࡚࠸࡞࠸ࠋᮏ◊✲࡛ࡣࠊ๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲࡢ OL-HDF ࡢ⮫ᗋ⑕≧ࠊ⾑ᾮ᳨ᰝࠊ㏱ᯒ᤼ᾮ᳨ᰝࠊ᭷
ᐖ஦㇟࡟ࡘ࠸࡚ẚ㍑ࡋࡓࠋ
᪉ἲ㸸2019 ᖺ 1 ᭶ 1 ᪥࠿ࡽ 2019 ᖺ 10 ᭶ 30 ᪥ࡢ㛫࡟ OL-HDF ࢆᐇ᪋ࡋࡓ 20 ྡࡢᝈ⪅ࢆᑐ㇟࡟๓ྥࡁ◊✲ࢆ᪋⾜ࡋࠊ⮫ᗋ⑕≧࡜㏱ᯒຠᯝࢆホ౯ࡋࡓࠋ඲ᝈ⪅ࡣࠊ1 ᅇ┠๓ᕼ㔘ἲࠊᚋᕼ㔘ἲࠊ2 ᅇ┠๓ᕼ㔘ἲࡢ㡰␒࡛ࡑࢀࡒࢀ 3 ࣧ᭶ẖࡢ OL-HDF ࢆᐇ᪋ࡋࡓࠋ⮫ᗋ◊✲࡜ࡋ࡚ 18 ྡࠊ㏱ᯒ᤼ᾮ᳨ᰝ࡜ࡋ࡚ 6 ྡࡢᝈ⪅ࢆホ౯ࡋࡓࠋ⤖ᯝ㸸㏱ᯒ᤼ᾮ᳨ᰝࡢᑠศᏊ≀㉁࠿ࡽపศᏊ㔞⺮ⓑࠊ⾑ᅽࠊᅇ᚟᫬㛫ࠊ⮫ᗋ⑕≧࡟ࡘ࠸࡚ࡣࠊ
๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲࡢ㛫࡟᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋࡋ࠿ࡋࠊᚋᕼ㔘ἲ OL-HDF ࡢ⾑Ύ α1-࣑ࢡࣟࢢࣟࣈࣜࣥ⃰ᗘࡣࠊ๓ᕼ㔘ἲ OL-HDF ࡟ẚ࡭࡚ప್࡛࠶ࡗࡓ㸦1 ᅇ┠๓ᕼ㔘ἲ㸸124.8 ± 14.3
mg/Lࠊᚋᕼ㔘ἲ㸸116.6 ± 13.9 mg/Lࠊ2 ᅇ┠๓ᕼ㔘ἲ㸸125.8 ± 13.0 mg/Lࠊ1 ᅇ┠๓ᕼ㔘ἲ vs.
ᚋᕼ㔘ἲࠊᚋᕼ㔘ἲ vs. 2 ᅇ┠๓ᕼ㔘ἲࠊ1 ᅇ┠๓ᕼ㔘ἲ vs. 2 ᅇ┠๓ᕼ㔘ἲ㸸ࡑࢀࡒࢀ p =0.001ࠊp < 0.001ࠊp = 1.000㸧ࠋ᭱ከࡢ᭷ᐖ஦㇟ࡣࠊᚋᕼ㔘ἲ࡟࠾ࡅࡿ⭷㈏㏻ᅽᕪࡢୖ࡛᪼࠶ࡗ
ࡓࠋ⤖ㄽ㸸๓ᕼ㔘ἲ࡜ẚ㍑ࡋ࡚ᚋᕼ㔘ἲࡣ⾑Ύ α1-࣑ࢡࣟࢢࣟࣈ್ࣜࣥࢆపୗࡉࡏࡓࡀࠊ⮫ᗋ⑕≧ࡸ᳨ᰝ್࡟ࡣ᭷ពᕪࡣ࡞࠿ࡗࡓࠋ

