IV．CKD患者における肝炎，肝硬変治療
C型肝炎治療では，ゲノタイプ1型では慢性腎臓病（chronic kidney disease：CKD）患者においても95％以上の著効率が期待される．一方，2型に関しては，リバビリン（ribavirin：RBV）の併用のために中等度以上のCKD患者では使用できない状況である．B型肝炎治療では，アデホビルとテノホビルではeGFR（estimated glomerular filtration rate）の低下や低リン血症に注意して使用する必要がある．バソプレシン受容体拮抗薬トルバプタンは難治性腹水に有効であるが，その使用はフロセミド＋スピノロラクトンの少量投与時に追加する必要がある．...
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| Published in | 日本内科学会雑誌 Vol. 106; no. 5; pp. 936 - 941 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本内科学会
10.05.2017
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-5384 1883-2083 |
| DOI | 10.2169/naika.106.936 |
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| Abstract | C型肝炎治療では，ゲノタイプ1型では慢性腎臓病（chronic kidney disease：CKD）患者においても95％以上の著効率が期待される．一方，2型に関しては，リバビリン（ribavirin：RBV）の併用のために中等度以上のCKD患者では使用できない状況である．B型肝炎治療では，アデホビルとテノホビルではeGFR（estimated glomerular filtration rate）の低下や低リン血症に注意して使用する必要がある．バソプレシン受容体拮抗薬トルバプタンは難治性腹水に有効であるが，その使用はフロセミド＋スピノロラクトンの少量投与時に追加する必要がある． |
|---|---|
| AbstractList | C型肝炎治療では，ゲノタイプ1型では慢性腎臓病（chronic kidney disease：CKD）患者においても95％以上の著効率が期待される．一方，2型に関しては，リバビリン（ribavirin：RBV）の併用のために中等度以上のCKD患者では使用できない状況である．B型肝炎治療では，アデホビルとテノホビルではeGFR（estimated glomerular filtration rate）の低下や低リン血症に注意して使用する必要がある．バソプレシン受容体拮抗薬トルバプタンは難治性腹水に有効であるが，その使用はフロセミド＋スピノロラクトンの少量投与時に追加する必要がある． |
| Author | 中牟田, 誠 |
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| Copyright | 2017 一般社団法人 日本内科学会 |
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| DOI | 10.2169/naika.106.936 |
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| References | 13) Tanaka M, et al: Renal dysfunction and hypophosphatemia during long-term lamivudine plus adefovir dipivoxil therapy in patients with chronic hepatitis B. J Gastroenterol 49: 470-480, 2014. 2) Dalrymple LS, et al: Hepatitis C virus infection and the prevalence of renal insufficiency. Clin J Am Soc Nephrol 2: 715-721, 2007. 11) Pockros PJ, et al: Efficacy of direct-acting antiviral combination for patients with hepatitis c virus genotype 1 infection and severe renal impairment or end-stage renal disease. Gastroenterology 150: 1590-1598, 2016. 1) Park H, et al: A meta-analytic assessment of the risk of chronic kidney disease in patients with chronic hepatitis C virus infection. J Viral Hepat 22: 897-905, 2015. 3) Tanaka J, et al: Total numbers of undiagnosed carriers of hepatitis C and B viruses in Japan estimated by age- and area-specific prevalence on the national scale. Intervirology 54: 185-195, 2011. 9) Toyoda H, et al: Safety and efficacy of dual direct-acting antiviral therapy (daclatasvir and asunaprevir) for chronic hepatitis C virus genotype 1 infection in patients on hemodialysis. J Gastroenterol 51: 741-747, 2016. 4) 日本透析医学会: わが国の慢性透析療法の現況 (2007年12月31日). http://docs.jsdt.or.jp/overview/index2008.html 5) 日本透析医学会: 透析患者のC型肝炎治療ガイドライン. 日透析医学会誌 44: 481-531, 2011. 8) Suda G, et al: Efficacy and safety of daclatasvir and asunaprevir combination therapy in chronic hemodialysis patients with chronic hepatitis C. J Gastroenterol 51: 733-740, 2016. 17) Sakaida I, et al: Tolvaptan for improvement of hepatic edema: a phase 3, multicenter, randomized, double-blind, placebo-controlled trial. Hepatol Res 44: 73-82, 2014. 14) Shimizu M, et al: Predictors of kidney tubular dysfunction induced by adefovir treatment for chronic hepatitis B. World J Gastroenterol 21: 2116-2123, 2015. 12) Roth D, et al: Grazoprevir plus elbasvir in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and stage 4-5 chronic kidney disease (the C-SURFER study): a combination phase 3 study. Lancet 386: 1537-1545, 2015. 6) Fabrizi F, et al: The impact of hepatitis C virus infection on survival in dialysis patients: meta-analysis of observational studies. J Viral Hepat 14: 697-703, 2007. 7) 国府島庸之, 他: 腎機能低下C型慢性肝炎症例に対するダクラタスビル・アスナプレビル併用療法の安全性と有効性. 肝臓 57: 142-145, 2016. 15) 西島 健, 潟永博之: HIV感染者におけるテノホビルの腎障害. The Journal of AIDS Research 15: 1-6, 2013. 16) Maggi P, et al: Bone and kidney toxicity induced by nucleotide analogues in patients affected by HBV-related chronic hepatitis: a longitudinal study. J Antimicrob Chemother 70: 1150-1154, 2015. 10) Kawakami Y, et al: Pharmacokinetics, efficacy and safety of daclatasvir plus asunaprevir in dialysis patients with chronic hepatitis C: pilot study. J Viral Hepat 23: 850-856, 2016. |
