Seiichi Shimabukuro

IS PERITONEAL REST A TREATMENT FOR ULTRAFILTRATION FAILURE DURING CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

Abstract Deterioration of the peritoneums ultrafiltration capacity is an important factor for determining whether continuous ambulatory peritoneal dialysis (CAPD) should be continued or discontinued. Why the ultrafiltration capacity deteriorates is not clearly understood, and effective treatment for this problem has not yet been established. To examine the effect of discontinuing CAPD on the recovery of ultrafiltration capacity, we followed up one patient who showed deteriorated peritoneal function 4 years after the initiation of CAPD for 6 months without performing CAPD. A catheter inserted into the peritoneal cavity was not removed during the 6-month period of peritoneal rest. We found that the amount of fluid removed after a 240-minute CAPD increased significantly (from −450 ml to 150 ml) after 6 months of peritoneal rest. The patients glucose reabsorption rate improved slightly, but the blood urea nitrogen dialysate/plasma ratio did not show any change. The phosphatidylcholine concentration in the dialysate increased from 0.71 mg/dl to 2.07 mg/dl after 6 months of peritoneal rest. At the end of the 6-month period, the patients ultrafiltration capacity improved, and he was able to resume CAPD therapy. We conclude that peritoneal rest is a useful treatment for deteriorated ultrafiltration capacity of the peritoneum.

An autopsied case of primary macroglobulinemia whose heart failure and anemia were controlled with double filtration plasmapheresis (DFPP) for 7 years.

維持二重濾過血漿交換療法 (DFPP) にて心不全と貧血を7年間にわたり管理しえた原発性マクログロブリン血症の剖検例について病理学的所見を検討した. 症例は56歳の男性で原発性マクログロブリン血症のため多臓器不全を呈し, 顆粒球減少症により化学療法が困難であった. 7年間にわたり計181回のDFPPを施行したが, 心不全にて死亡した. 剖検の結果, 心臓は660gと肥大していたが, 心筋にIgM等の均一構造物質の沈着は認められず, 僧帽弁と大動脈弁の弁口径は増大していた. 主たる死因は心収縮能の低下と弁口径の拡大による心不全と考えられた.心臓の前負荷が増大しかつ心筋虚血を伴う本例のような心不全を呈する原発性マクログロブリン血症例においては, IgMを選択的に除去するDFPPは有用な治療法であったと考えられる.