࠙ᗎㄽࠚ⥔ᣢ㏱ᯒࢆᚲせ࡜ࡍࡿᮎᮇ⭈୙඲㸦ESRD㸧ࡣࠊ་⒪ࡢྥୖ࡟ࡶ࠿࠿ࢃࡽࡎࠊ⏕Ꮡᮇ㛫ࡢ▷⦰ࡸ⏕࿨ࡢ㉁㸦QOL㸧ࡢపୗ࡜㛵㐃ࡋ࡚࠸ࡿࠋ⾑ᾮ㏱ᯒℐ㐣㸦HDF㸧ࡣࠊᣑᩓ࡜ℐ㐣ࡢ㍺㏦ࢆ⤌ࡳྜࢃࡏࡓ⾑ᾮί໬⒪ἲࡢ୍✀࡛ࠊ⾑ᾮ㏱ᯒ㸦HD㸧࡜ẚ㍑ࡋ࡚ β2-࣑ࢡࣟࢢࣟࣈࣜࣥ㸦β2-MG㸧
[1]ࡸྛ✀ࢧ࢖ࢺ࢝࢖ࣥࢆ㝖ཤ࡛ࡁࡿ⭈௦᭰⒪ἲ࡛࠶ࡿ[2, 3]ࠋ᭱㏆ࡢ◊✲࡛࢜ࣥࣛ࢖ࣥ⾑ᾮℐ㐣
㏱ᯒ㸦OL-HDF㸧ࡣࠊᑗ᮶ࡢ㏱ᯒ㛵㐃ྜే⑕㸦㏱ᯒప⾑ᅽࡸ㏱ᯒ㛵㐃࢔࣑ࣟ࢖ࢻ࣮ࢩࢫ࡞࡝㸧ࢆண㜵ࡋࠊESRD ᝈ⪅ࡢ QOL ࡸ⏕Ꮡ㌿ᖐࢆᨵၿࡍࡿྍ⬟ᛶࡀ࠶ࡿࡓࡵࠊୡ⏺୰࡛౑⏝ࡀቑຍࡋ࡚
࠸ࡿ[4-6]ࠋ᪥ᮏ࡛ࡣࠊ2012 ᖺ࡟ OL-HDF ࡀಖ㝤㐺⏝ࡉࢀࠊOL-HDF ࢆཷࡅࡿᝈ⪅ࡢ๭ྜࡀቑ
ຍࡋࡓ㸦2012 ᖺࠊ4.8%㸹2018 ᖺࠊ27.3%㸧[7]ࠋ
ప⾑ὶ㔞㸦Qb㸧࡛⺮ⓑ₃ฟᛶ࣊ࣔࢲ࢖࢔ࣇ࢕ࣝࢱ࣮ࢆ⏝࠸ࡓ๓ᕼ㔘ἲ OL-HDF ࡣࠊ⾑ᾮ⃰⦰ࢆ㉳ࡇࡋ࡟ࡃࡃ㧗⨨᥮ᾮὶ㔞㸦Qs㸧ࢆ☜ಖ࡛ࡁࡿࡇ࡜࠿ࡽ᪥ᮏ࡛ࡣᗈࡃཷࡅධࢀࡽࢀ࡚࠸ࡿ[810]ࠋࡋ࠿ࡋࠊḢᕞ࡞࡝࡛ࡣࠊ㧗 Qb ࡛㠀⺮ⓑ₃ฟᛶ࣊ࣔࢲ࢖࢔ࣇ࢕ࣝࢱ࣮ࢆ⏝࠸ࡓᚋᕼ㔘ἲ OLHDF ࡀ୍⯡ⓗ࡟ᐇ᪋ࡉࢀ࡚࠸ࡿࠋ㧗 Qs ࡜㧗 Qb ࡢᚋᕼ㔘ἲ OL-HDF ࡣணᚋࢆᨵၿࡋࠊQs ࡀ㧗ࡃ࡞ࡿ࡯࡝ຠᯝࡀ㧗ࡲࡿࠊ࡜ࡢሗ࿌ࡀ࠶ࡿ[11-13]ࠋࡋ࠿ࡋ᪥ᮏ࡛ࡣࠊ㧗 Qb ࡀዲࡲࢀ࡞࠸ࡇ
࡜ࠊ࢔ࣝࣈ࣑ࣥ₃ฟࡢ⟶⌮ࡀᅔ㞴࡛࠶ࡿࡇ࡜࠿ࡽࠊ
ᚋᕼ㔘ἲ OL-HDF ࡣཷࡅධࢀࡽࢀ࡚࠸࡞࠸ࠋ
Ḉ஭ࡽࡣ௨๓ࠊ๓ᕼ㔘ἲ OL-HDF ࡀᚋᕼ㔘ἲ OL-HDF ࡼࡾࡶ⏕య㐺ྜᛶࡢⅬ࡛ඃࢀ࡚࠸ࡿࡇ
࡜ࢆ♧ࡋࡓ[14]ࠋࡋ࠿ࡋࠊᙼࡽࡣࡲࡓࠊ㐺ษ࡞࣊ࣔࢲ࢖࢔ࣇ࢕ࣝࢱ࣮ࢆ⏝࠸ࡓᚋᕼ㔘ἲ OL-HDF
ࡣࠊపศᏊ㔞⺮ⓑ㸦LMWP㸧ࢆຠ⋡ⓗ࡟㝖ཤࡋࠊ㧗 Qb ࡜㧗 Qs ࢆకࢃ࡞࠸⦆ᚎ࡞࢔ࣝࣈ࣑ࣥ₃ฟࢆ㐩ᡂࡋ࡚࠾ࡾࠊ⏕య㐺ྜᛶࡢⅬ࡛ࡶ๓ᕼ㔘ἲ OL-HDF ࡜ྠ➼࡛࠶ࡿࡇ࡜ࢆሗ࿌ࡋ࡚࠸ࡿ
[15]ࠋࡋ࠿ࡋࠊ㏱ᯒ㛵㐃ࡢ⮫ᗋ⑕≧࡜ᕼ㔘᪉ἲ࡜ࡢ㛵㐃ᛶࢆ᳨ウࡋࡓ◊✲ࡣ࡯࡜ࢇ࡝࡞࠸ࠋ
᪥ᮏ࡟࠾ࡅࡿ OL-HDF ࡢ๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲࡢ⮫ᗋⓗ࡞㐪࠸ࡣ୙࡛᫂࠶ࡾࠊ⮫ᗋⓗ࡟᭱㐺࡞
OL-HDF ࢆᐇ⌧ࡍࡿࡓࡵ࡟ࡣㄪᰝࡀᚲせ࡛࠶ࡿࠋࡑࡢࡓࡵࠊOL-HDF ࡢ๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲ࡟㛵㐃ࡍࡿ⮫ᗋ⑕≧ࠊ⾑ᾮ᳨ᰝࠊ㏱ᯒ᤼ᾮ᳨ᰝࠊ᭷ᐖ஦㇟࡟ࡘ࠸᳨࡚ウࡋࡓࠋ࠙᪉ἲࠚ೔⌮ⓗᢎㄆ㸸ᮏ◊✲࡜ᡭ㡰࡟ࡘ࠸࡚ࡣࠊᅵ㇂⥲ྜ⑓㝔ࡢࣄࢺ◊✲࡟㛵ࡍࡿ἞㦂ᑂᰝጤဨ఍㸦ᢎㄆ␒ྕ㸸E180618-1㸧ࡢᢎㄆࢆᚓ࡚࠾ࡾࠊⓏ㘓ࡉࢀࡓ⿕㦂⪅඲ဨ࡟࢖ࣥࣇ࢛࣮࣒ࢻ࣭ࢥࣥࢭࣥࢺ
ࢆᐇ᪋ࡉࢀ࡚࠸ࡿࠋᮏ◊✲ࡣࠊ࣊ࣝࢩࣥ࢟ᐉゝ㸦2004 ᖺᮾிᨵゞ∧㸧ࡢཎ๎࡟ᚑࡗ࡚ᐇ᪋ࡉࢀࡓࠋ ◊✲ࢹࢨ࢖ࣥ࠾ࡼࡧᑐ㇟⪅㸸๓ྥࡁ༢᪋タࡢᮏ◊✲࡛ࡣࠊ࠶࠿ࡡ఍୰ᓥᅵ㇂ࢡࣜࢽࢵࢡ࡛ OLHDF ࢆཷࡅ࡚࠸ࡿᝈ⪅ 20 ྡࢆⓏ㘓ࡋࡓࠋ㐺᱁ᇶ‽ࡣࠊ20 ṓ௨ୖࠊ㐌 3 ᅇ࣭1 ᅇ 4 ᫬㛫ࡢ๓ᕼ㔘ἲ OL-HDF ࢆ 3 ࣧ᭶௨ୖᐇ᪋ࡉࢀ࡚࠸ࡿᝈ⪅࡜ࡋࡓࠋ㝖እᇶ‽ࡣࠊ㔜⠜࡞ᚰ⾑⟶ྜే⑕㸦ࢽ࣮࣮ࣗࣚࢡᚰ⮚༠఍ࡢᚰ୙඲ศ㢮㸦NHYA㸧 Ӎ III㸧ࠊ㔜⠜࡞⫢ᶵ⬟㞀ᐖ㸦࢔ࢫࣃࣛࢠࣥ㓟࢔࣑ࣀࢺࣛࣥࢫࣇ࢙࣮ࣛࢮࡲࡓࡣ࢔ࣛࢽࣥ࢔࣑ࣀࢺࣛࣥࢫࣇ࢙࣮ࣛࢮ Ӎ 100 IU/L㸧ࠊ㓟⣲ᢞ୚ࢆせࡍࡿ࿧྾୙඲ࠊ᰿ᮏⓗ἞⒪ࡉࢀ࡚࠸࡞࠸ᝏᛶ⭘⒆ࠊ㔜ᗘࡢㄆ▱ᶵ⬟పୗ㸦ᨵゞ㛗㇂ᕝᘧㄆ▱⑕ࢫࢣ࣮ࣝ ӌ 23㸧ࠊᝈ⪅ࡢ㐺᱁ᛶ࡟ᑐࡍࡿ◊✲⪅ࡢุ᩿࡜ࡋࡓࠋ◊✲ᮇ㛫୰ࡢ୰Ṇᇶ‽ࡣࠊྠពࡢ
᧔ᅇࠊ᭷ᐖ஦㇟࡟ࡼࡿᮏ◊✲ࡢ⥅⥆ᅔ㞴ࠊṚஸࠊዷፎࠊ◊✲⤊஢࡟㛵ࡍࡿ἞㦂㈐௵་ᖌࡢุ᩿ࡀ
ྵࡲࢀࡓࠋ◊✲ᮇ㛫ࡣࠊ2019 ᖺ 1 ᭶ 1 ᪥࠿ࡽ 2019 ᖺ 10 ᭶ 30 ᪥࡛࠶ࡗࡓࠋ᭱ึࡢ 1 ࣧ᭶ࡣほᐹᮇ㛫࡜ࡋࠊᮏ◊✲๓࡜ྠ᮲௳࡛ HDF ࢆᐇ᪋ࡋࡓࠋࡑࡢᚋࠊ1 ᅇ┠๓ᕼ㔘ἲ࡛ 3 ࣧ᭶ࠊᚋᕼ㔘ἲ࡛ 3 ࣧ
