糖尿病性腎不全 : 透析療法と移植(シリーズ「糖尿病の治療」(5))

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  • シリーズ トウニョウビョウ ノ チリョウ 5 トウニョウビョウセイ ジンフゼン トウセキ リョウホウ ト イショク
  • Dialysis and Transplantation in Diabetic Patients with End-Stage Renal Disease(Series "Treatment of Diabetes Mellitus" (5))

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Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) among incident dialysis patients in most industrialized countries, including Japan. Diabetic nephropathy is associated with a higher mortality during renal replacement therapy (RRT) than are non-diabetic renal diseases. This excess mortality results mainly from higher prevalence of cardiovascular diseases at the onset of RRT. Hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), and kidney transplantation are treatment of choice for ESRD in diabetic patients as well as non-diabetic individuals; however, the vast majority of diabetic patients undergo hemodialysis in Japan. Dialysis modality should be selected based upon comorbid conditions, personality, and family background of each patient. Kidney transplantation is associated with better survival and quality of life in diabetic patients. In addition, successful pancreas and kidney transplantation provides both an insulin-independent euglycemia and withdrawal from dialysis therapy. As of May 2005, a total of 37 patients with type 1 diabetes and ESRD underwent pancreas transplantation simultaneously with or subsequently to kidney transplantation in Japan. Improvements in graft procurement and immunosuppressive regimens and modifications in operative technique have provided excellent pancreatic graft survival.

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