| References_xml | – reference: 8) Suda G, et al: Efficacy and safety of daclatasvir and asunaprevir combination therapy in chronic hemodialysis patients with chronic hepatitis C. J Gastroenterol 51: 733-740, 2016. – reference: 4) 日本透析医学会: わが国の慢性透析療法の現況 (2007年12月31日). http://docs.jsdt.or.jp/overview/index2008.html – reference: 13) Tanaka M, et al: Renal dysfunction and hypophosphatemia during long-term lamivudine plus adefovir dipivoxil therapy in patients with chronic hepatitis B. J Gastroenterol 49: 470-480, 2014. – reference: 12) Roth D, et al: Grazoprevir plus elbasvir in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and stage 4-5 chronic kidney disease (the C-SURFER study): a combination phase 3 study. Lancet 386: 1537-1545, 2015. – reference: 10) Kawakami Y, et al: Pharmacokinetics, efficacy and safety of daclatasvir plus asunaprevir in dialysis patients with chronic hepatitis C: pilot study. J Viral Hepat 23: 850-856, 2016. – reference: 17) Sakaida I, et al: Tolvaptan for improvement of hepatic edema: a phase 3, multicenter, randomized, double-blind, placebo-controlled trial. Hepatol Res 44: 73-82, 2014. – reference: 3) Tanaka J, et al: Total numbers of undiagnosed carriers of hepatitis C and B viruses in Japan estimated by age- and area-specific prevalence on the national scale. Intervirology 54: 185-195, 2011. – reference: 15) 西島 健, 潟永博之: HIV感染者におけるテノホビルの腎障害. The Journal of AIDS Research 15: 1-6, 2013. – reference: 2) Dalrymple LS, et al: Hepatitis C virus infection and the prevalence of renal insufficiency. Clin J Am Soc Nephrol 2: 715-721, 2007. – reference: 16) Maggi P, et al: Bone and kidney toxicity induced by nucleotide analogues in patients affected by HBV-related chronic hepatitis: a longitudinal study. J Antimicrob Chemother 70: 1150-1154, 2015. – reference: 5) 日本透析医学会: 透析患者のC型肝炎治療ガイドライン. 日透析医学会誌 44: 481-531, 2011. – reference: 11) Pockros PJ, et al: Efficacy of direct-acting antiviral combination for patients with hepatitis c virus genotype 1 infection and severe renal impairment or end-stage renal disease. Gastroenterology 150: 1590-1598, 2016. – reference: 1) Park H, et al: A meta-analytic assessment of the risk of chronic kidney disease in patients with chronic hepatitis C virus infection. J Viral Hepat 22: 897-905, 2015. – reference: 7) 国府島庸之, 他: 腎機能低下C型慢性肝炎症例に対するダクラタスビル・アスナプレビル併用療法の安全性と有効性. 肝臓 57: 142-145, 2016. – reference: 14) Shimizu M, et al: Predictors of kidney tubular dysfunction induced by adefovir treatment for chronic hepatitis B. World J Gastroenterol 21: 2116-2123, 2015. – reference: 9) Toyoda H, et al: Safety and efficacy of dual direct-acting antiviral therapy (daclatasvir and asunaprevir) for chronic hepatitis C virus genotype 1 infection in patients on hemodialysis. J Gastroenterol 51: 741-747, 2016. – reference: 6) Fabrizi F, et al: The impact of hepatitis C virus infection on survival in dialysis patients: meta-analysis of observational studies. J Viral Hepat 14: 697-703, 2007. |
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| SubjectTerms | B型肝炎 C型肝炎 バソプレシン受容体拮抗薬 直接作用型抗ウイルス薬 |
| Title | IV．CKD患者における肝炎，肝硬変治療 |
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