᭶ࠊ2 ᅇ┠๓ᕼ㔘ἲ࡛ 3 ࣧ᭶ࡢ OL-HDF ࢆᐇ᪋ࡋࡓࠋᮏ◊✲࡟࠾ࡅࡿ OL-HDF ࡣࠊ㐌 3 ᅇࠊ1ᅇ 4 ᫬㛫ࠊFIX-210Seco®㸦㠀ᑐ⛠ࢺࣜ࢔ࢭࢸ࣮ࢺ㏱ᯒ⭷㸸ࢽࣉࣟᰴᘧ఍♫ࠊ኱㜰ࠊ᪥ᮏ㸧
ࠊQb
250 mL/minࠊQs ࢆྵࡴ⥲㏱ᯒᾮὶ㔞㸦Qd㸧 500 mL/minࠊ๓ᕼ㔘ἲ࡛ࡣ Qs 200 mL/min㸦1ᅇ࠶ࡓࡾྜィ 48L㸧ࠊᚋᕼ㔘ἲ࡛ࡣ Qs 60 mL/min㸦1 ᅇ࠶ࡓࡾྜィ 14.4L㸧ࢆᶆ‽ⓗ࡞㏱ᯒ᮲௳࡜ࡋࡓ㸦⿵㊊ᅗ 1㸧ࠋࡇࢀࡽࡢ OL-HDF ᮲௳ࡣࠊOL-HDF ୰ࡢࣂ࢖ࢱࣝࢧ࢖ࣥࠊ⭷㈏㏻ᅽᕪ㸦TMP㸧ࠊ⾑ᾮ᳨ᰝ࡜࠸ࡗࡓྛᝈ⪅ࡢ≧ែ࡟ᛂࡌ࡚ㄪᩚࡉࢀࡓࠋHDF ࡢ᮲௳ࡸ⸆๣ࡣࠊྛᝈ⪅ࡢ≧ែ࡟ᛂࡌ࡚ㄪᩚࡉࢀࡓࠋGC-110N®㏱ᯒ⿦⨨㸦ᰴᘧ఍♫ JMSࠊᗈᓥࠊ᪥ᮏ㸧ࢆ HDF ࡟౑⏝ࡋࡓࠋ࢟ࣥ
ࢲ࣮ࣜ4E®㸦ᢇ᱓⸆ရᕤᴗᰴᘧ఍♫ࠊ኱㜰ࠊ᪥ᮏ㸧ࢆ㏱ᯒᾮ࡟౑⏝ࡋࠊ㏱ᯒᾮࡢㄪ〇ᚋࡢ⌮ㄽ್ࡣࠊࢼࢺ࣒ࣜ࢘㸦Na㸧140 mEq/Lࠊ࣒࢝ࣜ࢘㸦K㸧 2. 0 mEq/Lࠊ࢝ࣝࢩ࣒࢘㸦Ca㸧 2.75 mEq/Lࠊ࣐ࢢࢿࢩ࣒࢘㸦Mg㸧 1.0 mEq/Lࠊሷ⣲㸦Cl㸧 112.25 mEq/LࠊCH3COO 8mEq/LࠊHCO3 27.5
mEq/LࠊC6H12O6 125 mg/dL ࡛࠶ࡗࡓࠋ㏱ᯒᾮ࡜⨨᥮ᾮࡢỈ㉁ࡣࠊ
ࠕ2016 ᖺ∧᪥ᮏ㏱ᯒᾮỈ㉁ᇶ‽ࠖ࡟‽ᣐࡋࡓ[16]ࠋ
ࢹ࣮ࢱ཰㞟㸸ᛶูࠊᖺ㱋ࠊ㏱ᯒṔࠊHDF ṔࠊHDF ᵝᘧࠊHD ࠿ࡽ HDF ࡬ࡢኚ᭦⌮⏤ࠊ⫧‶ᗘᣦᩘࠊႚ↮Ṕࠊ᪤ ṔࠊేᏑ⑌ᝈࠊ⾑⟶࢔ࢡࢭࢫࠊESRD ࡢཎ⑌ᝈࠊ⭡⭷㏱ᯒ㸦PD㸧ࡲࡓࡣ⭈⛣᳜ࡢ⭈἞⒪Ṕࠊヨ㦂㛤ጞ᫬ࡢ࣮࢝ࣝࢯࣥేᏑ⑌ᝈᣦᩘ㸦CCI㸧ࢫࢥ࢔[17]ࠊほᐹᮇ㛫࡛ࡢ HDF
᮲௳࡟ࡘ࠸࡚ࢹ࣮ࢱࢆ཰㞟ࡋࡓࠋྛ἞⒪ᮇ㛫ࡢ᭱⤊㐌ࡢ㐌ึࡵࡢ OL-HDF ࢭࢵࢩࣙࣥ࡟ᑐࡋ࡚ホ౯ࢆᐇ᪋ࡋࡓࠋ
◊✲⤖ᯝࡣࠊHDF ๓ᚋࡢ⾑ᅽࠊᅇ᚟᫬㛫㸦RT㸧ࠊどぬⓗ࢔ࢼࣟࢢᑻᗘ㸦VAS㸧ࢫࢥ࢔ࠊ⮫ᗋ᳨ᰝࢹ࣮ࢱ࡜ࡋࡓࠋ⾑ᅽࡣᗙ఩࡛ᐃࡋࡓࠋホ౯ࢭࢵࢩࣙࣥࡢḟࡢࢭࢵࢩࣙࣥ࡟࠾࠸࡚ࠊホ౯ࢭࢵࢩࣙࣥ⤊஢ᚋ࠿ࡽᝈ⪅ࡀ⑂ປ࠿ࡽ᏶඲࡟ᅇ᚟ࡍࡿࡢ࡟せࡋࡓ᫬㛫㸦RT㸧ࢆศ༢఩࡛ሗ࿌ࡋࡓࠋ
࠿ࡺࡳࠊࣞࢫࢺࣞࢫࣞࢵࢢ⑕ೃ⩌ࠊ㦵ࡸ㛵⠇ࡢ③ࡳࠊࡅ࠸ࢀࢇࠊ㏱ᯒᚋࡢ೏ᛰឤࠊ╧╀㞀ᐖࠊ୙ᶵ᎘࡟ࡘ࠸࡚ࡣ VAS ࢆ⏝࠸࡚ 0-10 Ⅼࡢ⠊ᅖ࡛ㄪᰝࡋࡓࠋᶆ‽໬⺮ⓑ␗໬⋡ࠊ㧗㱋⪅ᰤ㣴ࣜࢫࢡ
ᣦᶆࠊ㏱ᯒຠ⋡㸦Kt/V㸧ࠊᒀ⣲㝖ཤ⋡ࠊC ཯ᛂᛶ⺮ⓑࠊ⥲⺮ⓑࠊ࢔ࣝࣈ࣑ࣥࠊᒀ⣲❅⣲ࠊࢡࣞ࢔ࢳࢽࣥ㸦Cre㸧ࠊᒀ㓟㸦UA㸧ࠊNaࠊKࠊClࠊCaࠊࣜࣥ㸦P㸧ࠊⓑ⾑⌫ࠊ㉥⾑⌫ࠊ࣊ࣔࢢࣟࣅࣥࠊ࣊
࣐ࢺࢡࣜࢵࢺࠊ⾑ᑠᯈࠊ㕲ࠊ⥲㕲⤖ྜ⬟ࠊ୙㣬࿴㕲⤖ྜ⬟ࠊࣇ࢙ࣜࢳࣥࠊ⥲ࢥࣞࢫࢸ࣮ࣟࣝࠊ㧗ẚ㔜࣏ࣜࢱࣥࣃࢡ-ࢥࣞࢫࢸ࣮ࣟࣝࠊపẚ㔜࣏ࣜࢱࣥࣃࢡ-ࢥࣞࢫࢸ࣮ࣟࣝࠊ୰ᛶ⬡⫫ࠊ⬻ᛶࢼࢺ࣒ࣜ࢘฼ᒀ࣌ࣉࢳࢻࠊ⿵ṇ࢝ࣝࢩ࣒࢘ࠊࢺࣛࣥࢫࣇ࢙ࣜࣥ㣬࿴ᗘࠊࣄࢺᚰᡣᛶࢼࢺ࣒ࣜ࢘฼ᒀ࣌
ࣉࢳࢻࠊ๪⏥≧⭢࣍ࣝࣔࣥࠊα1-࣑ࢡࣟࢢࣟࣈࣜࣥ㸦α1-MG㸧࠾ࡼࡧ β2-MG ࡢ⾑ᾮ᳨ᰝࢆホ౯ࡋࡓࠋ᭷ᐖ஦㇟ࡣヨ㦂ᮇ㛫୰ࠊ⥅⥆ࡋ࡚グ㘓ࡋࡓࠋ
㏱ᯒ᤼ᾮࡢ᥇ྲྀ㸸ᑐ㇟࡜࡞ࡗࡓ OL-HDF ᝈ⪅ 20 ྡࡢෆ 10 ྡ࡟࠾࠸࡚ࠊOL-HDF ᮲௳ୗ࡛ࡢ㏱ᯒ᤼ᾮࡢ⥲㔞ࢆ᥇ྲྀࡋࠊㄪᰝࡋࡓࠋ㏱ᯒ᤼ᾮࡣࠊホ౯ࢭࢵࢩࣙࣥ୰࡟ 20 mL/min ࡢ㏿ᗘ࡛㒊ศⓗ࡟㈓␃㸦1 ࢭࢵࢩࣙࣥྜィ 4.8 L㸧ࡋࠊ㈓␃ࡋࡓ඲㔞ࢆࡼࡃΰ࿴ࡋࡓࠋࡑࡢᚋࠊ㈓␃ࡋࡓ
㏱ᯒ᤼ᾮࡢ୍㒊ࢆᐃࡋࡓࠋࡲࡓࠊᒀ⣲❅⣲㸦ศᏊ㔞㸸28㸧ࠊCre㸦113㸧ࠊUA㸦168㸧ࠊP㸦30㸧ࢆ⏝࠸࡚ᑠศᏊ⁐㉁㸦SMWS㸧ࡢ㝖ཤࢆホ౯ࡋࠊβ2-MG㸦11,800㸧ࠊα1-MG㸦33,000㸧ࢆ⏝࠸࡚
LMWP ࡢ㝖ཤࢆホ౯ࡋࡓࠋ㝖ཤ⋡㸦RR㸧
ࠊ࢔ࣝࣈ࣑ࣥ₃ฟࢆྵࡵࡓ㝖ཤ㔞㸦RA㸧ࠊࢡࣜ࢔ࢫ࣌
࣮ࢫ㸦CS㸧
ࠊࢡࣜ࢔ࢫ࣮࣌ࢫ⋡㸦CSR㸧[18]ࢆ᳨ウࡋࡓࠋβ2-MG ࡜ α1-MG ࡢ RR ࡣࠊ⾑୰⃰ᗘࡢᙳ㡪ࢆ㝖ࡃࡓࡵ࡟࣐࣊ࢺࢡࣜࢵࢺ್ࢆ⏝࠸࡚⿵ṇࡋࠊRA ࡣ࢔ࣝࣈ࣑ࣥ₃ฟ㔞ࢆྵࡵࡓࠋRRࠊ
RAࠊCSࠊCSR ࡢィ⟬ᘧ㸦⿵㊊ᅗ 2㸧ࡣࠊᮏ◊✲ࡢ࡯࠿ࡢᑐ㇟ HDF ᝈ⪅ࡢ㏱ᯒ᤼ᾮ᳨ᰝ࡜ྠᵝ࡜ุ᩿ࡋࡓࠋ

