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Background/Aim: Angiotensin II plays a central role in the progression of chronic renal failure (CRF), and administration of angiotensin-converting enzyme inhibitor (ACEI) in rats delays the progression of CRF. However, ACEI has little effect on CRF progression in rats with established CRF. We therefore examined whether combination therapy with ACEI and oral adsorbent for uremic toxins in the gastrointestinal tract has the desired effect. Methods: Rats subjected to subtotal nephrectomy were given enalapril at 20 mg/kg (n = 10, group E), AST-120 at 5 g (n = 10, group A), enalapril and AST-120 together at the same doses (n = 10, group EA), or no treatment (n = 10, group C) 8 weeks after the operation. The substances were administered in 100 g rat chow. All animals were pair-fed, and all were killed after 8 weeks of pair-feeding. Results: Body weight did not differ between groups during the study. Blood pressure at week 8 was significantly lower in groups E and EA than in groups C and A (p < 0.05). Urinary protein excretion level and renal plasma flow rate at week 8 were significantly less in groups E and EA than in group C (p < 0.05, p < 0.01). The glomerular filtration rate at week 8 was significantly higher in group EA than in group C (p < 0.05). The glomerular sclerosis index and interstitial fibrosis area at week 8 were significantly less in group EA than in group C (p < 0.01). Conclusion: ACEI and AST-120 in combination can delay progression of established CRF in rats by inhibiting the appearance of glomerular sclerosis and interstitial fibrosis.

ブラッドアクセスカテーテルを鼠径部に留置する場合, 当院では, コアクシャル型UKカテーテルを使用する際には, 歩行が可能であったという報告に基づき歩行を許可しているが, ダブルアクシャル型カテーテルを使用する際には, 同様の報告がないため歩行禁止としている. 今回, 各種ダブルアクシャル型カテーテルの柔軟性に対する基礎的研究を施行し, その中で最も柔軟性のあるカテーテルを使用し, 鼠径部に留置した時の体動を中心とした臨床的研究を行った.基礎的研究: コアクシャル型ブラッドアクセスUKカテーテル (UK-C), ダブルアクシャル型ブラッドアクセスUKカテーテル (UK-D), ダブルアクシャル型Vas-cath Flexxicon, ダブルアクシャル型Quinton血管留置用カテーテルを用いて, カテーテルの硬度を常温と37℃の条件で測定した. 常温ではUK-Cが最も硬度が低かったが, 37℃の温水ではUK-Dが最も硬度が低下した.臨床的研究: ブラッドアクセスとして, 最も柔軟性のあるUK-Dを使用し, 観察期間は6回のHD施行後までとした. 内頸静脈からアプローチした症例 (IJV group, n=20) の体動は制限しなかったが, 大腿静脈からアプローチした症例 (FV group, n=20) には体動を制限した. 試験開始時と終了時の体温, 白血球数, CRP, 血流量は両groupとも試験開始時と終了時で有意差はなかった. 試験終了時のカテーテル挿入部と縫合部の発赤発生率は, 両groupで有意差はなかった.UK-Dを鼠径部に短期間留置した場合, 本研究で許可した体動では内頸静脈からのアプローチと比較し, 臨床上問題となる感染や血栓形成には明らかな差は認めなかった. よって, 柔軟性のあるUK-Dを使用した場合には, 短時間の歩行や座位などの体動は許容範囲内であると思われた.

The relationship between insulin resistance and local uremic toxins was examined using an oral adsorbent. Fourteen rats demonstrating a diabetic state underwent two-thirds, nephrectomy and were divided into two groups. The control group was fed standard rat chow, and the test group was fed standard rat chow containing 5% AST-120. The target level of blood glucose was achieved by controlling the dosage of exogenous insulin. All rats were sacrificed at week 6. Body weight, blood glucose level, and renal function at week 6 were not significantly different between both groups. However, the mean blood glucose level and the mean dose of exogenous insulin in the AST-120-fed group were significantly reduced as compared with the control group. The results of the present study indicate that administration of an oral adsorbent in diabetic nephropathy decreases the doses of exogenous insulin and improves insulin resistance, and that uremic toxins which exist in the gastrointestinal tract play important roles.