⤫ィゎᯒ㸸඲࡚ࡢ⤖ᯝࡣࠊᩘ್࡜ࣃ࣮ࢭࣥࢸ࣮ࢪࠊࡲࡓࡣᖹᆒ್࡜ᶆ‽೫ᕪ࡛♧ࡋ࡚࠸ࡿࠋ1ᅇ┠๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲࠊᚋᕼ㔘ἲ࡜ 2 ᅇ┠๓ᕼ㔘ἲࠊ1 ᅇ┠๓ᕼ㔘ἲ࡜ 2 ᅇ┠๓ᕼ㔘ἲ࡟ᑐࡋ࡚⥺ᙧΰྜࣔࢹࣝ࡟ࡼࡿከ㔜ẚ㍑᳨ᐃࢆᐇ᪋ࡋࡓࠋࡉࡽ࡟ࠊ࣎ࣥࣇ࢙࣮ࣟࢽ⿵ṇࢆ⏝࠸ࡓከ㔜ẚ
㍑᳨ᐃࢆᐇ᪋ࡋࡓ[19]ࠋp ್ࡣඖࡢ p ್ࡢ 3 ಸ࡛⿵ṇࡋࠊ⿵ṇᚋࡢ p ್ࡀ 㸼1 ࡛࠶ࡗࡓሙྜࠊ

p = 1.000 ࡜ࡋ࡚グ㍕ࡋࡓࠋከ㔜ẚ㍑᳨ᐃࡢᐇ᪋࡟ࡣ SPSS ࢯࣇࢺ࢙࢘࢔㸦SPSS ࣂ࣮ࢪࣙࣥ 25㸹
SPSS ᰴᘧ఍♫ࠊࢩ࢝ࢦࠊ࢖ࣜࣀ࢖ࠊ࢔࣓ࣜ࢝ྜ⾗ᅜ㸧ࢆ౑⏝ࡋࠊ⿵ṇᚋࡢ p 㸺 0.05 ࢆ⤫ィⓗ࡟᭷ព࡜ᐃ⩏ࡋࡓࠋ᭷ᐖ஦㇟ࡢ஦㇟௳ᩘࢆᢕᥱࡍࡿࡓࡵࠊ1 ࣧ᭶࠶ࡓࡾࡢᝈ⪅ࡢ஦㇟௳ᩘࢆ⟬ฟ
ࡋࡓࠋ

࠙⤖ᯝࠚ
ᑐ㇟࡜࡞ࡗࡓ 20 ྡࡢ HDF ᝈ⪅ࡢ࠺ࡕ 2 ྡࡣࠊほᐹᮇ㛫୰ࡢෆ᭹⸆ࡢࢥࣥࣉࣛ࢖࢔ࣥࢫ୙Ⰻ
࡜ 1 ᅇ┠๓ᕼ㔘ἲࡢᮇ㛫୰࡟࢖ࣞ࢘ࢫ࡛㛗ᮇ㛫ࡢධ㝔ࡢࡓࡵヨ㦂୰Ṇ࡜ࡋࡓࠋヨ㦂ᮇ㛫ࢆ㏻ࡋ
࡚ HDF ἞⒪ࢆᐇ᪋ࡋࡓᝈ⪅ࡣ 18 ྡ࡛࠶ࡗࡓࠋࡑࡢ࠺ࡕ 1 ྡࡢࡳࡀᚋᕼ㔘ἲ୰࡟㧗࣒࢝ࣜ࢘⾑⑕࡟ࡼࡿ Qb ࡢୖ᪼㸦300 mL/min㸧࡜ࡋࠊ2 ᅇ┠๓ᕼ㔘ἲࡢ㛫ࡶྠ㔞ࡢ Qb ࢆ⥅⥆ࡋࡓࠋᝈ⪅≉ᚩࢆ⾲ 1 ࡟♧ࡋ࡚࠸ࡿࠋᑐ㇟࡜࡞ࡗࡓ 18 ྡࡢ࠺ࡕࠊ14 ྡ㸦78%㸧ࡀ⏨ᛶࠊ4 ྡ㸦22%㸧
ࡀዪᛶ࡛࠶ࡗࡓࠋ㏱ᯒṔ࡜ HDF Ṕࡣࠊࡑࢀࡒࢀ 18.1 ± 7.1 ࣧ᭶࡜ 13.3 ± 6.6 ࣧ᭶ࠊESRD ࡢ᭱ከࡢཎ⑌ᝈࡣ៏ᛶ⣒⌫య⭈⅖㸦72%㸧࡛࠶ࡗࡓࠋPD ࡢ᪤ ࡣ 5 ྡ㸦28%㸧ࠊ⭈⛣᳜ࡢ᪤ ࡣ 1 ྡ
㸦6%㸧࡛࠶ࡗࡓࠋCCI ࢫࢥ࢔ࡣ 3.0 ± 1.2 Ⅼ࡛࠶ࡗࡓࠋ
⥺ᙧΰྜࣔࢹࣝ࡟࠾࠸࡚ࠊHDF ๓ᚋࡢ⾑ᅽ࡜ RT ࡣࠊヨ㦂ᮇ㛫୰࡟᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓࠋ
ྠᵝ࡟ࠊ࠿ࡺࡳࠊࣞࢫࢺࣞࢫࣞࢵࢢࢫ⑕ೃ⩌ࠊ㦵࣭㛵⠇③ࠊࡅ࠸ࢀࢇࠊ㏱ᯒᚋࡢ೏ᛰឤࠊ╧╀㞀ᐖࠊ୙ᶵ᎘ࡢ VAS ホ౯࡛ࡶࠊヨ㦂ᮇ㛫୰࡟᭷ពᕪࡣ࡞࠿ࡗࡓ㸦⾲ 2㸧ࠋ
⾲ 3 ࡣࠊ⾑ᾮ᳨ᰝࢆ♧ࡋ࡚࠸ࡿࠋα1-MG ್ࡢࡳࡀࠊ1 ᅇ┠๓ᕼ㔘ἲ vs. ᚋᕼ㔘ἲࠊᚋᕼ㔘ἲvs. 2 ᅇ┠๓ᕼ㔘ἲࡢホ౯࡛᭷ពᕪࢆㄆࡵࡓࠋα1-MG ್ࡣࠊ124.8 ± 14.3 mg/L㸦1 ᅇ┠๓ᕼ㔘ἲ㸧
ࠊ116.6 ± 13.9 mg/L㸦ᚋᕼ㔘ἲ㸧
ࠊ125.8 ± 13.0 mg/L㸦2 ᅇ┠๓ᕼ㔘ἲ㸧
㸦1 ᅇ┠๓ᕼ㔘ἲ vs.
ᚋᕼ㔘ἲࠊᚋᕼ㔘ἲ vs. 2 ᅇ┠๓ᕼ㔘ἲࠊ1 ᅇ┠๓ᕼ㔘ἲ vs. ᚋᕼ㔘ἲ㸸ࡑࢀࡒࢀ p = 0.001, p< 0.001, p = 1.000㸧 ࡛࠶ࡗࡓࠋβ2-MG ್ࡣࠊ25.3 ± 3.1 mg/L㸦1 ᅇ┠๓ᕼ㔘ἲ㸧ࠊ24.5 ± 2.7
mg/L㸦ᚋᕼ㔘ἲ㸧
ࠊ25.9 ± 3.1 mg/L㸦2 ᅇ┠๓ᕼ㔘ἲ㸧㸦1 ᅇ┠๓ᕼ㔘ἲ vs. ᚋᕼ㔘ἲࠊᚋᕼ㔘ἲ vs. 2 ᅇ┠๓ᕼ㔘ἲࠊ1 ᅇ┠๓ᕼ㔘ἲ vs. 2 ᅇ┠๓ᕼ㔘ἲ㸸ࡑࢀࡒࢀ p 㸻 0.139ࠊp 㸻 0.003ࠊ

p 㸻 0.414㸧࡛࠶ࡾࠊᚋᕼ㔘ἲ࡜ 2 ᅇ┠๓ᕼ㔘ἲࡢ㛫࡟᭷ពᕪࢆㄆࡵࡓࠋ
㏱ᯒ᤼ᾮ᳨ᰝࢆᐇ᪋ࡋࡓᑐ㇟ HDF ᝈ⪅ 10 ྡࡢ࠺ࡕ 4 ྡࡣ㏱ᯒ᤼ᾮ᳨ᰝࡢࢹ࣮ࢱࡢ୍㒊Ḟᦆࡢࡓࡵ㝖እࡋࡓࠋࡑࡢࡓࡵࠊ6 ྡࡢ HDF ᝈ⪅ࡀ㏱ᯒ᤼ᾮ᳨ᰝ࡟ྵࡲࢀࡓࠋ㏱ᯒ᤼ᾮ᳨ᰝࢆᐇ᪋
ࡋࡓᝈ⪅≉ᛶࡣࠊ⿵㊊⾲ 1 ࡟♧ࡋ࡚࠸ࡿࠋRRࠊCSࠊCSRࠊ࢔ࣝࣈ࣑ࣥ₃ฟࢆྵࡵࡓ RA ࡟᭷ពᕪࡣ࡞࠿ࡗࡓࡀࠊRR ࡢ P ್࡟୍㒊᭷ពᕪࢆㄆࡵࡓ㸦ᅗ 1 ࠾ࡼࡧ⿵㊊⾲ 2㸧ࠋ᭷ᐖ஦㇟ࡣ⿵㊊⾲ 3 ࡟グ㍕ࡋ࡚࠸ࡿࠋྛᮇ㛫⤊஢ᚋࡢ HDF ᵝᘧࡢษࡾ᭰࠼࡟㛵㐃ࡋࡓ㔜⠜࡞᭷ᐖ஦㇟ࡣ࡞࠿ࡗࡓࠋ᭱ࡶ୍⯡ⓗ࡞᭷ᐖ஦㇟ࡣࠊ1 ᅇ┠๓ᕼ㔘ἲᮇ㛫୰ࡢ㏱ᯒప⾑ᅽ࡜ᚋᕼ㔘ἲᮇ㛫୰ࡢ TMP ୖ࡛᪼࠶ࡗࡓࠋ㏱ᯒప⾑ᅽࡣࠊ㝖Ỉ㏿ᗘࡢపୗࠊ⾑ᅽపୗ᫬ࡢ⿵ᾮࠊ㝆ᅽ⸆ࡢῶ㔞࡟ࡼࡗ࡚἞⒪ࡉࢀࡓࠋ࠙⪃ᐹࠚᮏ◊✲࡛ࡣࠊ๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲ࡟㛵㐃ࡍࡿ HDF ࡢ⮫ᗋ⑕≧ࠊ⾑ᾮ᳨ᰝࠊ㏱ᯒ᤼ᾮ᳨ᰝࠊ᭷
ᐖ஦㇟࡟ࡘ࠸࡚ㄪᰝࡋࡓࠋࡑࡢ⤖ᯝࠊCSࠊCSRࠊ⾑ᅽࠊRTࠊVAS ࢫࢥ࢔࡟ࡼࡿ⮫ᗋ⑕≧࡟ࡘ࠸࡚ࡣࠊ๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲࡢ OL-HDF 㛫࡟᭷ព࡞ᕪࢆㄆࡵ࡞࠿ࡗࡓࠋࡲࡓࠊᚋᕼ㔘ἲ OL-HDF
࡛ࡣࠊ⾑Ύ α1-MG ್ࡀ᭷ព࡟పୗࡍࡿࡇ࡜ࡀ♧ࡉࢀࡓࠋᮏ⤖ᯝࡣࠊᚋᕼ㔘ἲ OL-HDF ࡣ๓ᕼ㔘ἲ OL-HDF ࡼࡾࡶຠ⋡ⓗ࡟⾑Ύ α1-MG ࢆ㝖ཤ࡛ࡁࡿࡇ࡜ࢆ♧၀ࡋ࡚࠸ࡿࡀࠊ⮫ᗋ⑕≧࡟࠾࠸࡚᭷ពᕪࡣ࡞࠿ࡗࡓࠋ
CS ࡣࠊ἞⒪࡟ࡼࡗ࡚┠ⓗࡢ⁐㉁ࡢ⃰ᗘࡀࢮࣟ࡟࡞ࡿయᾮ㔞ࢆ♧ࡋ࡚࠸ࡿࠋCSR ࡣࠊ⥲యᾮ㔞࡟ᑐࡍࡿ CS ࡢẚ⋡ࢆィ⟬ࡍࡿ[18]ࠋHDF ᝈ⪅ 20 ྡࡢ࠺ࡕ 10 ྡ࡟ᑐࡋ࡚㏱ᯒ᤼ᾮࢆ᳨ᰝࡍࡿ
ணᐃ࡛࠶ࡗࡓࡀࠊ㐺᱁࡞᳨ᰝࢆ࡛ࡁࡓࡢࡣ 6 ྡࡢࡳ࡛࠶ࡗࡓࠋᮏ◊✲ࡢ OL-HDF ᮲௳ୗ࡛ࡣࠊ
3 ࡘࡢᮇ㛫࡟ᐇ᪋ࡋࡓ㏱ᯒ᤼ᾮ᳨ᰝ࡟࠾࠸࡚ࠊCS ࡜ CSR ࡟᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓࠋ௒ᚋࡢ◊✲࡛ࡣࠊHDF ࢆྵࡴᵝࠎ࡞἞⒪ἲ࡟ࡘ࠸࡚ CS ࡜ CSR ࢆㄪᰝࡍࡿᚲせࡀ࠶ࡿࠋྛ㏱ᯒᝈ⪅࡟࡜ࡗ࡚᭱Ⰻࡢ QOL ࡜⏕Ꮡ㌿ᖐࢆᚓࡿࡓࡵ࡟ࠊ᭱㐺࡞ OL-HDF ᮲௳ࢆ㑅ᢥࡍࡿࡇ࡜ࡣᅔ㞴࡛࠶ࡿࠋ࠺ࡘ⑓[20]ࠊ╧╀㞀ᐖ[21]ࠊ࠿ࡺࡳ[22]ࠊ⥙⭷ప⾑ᅽ[23]ࠊ㏱ᯒᚋࡢ RT[24]࡜࠸ࡗࡓᵝࠎ࡞㏱ᯒ㛵㐃⑕≧ࡀほᐹࡉࢀࠊṚஸ⋡ࡢ༴㝤ᅉᏊ࡜࡞ࡿࠋ୰➼ᗘࡲࡓࡣ㔜ᗘࡢ࠿ࡺࡳ
ࡢ᭷⑓⋡ࡣ 40-50%࡜ẚ㍑ⓗ㧗ࡃ[22]ࠊ╧╀㞀ᐖࡢ᭷⑓⋡ࡣ 49%[21]࡛࠶ࡿࠋࣞࢫࢺࣞࢫࣞࢵࢢ
⑕ೃ⩌ࠊ୙ᶵ᎘ࠊ⓶⭵ࡢⰍ⣲ỿ╔ࡣṚஸ⋡ࡢ༴㝤ᅉᏊ࡛ࡣ࡞࠸ࡀࠊ୙ᛌឤࡣᏑᅾࡍࡿࠋḈ஭ࡽࡣࠊ
3-5 g ࡢ࢔ࣝࣈ࣑ࣥ₃ฟࢆチᐜࡋ࡞ࡀࡽከࡃࡢ LMWP ࢆ✚ᴟⓗ࡟㝖ཤࡍࡿࡇ࡜࡛ࠊ㔜⑕ࣞࢫࢺࣞࢫࣞࢵࢢ⑕ೃ⩌ࡀᨵၿࡋࡓࠊ࡜ሗ࿌ࡋ࡚࠸ࡿࠋLMWP 㝖ཤホ౯ࡢ௦࣐࣮࣮࡛᭰࢝࠶ࡿ α1-MG࡟ᑐࡋ࡚ RR ┠ᶆࡣ Ӎ 35%࡛࠶ࡿ[25-27]ࠋᮏ◊✲୰ࠊ㏱ᯒ㛵㐃⑕≧ࡢ୺ほⓗホ౯࡛࠶ࡿ RT ࡜
VAS ࡢ⤖ᯝ࡟᭷ពᕪࡣ࡞࠿ࡗࡓࠋ௒ᚋࡢ◊✲࡟࠾࠸࡚ࠊHDF ࡢ≧ែ࡜⮫ᗋ⑕≧࡜ࡢ㛵㐃ᛶࢆ᫂ࡽ࠿࡟ࡍࡿࡇ࡜ࡀᚲせ࡛࠶ࡿࠋࢢ࣮ࣟࢪࣕࣥࡽࡣࠊࣞࢳࣀ࣮ࣝ⤖ྜࢱࣥࣃࢡ 4㸦RBP4㸧ࡀ࢖ࣥࢫࣜࣥ᢬ᢠᛶ࡜࣓ࢱ࣎ࣜࢵࢡ
ࢩࣥࢻ࣮࣒ࣟ࡟㛵㐃ࡍࡿ LMWP ࡛࠶ࡿࡇ࡜ࢆሗ࿌ࡋࡓࠋࡲࡓࠊRBP4 ࡣ⥲ࢥࣞࢫࢸ࣮ࣟࣝࡸ୰
ᛶ⬡⫫࡜ṇࡢ┦㛵ࡀ࠶ࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋᐇ㝿ࠊESRD ᝈ⪅ࡣ୍⯡㞟ᅋ࡟ẚ࡭࡚ RBP4
ࡀ 4 ಸࡶ㧗࠸ࠋHDF ࡟ࡼࡿ἞⒪ࡸ⭈⛣᳜ࡣࠊ⾑Ύ RBP4 ್ࢆపୗࡉࡏࡿ[28]ࠋᮏ◊✲࡛ࡣࠊ
RBP4 ࡣ

ᐃࡉࢀࡎࠊ⬡㉁␗ᖖ⑕ࡢ἞⒪⸆ࡢ౑⏝ࡣไ㝈ࡉࢀ࡚࡞࠸ࡓࡵ 4 ྡࡢᝈ⪅࡛⬡㉁␗ᖖ

⑕ࡢ἞⒪⸆ࡢ㏣ຍࡸቑຍࡉࢀࡓࠋHDF ࡜ RBP4 ࡜ࡢ㛵㐃࡟ࡘ࠸࡚ࡣࡉࡽ࡞ࡿ◊✲ࡀᚲせ࡛࠶ࡿࠋ
α1-MG ࡣ༙ῶᮇࡀᩘ᫬㛫࡜▷ࡃࠊ⾑୰࡛ࡣ㐟㞳ᆺ࡜ IgAࠊ࢔ࣝࣈ࣑ࣥࠊࣉࣟࢺࣟࣥࣅࣥ࡜ࡢ
⤖ྜᆺࡀྠࡌẚ⋡࡛Ꮡᅾࡋ࡚࠸ࡿ[29]ࠋ᭱㏆࡛ࡣࠊᙉຊ࡞ࣛࢪ࢝ࣝࢫ࢝࣋ࣥࢪ࣮ࣕࡸ࣒࣊⤖ྜࢱࣥࣃࢡ࡜ࡋ࡚ࡢ⏕⌮άᛶࡀὀ┠ࡉࢀ࡚࠸ࡿ[30]ࠋ㏱ᯒᝈ⪅࡛ࡣࠊ㓟໬࡟ࡼࡾከ㔞ࡢ α1-MG ࡀศᏊⓗ࡟ຎ໬ࡉࢀࠊࡑࡢ⾑୰⃰ᗘࡣ㧗࠸[31]ࠋࡑࡢࡓࡵ α1-MG ࡀࣛࢪ࢝ࣝࢫ࢝࣋ࣥࢪ࣮ࣕ࡜ࡋ࡚
ṇᖖ࡟ᶵ⬟ࡋ࡚࠸࡞࠸ࡇ࡜ࡀ␲ࢃࢀࡿࠋα1-MG ࡢ✚ᴟⓗ࡞㝖ཤ࡟ࡼࡾࠊα1-MG ࡢࢱ࣮࣮ࣥ࢜ࣂ
࣮ࡀಁ㐍ࡉࢀࠊࣛࢪ࢝ࣝࢫ࢝࣋ࣥࢪ࣮ࣕ࡜ࡋ࡚ࡢᮏ᮶ࡢᶵ⬟ࡀᅇ᚟ࡍࡿࡇ࡜ࡀ♧၀ࡉࢀ࡚࠸ࡿ
[30]ࠋ᭱㏆ࡢ᪥ᮏࡢ◊✲࡟࠾࠸࡚ ᰩཎࡽࡣࠊHDࠊ๓ᕼ㔘ἲ OL-HDFࠊᚋᕼ㔘ἲ OL-HDF ࡢ㛫࡛⏕య㐺ྜᛶࣃ࣓࣮ࣛࢱ࣮࡟᭷ពᕪࡣ࡞ࡃࠊᚋᕼ㔘ἲ OL-HDF ࡟࠾ࡅࡿ α1-MG ࡢ RR ࡜ Albࡢ₃ฟ㔞ࡀ᭷ព࡟㧗࠸ࡇ࡜ࢆ᫂ࡽ࠿࡟ࡋࡓ[32]ࠋࡲࡓᒸ⏣ࡽࡣࠊᚋᕼ㔘ἲ OL-HDF ࡢ᭱ᑠ⨨᥮ᾮ㔞 6 L/ࢭࢵࢩࣙࣥࡢ࡯࠺ࡀ๓ᕼ㔘ἲ OL-HDF ࡢ᭱኱⨨᥮ᾮ㔞 48 L/ࢭࢵࢩࣙࣥࡼࡾ α1-MG ࡢ
RR ࡀ㧗ࡃ࡞ࡿࡇ࡜ࢆ♧ࡋࡓ[33]ࠋᮏ◊✲࡛ࡣࠊ⾑Ύ α1-MG ࡢࡳࡀࠊ1 ᅇ┠๓ᕼ㔘ἲ࡜ 2 ᅇ┠๓ᕼ㔘ἲࡼࡾࡶᚋᕼ㔘ἲ࡛᭷ព࡟ῶᑡࡋࡓࠋα1-MG ࡢ RA ࡣ᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓࡀࠊ㏱ᯒ᤼ᾮ
᳨ᰝ࡟࠾࠸࡚๓ᕼ㔘ἲࡼࡾࡶᚋᕼ㔘ἲࡢ᪉ࡀ㧗್࡛࠶ࡗࡓࠋᐇ㝿ࠊ๓ᕼ㔘ἲ࡜ẚ㍑ࡋ࡚⨨᥮㔞ࡀ
6 L ௨ୖ/ࢭࢵࢩࣙࣥࡢᚋᕼ㔘ἲࡣ α1-MG ࡢ RR ࢆୖ᪼ࡉࡏࡓ[33]ࠋᮏ◊✲࡛ࡣࠊᚋᕼ㔘ἲࡣ๓ᕼ㔘ἲ࡟ẚ࡭࡚⾑Ύ α1-MG ࢆ⣙ 10 mg/L పୗࡉࡏࡓࠋα1-MG ࡀ✚ᴟⓗ࡟㝖ཤࡉࢀࡓࡇ࡜࡛ࠊ
ᮏ᮶ࡢᶵ⬟࡬࡜ᨵၿࡋࡓ࠿ࡶࡋࢀ࡞࠸ࠋࡉࡽ࡟ࠊ㏱ᯒ᤼ᾮ᳨ᰝࢆᐇ᪋ࡋࡓ 6 ྡ඲ဨࡀࠊ3 ࡘࡢᮇ㛫୰࡟ 6 g ࢆ㉸࠼ࡿ࢔ࣝࣈ࣑ࣥ₃ฟࢆㄆࡵࡓࠋα1-MG ࡢ RR ࡣࠊ1 ᅇ┠๓ᕼ㔘ἲ࡛ 40.3 ± 4.7 %ࠊ
ᚋᕼ㔘ἲ࡛ 38.4 ± 6.1 %ࠊ2 ᅇ┠๓ᕼ㔘ἲ࡛ 36.3 ± 6.6 %࡛࠶ࡾࠊ࠸ࡎࢀࡶᮏ◊✲࡛ࡣ α1-MG
ࡢ RR Ӎ 35%ࢆ㐩ᡂࡋࡓࠋࡋ࠿ࡋࠊα1-MG ࡜㛵㐃ࡍࡿࣞࢫࢺࣞࢫࣞࢵࢢ⑕ೃ⩌࡛ࡣ᭷ពᕪࢆㄆ
ࡵ࡞࠿ࡗࡓࠋᮏ◊✲ࡢ⤖ᯝࡣࠊࣞࢫࢺࣞࢫࣞࢵࢢ⑕ೃ⩌ࡢ⛬ᗘࡀ㍍ᗘ࡛࠶ࡗࡓࡇ࡜ࠊ࠶ࡿ࠸ࡣ 3ࣧ᭶࡜࠸࠺ᮇ㛫ࡀࣞࢫࢺࣞࢫࣞࢵࢢ⑕ೃ⩌ࡢኚ໬ࢆほᐹࡍࡿ࡟ࡣ▷ࡍࡂࡓྍ⬟ᛶࡀ♧၀ࡉࢀࡓࠋ
ࡲࡓࠊα1-MG ࡜࢔ࣝࣈ࣑ࣥ₃ฟࡢ RR ࡣඛ⾜◊✲[32, 33]࡜୍⮴ࡋ࡚࠾ࡾࠊ⾑Ύ α1-MG ࡣ᭷ព࡟ῶᑡࡍࡿࡇ࡜ࡀ♧ࡋࡓࠋᮏ◊✲࡛ࡣࠊα1-MG ࡟ࡼࡿ⮫ᗋ⑕≧ࡢ᭷ពᕪࡣㄆࡵ࡞࠿ࡗࡓࠋα1-MGࡢ⮫ᗋⓗព⩏࡟ࡘ࠸࡚ࡣࡉࡽ࡞ࡿ◊✲ࡀᚲせ࡛࠶ࡿࠋβ2-MG ࡣࠊ㏱ᯒ࢔࣑ࣟ࢖ࢻ࣮ࢩࢫ࡟࠾ࡅࡿ࢔࣑ࣟ࢖ࢻ⥺⥔ࡢ๓㥑య࡛࠶ࡿࠋᐇ㝿ࠊඛ⾜◊✲࡟ࡼࡿ࡜ࠊ㏱ᯒ๓ࡢ β2-MG ್ࡣ ӌ 27.5 mg/L [34]࡜ ӌ 32.2 mg/L [35]࡛⏕Ꮡ฼┈ࡀ♧၀ࡉࢀ࡚࠸ࡿࠋ᪥ᮏ㏱ᯒ་Ꮫ఍ࡣࠊ㏱ᯒ๓ࡢ⾑Ύ β2-MG ್ ӌ 30 mg/L ࡜ࡍࡿࡇ࡜ࢆ᥎ዡࡋ࡚࠾ࡾ
[36]ࠊᮏ◊✲ࡢ HDF ᮲௳ࡣࡇࢀࢆ㑂Ᏺࡋࡓࠋᮏ◊✲ࡢ CCI ࢫࢥ࢔ࡣࠊ2007 ᖺࡢ᪥ᮏ࡟࠾ࡅࡿᑟධ㏱ᯒᝈ⪅ࡢ 6.5 ± 2.8 Ⅼ[37]ࡼࡾࡶእ᮶
㏱ᯒ࠿ࡘ HDF ࢆチᐜ࡛ࡁࡿ㐺᱁࡞ᝈ⪅࡛࠶ࡗࡓࡓࡵ 3.0 ± 1.2 Ⅼ࡜ప್࡛࠶ࡗࡓࠋ᪤ ⑕࡟㛵㐃ࡍࡿ᫂ࡽ࠿࡞᭷ᐖ஦㇟ࡣࠊ1 ྡࡢᝈ⪅ࡢ࢖ࣞ࢘ࢫࢆ㝖࠸࡚ㄆࡵ࡞࠿ࡗࡓࠋ1 ᅇ┠๓ᕼ㔘ἲࡢᮇ㛫࡛ࡣࠊ㏱ᯒప⾑ᅽࡀࡼࡾ㢖⦾࡟Ⓨ⏕ࡋࡓࠋࡑࡢࡓࡵ 4 ྡ࡟ࡘ࠸࡚ࡣࠊほᐹᮇ㛫࡜ 1 ᅇ┠๓ᕼ㔘ἲࡢᮇ㛫࡟ࢻࣛ࢖࢙࢘࢖ࢺࡸ㝆ᅽ⸆࡛἞⒪ෆᐜࢆㄪᩚࡋࡓࠋᚋᕼ㔘ἲ࡛ࡣࠊ࣊ࣔࢲ࢖࢔ࣇ࢕
ࣝࢱ࣮ෆࡢ⾑ᾮ⃰⦰ࡢࡓࡵ Qb ࡟ࡼࡗ࡚⨨᥮ᾮ㔞ࡀไ㝈ࡉࢀࡿࠋ⨨᥮ᾮ㔞ࡀ㐣ᗘ࡟ቑຍࡍࡿ࡜ࠊ
࢔ࣝࣈ࣑ࣥࡢ㐣๫₃ฟ࡜⾑ᾮ⃰⦰ࡢ༴㝤ࡀ࠶ࡿ[38]ࠋᮏ◊✲ࡢᚋᕼ㔘ἲ࡛ࡣࠊTMP ࡢୖ᪼ࡀᑡ
࡞࠸ഴྥ࡟࠶ࡿ FIX ࣊ࣔࢲ࢖࢔ࣇ࢕ࣝࢱ࣮ࢆ㑅ᢥࡋࡓࡀ[39]ࠊᐇ㝿࡟ࡣࣇ࢓࢘ࣜࣥࢢ࡜࠸࠺ࢱ
ࣥࣃࢡࡢ௜╔࡟ࡼࡿ࣊ࣔࢲ࢖࢔ࣇ࢕ࣝࢱ࣮ࡢ┠ワࡲࡾࡢࡓࡵ TMP ࡢୖ᪼ࡀⓎ⏕ࡋࡓࠋࡑࡢࡓࡵ
Qs ࢆపୗࡉࡏ࡚ࡿᚲせࡀ࠶ࡗࡓࠋᮏ◊✲ࡢᐇ㝿ࡢ⨨᥮ᾮ㔞ࡣࠊ1 ᅇ┠๓ᕼ㔘ἲࡀ 47.0 ± 0.4 L/ࢭࢵࢩࣙࣥࠊᚋᕼ㔘ᚋࡀ 13.9 ± 1.1 L/ࢭࢵࢩࣙࣥࠊ2 ᅇ┠๓ᕼ㔘ἲࡀ 46.8 ± 0.5 L/ࢭࢵࢩࣙࣥ࡜
࡞ࡗࡓࠋࡋࡓࡀࡗ࡚ࠊTMP ୖ᪼ࡢ࡞࠸ HDF ᮲௳ࢆタᐃࡍࡿࡇ࡜ࡀᚲせ࡛࠶ࡿࠋᮏ◊✲࡟ࡣ࠸ࡃࡘ࠿ࡢไ㝈ࡀ࠶ࡗࡓࠋ1 ࡘ┠࡟ࠊࢧࣥࣉࣝᩘࡀᑡ࡞࠸༢᪋タ࡛ࡢ◊✲࡛࠶ࡗࡓࠋ
ࡑࡢࡓࡵࠊᮏ⤖ᯝࢆูࡢ᪋タࡸ᪥ᮏ௨እࡢ OL-HDF ࡢ᪉ἲ࡜ࡋ୍࡚⯡໬࡛ࡁࡿ࠿ࡣ୙࡛᫂࠶ࡿࠋ
ࡋ࠿ࡋࠊᮏ◊✲ࡢ㛗ᡤࡣࠊ⮫ᗋ⑕≧ࡸ᭷ᐖ஦㇟ࢆྵࡴヲ⣽࠿ࡘ᥈⣴ⓗ࡞᳨ウࢆ⾜ࡗࡓࡇ࡜࡟࠶ࡿࠋ
2 ࡘ┠࡟ࠊVAS ࢫࢥ࢔࡜ RT ࡣཧຍ⪅ࡢ⮬ᕫ⏦࿌࡟ࡼࡿࡶࡢ࡛࠶ࡾࠊ┣᳨໬࡛ࡁ࡞࠸ࡓࡵཧຍ⪅ࣂ࢖࢔ࢫࡢྍ⬟ᛶࡣྰᐃ࡛ࡁ࡞࠸ࠋࡋ࠿ࡋࠊᮏ◊✲࡛ࡣࠊ୺ほⓗホ౯࡟᭷ពᕪࢆㄆࡵ࡞࠿ࡗࡓࠋ
3 ࡘ┠࡟ࠊ㏱ᯒ㛤ጞ࠿ࡽ 60 ศᚋ࡟㟼⬦ᅇ㊰㸦ࢲ࢖࢔ࣛ࢖ࢨ࣮ࡢฟཱྀ㸧࠾ࡼࡧື⬦ᅇ㊰㸦ࢲ࢖࢔ࣛ࢖ࢨ࣮ࡢධཱྀ㸧࠿ࡽ⾑ᾮࡀ᥇ྲྀࡉࢀ࡚࠸࡞࠸ࠋࡋࡓࡀࡗ࡚ࠊᮏ◊✲࡛ࡣྛ⁐㉁ࡢࢡࣜ࢔ࣛࣥࢫ
ࡣ⟬ฟ࡛ࡁ࡞࠿ࡗࡓࠋࡋ࠿ࡋࠊ㏱ᯒ᤼ᾮ᳨ᰝࡢ CS ࡜ CSR ࡟࠾࠸࡚ 3 ࡘࡢᮇ㛫࡛ࡢ᭷ពᕪࡣㄆ
ࡵ࡞࠿ࡗࡓࠋ

࠙⤖ㄒࠚ
OL-HDF ࡢ๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲࢆ⏝࠸ࡓሙྜࠊCSࠊCSRࠊ⾑ᅽࠊ⮫ᗋ⑕≧࡟᭷ពᕪࢆㄆࡵ࡞
࠿ࡗࡓࠋ⾑Ύ α1-MG ⃰ᗘ࡛ࡣࠊ๓ᕼ㔘ἲࡼࡾࡶᚋᕼ㔘ἲࡢ᪉ࡀ᭷ព࡟ప್࡛࠶ࡗࡓࠋ௒ᚋࠊᝈ
⪅ࡈ࡜࡟᭱㐺࡞㏱ᯒ᮲௳ࢆ㑅ᢥࡍࡿࡓࡵ๓ᕼ㔘ἲ࡜ᚋᕼ㔘ἲࡢ㐪࠸ࢆ᫂ࡽ࠿࡟ࡍ࡭ࡁ࡛࠶ࡿࠋ

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࠙⾲ࠚ
⾲ 1 ᝈ⪅≉ᛶ㸦n = 18㸧
Men/Women

14 (78%)/4 (22%)

Age (years)

61.1 ± 7.1

Dialysis vintage (months)

18.1 ± 7.1

HDF vintage (months)

13.3 ± 6.6

HDF modality
Pre-dilution

18 (100%)

Post-dilution

0 (0%)

Reasons for conversion to HDF fromHD
Itchiness

2 (11%)

Post-dialysis malaise,

2 (11%)

Anemia1 (6%)

LMWP removal

13 (72%)

Body mass index (kg/m2)

23.9 ± 3.7

Smoking status
Current smoker

4 (22%)

Ex-smoker

5 (28%)

Never smoker

9 (50%)

Vascular access
Arteriovenous fistula

18 (100%)

Arteriovenous graft

0 (0%)

Central venous catheter

0 (0%)

Primary cause of ESRD
Chronic glomerulonephritis

13 (72%)Diabetic nephropathy

1 (6%)

Nephrosclerosis

1 (6%)

Polycystic kidney disease

3 (16%)

History of renal treatment
Peritoneal dialysis

5 (28%)

Kidney transplant

1 (6%)Charlson comorbidity index score

3.0 ± 1.2

Data are presented as n (%) and mean ± standard deviation
Abbreviations: ESRD, end-stage renal disease; HD, hemodialysis; HDF, hemodiafiltration;
LMWP, low-molecular-weight proteinmalaisePost-dialysis

Crampsand joints

Pain of the bones

syndrome

Restless legs

Itchiness

Visual analog scale

Recovery time (min)volume (L)Total body fluid(mmHg)

Post-HDF DBP(mmHg)

Post-HDF SBP(mmHg)

Pre-HDF DBP(mmHg)

Pre-HDF SBP

15.2 (0–59)

9.2 (0–60)

16.4 (0–78)

7.8 (0–93)

8.9 (0–46)

60.0 (0–720)

39.2 ± 9.6

81.9 ± 11.0

125.4 ± 16.1

93.8 ± 11.7

157.7 ± 18.9

OL-HDF25.8 (0–83)

7.9 (0–81)

14.3 (0–87)

7.1 (0–45)

7.4 (0–46)

61.7 (0–720)

39.4 ± 9.5

82.2 ± 11.5

126.8 ± 19.3

89.4 ± 9.6

146.7 ± 16.9

OL-HDF19.8 (0–77)

10.3 (0–59)

15.3 (0–75)

5.5 (0–33)

16.6 (0–61)

60.0 (0–720)

39.0 ± 9.6

81.7 ± 14.1

127.9 ± 24.2

89.8 ± 12,6

140.7 ± 35.2

OL-HDF

0.068

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

0.248

0.552

Post-dilution

First pre-dilution Post-dilution Second pre-dilution First pre-dilution vs.

⾲ 2 HDF ⾑ᅽࠊ⥲యᾮ㔞ࠊᅇ᚟᫬㛫ࠊどぬⓗ࢔ࢼࣟࢢᑻᗘ

0.551

1.000

1.000

1.000

0.089

1.000

1.000

1.000

1.000

1.000

1.000

Second pre-dilution

Post-dilution vs.

0.926

1.000

1.000

1.000

0.204

1.000

1.000

1.000

1.000

0.337

0.128

Second pre-dilution

First pre-dilution vs.

9.2 (0–69)

Moodiness

10.5 (0–76)

18.3 (0–74)
10.6 (0–52)

19.9 (0–78)
1.000

1.000
1.000

1.000
1.000

1.000

blood pressure

Abbreviations: BP, blood pressure; DBP, diastolic blood pressure; HDF, hemodiafiltration; OL-HDF, online hemodiafiltration; SBP, systolic

Data are presented as mean ± standard deviation and range

19.4 (0–75)

Sleep disorder1.15 ± 0.20

91.9 ± 5.1

1.5 ± 0.3

69.9 ± 7.2

0.6 ± 1.4

6.2 ± 0.4

3.5 ± 0.2

5.8 ± 1.2

64.6 ± 10.4

12.3 ± 2.6

140.0 ± 2.2

5.2 ± 0.6

106.4 ± 2.4

8.4 ± 0.7

6.0 ± 1.5

6.3 ± 1.6

4.0 ± 0.4

11.9 ± 0.7

36.6 ± 2.2

1.9 ± 0.5

GNRI

Kt/V

URR (%)CRP (mg/dL)

TP (g/dL)

Alb (g/dL)

UA (mg/dL)

BUN (mg/dL)

Cre (mg/dL)

Na (mEq/L)

K (mEq/L)

Cl (mEq/L)

Ca (mg/dL)

P (mg/dL)

WBC (×10*9/L)

RBC (×10*12/L)

Hb (g/dL)

Ht (%)Plt (×10*8/L)

OL-HDF1.9 ± 0.5

35.8 ± 2.7

11.7 ± 0.9

3.9 ± 0.3

5.9 ± 1.2

5.1 ± 1.4

8.2 ± 0.6

103.6 ± 2.0

4.9 ± 0.5

139.3 ± 1.9

12.2 ± 2.9

57.5 ± 11.2

5.7 ± 1.1

3.5 ± 0.2

6.2 ± 0.3

0.3 ± 0.6

72.6 ± 7.1

1.6 ± 0.4

90.8 ± 4.7

1.08 ± 021

OL-HDF

First pre-dilution Post-dilution

nPCR (g/kg/day)⾲ 3 ⾑ᾮ᳨ᰝ

1.8 ± 0.5

36.4 ± 3.8

11.7 ± 1.1

3.9 ± 0.4

6.2 ± 1.5

5.3 ± 1.0

8.3 ± 0.5

103.3 ± 2.9

4.9 ± 0.7

139.4 ± 2.1

12.1 ± 2.7

59.3 ± 11.7

5.7 ± 1.0

3.5 ± 0.2

6.1 ± 0.3

0.3 ± 0.8

71.1 ± 6.5

1.6 ± 0.3

92.2 ± 4.8

1.09 ± 0.18

OL-HDF

1.000

1.000

1.000

0.511

0.553

0.060

0.774

<0.001

0.157

0.346

1.000

0.051

0.566

0.334

0.033

1.000

0.001

<0.001

0.416

0.340

Post-dilution

Second pre-dilution First pre-dilution vs.

0.585

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

0.623

0.420

1.000

0.078

0.062

0.192

1.000

Second pre-dilution

Post-dilution vs.

0.515

1.000

1.000

0.531

1.000

0.214

1.000

<0.001

0.079

0.422

1.000

0.208

1.000

1.000

0.744

1.000

0.263

0.190

1.000

0.465

Second pre-dilution

First pre-dilution vs.

160.6 ± 53.1

77.7 ± 49.3

163.4 ± 26.9

UIBC (μg/dL)

Ferritin (ng/mL)

T-chol (mg/dL)

314.4 ± 281.7

BNP (pg/mL)

147.1 ± 88.4

105.9 ± 73.6

25.3 ± 3.1

124.8 ± 14.3

hANP (pg/mL)

wPTH (pg/mL)

β2-MG (mg/L)

α1-MG (mg/L)

116.6 ± 13.9

24.5 ± 2.7

85.1 ± 50.7

145.3 ± 83.5

27.9 ± 10.7

8.8 ± 0.5

298.1 ± 248.8

135.6 ± 122.8

96.2 ± 20.2

48.8 ± 19.3

172.2 ± 29.6

91.3 ± 58.9

167.9 ± 33.2

232.6 ± 24.6

64.3 ± 26.2

125.8 ± 13.0

25.9 ± 3.1

70.3 ± 41.7

193.0 ± 213.6

28.8 ± 10.3

8.7 ± 0.4

247.6 ± 224.7

111.7 ± 73.4

82.3 ± 19.4

48.9 ± 16.3

153.9 ± 23.4

96.1 ± 51.8

168.9 ± 38.3

236.1 ± 30.0

67.1 ± 24.8

0.001

0.139

0.111

1.000

1.000

1.000

1.000

0.250

0.200

0.766

0.097

0.609

1.000

1.000

1.000

<0.001

0.003

0.832

0.825

1.000

1.000

0.583

0.494

<0.0011.000<0.001

1.000

1.000

1.000

1.000

1.000

0.414

0.007

0.994

1.000

0.724

0.267

1.000

0.036

0.635

0.062

0.271

1.000

0.825

1.000

TIBC, total iron-binding capacity; TP, total protein; TSAT, transferrin saturation; UA, uric acid; UIBC, unsaturated iron-binding capacity; URR,

catabolic rate; OL-HDF, online hemodiafiltration; P, phosphorus; Plt, platelet; RBC, red blood cell; T-chol, total cholesterol; TG, triglyceride;cholesterol; Hb, hemoglobin; Ht, hematocrit; K, potassium; LDL-chol, low-density lipoprotein cholesterol; Na, sodium; nPCR, normalized protein

reactive protein; Fe, iron; GNRI, geriatric nutritional risk index; hANP, human atrial natriuretic peptide; HDL-chol, high-density lipoprotein

Abbreviations: Alb, albumin; BNP, brain natriuretic peptide; BUN, blood urea nitrogen; Ca, calcium; Cl, chloride; Cre, creatinine; CRP, C-

Data are presented as mean ± standard deviation

31.2 ± 19.0

TSAT (%)(mg/dL)8.8 ± 0.6

105.6 ± 64.7

TG (mg/dL)

Corrected Ca

90.4 ± 20.2

LDL-chol (mg/dL)(mg/dL)47.1 ± 17.9

230.2 ± 24.5

TIBC (μg/dL)

HDL-chol

69.6 ± 40.2

Fe (μg/dL)

urea reduction ratio; WBC, white blood cell; wPTH, whole parathyroid hormone; α1-MG, α1-microglobulin; β2-MG, β2-microglobulinpost-HDF

second pre-HDF

α1-MG

0

Cre

UA
β2-MG

0

5

10

15

10

5

20

15

25

30

40

45

50

20

α1-MG

* p = 0.012

0

35

BUN

first pre-HDF

second pre-HDF

β2-MG

25

30

35

P

post-HDF

UA
BUN

Cre

P

BUN

Cre

first pre-HDF

D. Clear space rate

P

(%)

Cre

2

4

6

8

10

first pre-HDF

C. Clear space

BUN

ː

12

(L)

0

10

20

30

40

50

60

70

80

first pre-HDF

P

B. Removal amount(g)

A. Reduction rate(%)
90

ᅗ 1 ㏱ᯒ᤼ᾮ᳨ᰝ

࠙ᅗࠚ

post-HDF

ALB

second pre-HDF

UA

β2-MG

second pre-HDF

UA

post-HDF

β2-MG

α1-MG

0

50

100

150

200

250

300

(mg)

α1-MG

MG, β2-microglobulin

Abbreviations: BUN, blood urea nitrogen; Cre, creatinine; HDF, hemodiafiltration; P, phosphorus; UA, uric acid; α1-MG, α1-microglobulin; β2-a. 㝖ཤ⋡ࠋP ࡢࡳ 1 ᅇ┠๓ᕼ㔘ἲ࡜ 2 ᅇ┠๓ᕼ㔘ἲࡢ㛫࡟᭷ពᕪࢆㄆࡵࡓ㸦p = 0.012㸧ࠋb. 㝖ཤ㔞ࠋc. ࢡࣜ࢔ࢫ࣮࣌ࢫࠋd. ࢡࣜ࢔ࢫ࣮࣌ࢫ⋡ࠋ

65.4 ± 7.2
7.9 ± 5.0

Age (years)

Dialysis vintage (years)

Abbreviation: ESRD, end-stage renal disease

Data are presented as n (%) and mean ± standard deviation

2.8 ± 0.7

1 (17%)

Diabetic nephropathy (%)

Charlson comorbidity index score

5 (83%)

Chronic glomerulonephritis (%)

Primary cause of ESRD

5/1

Men/Women

⿵㊊⾲ 1 ㏱ᯒ᤼ᾮ᳨ᰝࡢᝈ⪅≉ᛶ㸦n = 6㸧࠙⿵㊊ࠚ64.8 ± 1.9

50.7 ± 9.3

76.8 ± 2.4

78.8 ± 3.1

40.3 ± 4.7

Cre

P

UA

β2-MG

α1-MG

25.7 ± 5.0

19.1 ± 3.8

19.1 ± 4.6

13.7 ± 3.4

Cre

P

UA

8.6 ± 0.7

BUN

Clear space (L)Alb (g)160.5 ± 38.6

0.8 ± 0.2

UA (g)

α1-MG (mg)0.8 ± 0.2

P (g)213.7 ± 72.1

1.8 ± 0.5

Cre (g)β2-MG (mg)

9.9 ± 2.0

BUN (g)Removal amount73.3 ± 2.5

BUN

Removal rate (%)

OL-HDF14.4 ± 2.5

19.9 ± 2.1

19.9 ± 3.0

27.0 ± 4.0

6.7 ± 1.0

166.7 ± 14.0

235.0 ± 42.4

0.9 ± 0.2

0.9 ± 0.2

1.9 ± 0.5

9.9 ± 2.0

38.4 ± 6.1

78.9 ± 3.9

76.7 ± 2.2

57.0 ± 5.5

65.6 ± 2.6

73.4 ± 3.0

OL-HDF15.4 ± 1.3

17.7 ± 1.9

18.2 ± 2.0

23.3 ± 2.6

6.7 ± 0.8

156.3 ± 29.1

194.0 ± 47.0

0.9 ± 0.1

0.9 ± 0.1

1.9 ± 0.5

8.9 ± 1.0

36.3 ± 6.6

76.9 ± 4.7

74.7 ± 2.2

61.3 ± 6.1

66.3 ± 1.3

74.0 ± 2.2

OL-HDF

1.000

1.000

1.000

1.000

0.143

1.000

0.718

0.521

1.000

0.402

1.000

1.000

1.000

1.000

0.112

1.000

1.000

Post-dilution

First pre-dilution Post-dilution Second pre-dilution First pre-dilution vs⿵㊊⾲ 2 ㏱ᯒ᤼ᾮ᳨ᰝ

1.000

0.690

0.408

0.073

1.000

1.000

0.137

1.000

1.000

1.000

0.922

0.990

0.091

0.588

0.351

1.000

1.000

Second pre-dilution

Post-dilution vs

0.596

1.000

1.000

0.292

0.119

1.000

0.819

0.127

0.320

0.402

0.955

0.266

0.115

0.505

0.012

0.647

0.994

Second pre-dilution

First pre-dilution vs1.6 ± 0.3

α1-MG28.8 ± 1.1

28.5 ± 2.5

20.4 ± 0.9

14.7 ± 0.8

2.5 ± 0.1

Cre

P

UA

β2-MG

α1-MG

2.6 ± 0.5

15.0 ± 1.8

21.7 ± 1.4

30.6 ± 4.4

30.3 ± 3.3

41.1 ± 3.3

1.7 ± 0.1

9.8 ± 1.1

2.6 ± 0.6

14.2 ± 1.9

24.2 ± 3.9

27.6 ± 2.8

28.3 ± 3.0

36.3 ± 3.8

1.6 ± 0.2

9.0 ± 0.8

1.000

1.000

1.000

1.000

1.000

0.825

1.000

1.000

1.000

0.966

0.639

0.923

0.731

0.121

1.000

0.646

1.000

1.000

0.238

1.000

1.000

0.627

1.000

0.728

MG, α1-microglobulin; β2-MG, β2-microglobulin

Abbreviations: Alb, albumin; BUN, blood urea nitrogen; Cre, creatinine; OL-HDF, on-line hemodiafiltration; P, phosphorus; UA, uric acid; α1-Data are presented as mean ± standard deviation

38.8 ± 2.2

BUN

Clear space rate (%)

9.8 ± 1.9

β2-MG

2 (0.04)

Abbreviation: OL-HDF, online hemodiafiltration

Data are presented as the incidents per patient per monthpressure

Increase in transmembrane

0 (0)4 (0.07)

Dialysis shunt dysfunction

Dizziness

15 (0.28)

First pre-dilution OL-HDF

Dialysis hypotension

⿵㊊⾲ 3 ᭷ᐖ஦㇟

26 (0.49)

1 (0.02)3 (0.06)

5 (0.09)

Post-dilution OL-HDF

3 (0.06)

1 (0.02)3 (0.06)

2 (0.04)

Second pre-dilution OL-HDF

Abbreviation: OL-HDF, online hemodiafiltration

HDF ᪋⾜๓࡟ᐇ᪋ࡋࡓ㸦▮༳㸧ࠋྛᮇ㛫ࡢ QbࠊQdࠊQs ࡜࣊ࣔࢲ࢖࢔ࣇ࢕ࣝࢱ࣮ࢆ♧ࡍࠋ

1 ࣧ᭶ࡢほᐹᮇ㛫ࡢᚋࠊ1 ᅇ┠๓ᕼ㔘ἲࠊᚋᕼ㔘ἲࠊ2 ᅇ┠๓ᕼ㔘ἲࡢ㡰࡟ 3 ࣧ᭶ẖ OL-HDF ࢆᐇ᪋ࡋࡓࠋホ౯ࡣྛᮇ㛫ࡢ᭱⤊㐌ࡢ㐌ึࡵࡢ OL-

⿵㊊ᅗ 1 ◊✲ࢹࢨ࢖ࣥ§1  Ht post u Ht pre u CB post ·¨1 ¸ u100 
¨
¸
1

Ht
u
Ht
u
CB
pre
post
pre ¹
©

B. RR(%)

CS L

V L

RA mg

CBpre mg / LL 

ᐃࡋࡓࠋd.ࢡࣜ࢔ࢫ࣮࣌ࢫࠋe.ࢡࣜ࢔ࢫ࣮࣌ࢫ⋡ࠋయ✚㸦9㸧

hematocrit level at the end of dialysis; Htpre, hematocrit level at the beginning of dialysis; Qd, dialysate flow rate

Abbreviations: CBpost, solute level at the end of dialysis; CBpre, solute level at the beginning of dialysis; HDF, hemodiafiltration; Htpost,ࡣࠊホ౯ࡢ㝿ࡢ HDF ๓ࡢ⥲యᾮ㔞ࢆ⏝࠸࡚ィ⟬ࡋࡓࠋࢩࣙࣥ࠶ࡓࡾࡢ⥲㔞 4.8 L㸧࡛㒊ศ᥇ྲྀࡋࡓ㏱ᯒ᤼ᾮ᳨ᰝࡢᖹᆒ⁐㉁㔞ࢆホ౯ࡢ㝿࡟MG ࡣࠊHt ࡢ⾑୰⃰ᗘຠᯝࢆ㝖እࡋ࡚ィ⟬ࡋࡓࠋc.㝖ཤ㔞ࠋ⥲㏱ᯒᾮ㔞ࡣ 120 L㸦Qd 0.5 Lศ240ศ㸧࡛࠶ࡿࡀࠊ20 mL/min ࡢ㏿ᗘ㸦1 ࢭࢵa.࣐࣊ࢺࢡࣜࢵࢺ࡛⿵ṇࡋ࡞࠸㝖ཤ⋡ࠋᒀ⣲❅⣲ࠊࢡࣞ࢔ࢳࢽࣥࠊࣜࣥࠊᒀ㓟ࡀィ⟬ࡉࢀࡓࠋb.࣐࣊ࢺࢡࣜࢵࢺ࡛⿵ṇࡋࡓ㝖ཤ⋡ࠋα1-MG ࡜ β2-

E. CSR %D. CS L

C. RA mg 㸻Mean solute levels in spent dialysate mg / L u total dialysate volume  fluid removal§ CBpost ·¨¨1 ¸¸ u100 © CBpre ¹

A. RR(%)⿵㊊ᅗ 2 ౑⏝ࡋࡓᘧ