臨牀透析 Vol.17 No.12(3)


特集名 臨床検査値から栄養管理への展開
題名 透析患者の蛋白代謝の栄養評価 -- Kt/V,PCR,CHI，アルブミン，クレアチニンからの評価
発刊年月 2001年 11月
著者 渡辺 栄吉 信楽園病院栄養科・管理栄養士
著者 鈴木 正司 信楽園病院内科
著者 平沢 由平 信楽園病院内科
【 要旨 】 多くの透析患者にたんぱく性の低栄養の状態が観察される．すなわち，筋肉量の減少(Cr産生速度，Crの減少，%CHIの減少)，血清蛋白濃度の低下(Albの低下)，たんぱく摂取量の不足(dPCRの低下)が，半数以上の患者にみられた．しかも，これらのパラメータ間には明瞭な相関性が認められ，dPCRと%CHI，透析前Cr,Alb,P，K,Kt/Vの間にも相関関係が認められた．しかし，透析効率は向上したが，高齢者のdPCR，%CHI,Cr,Alb,TFは加齢とともに低下の傾向が強くなっており，これらの蛋白栄養指標の多くは，予後と密接に関係していることが立証されており，内臓蛋白指標を良好に維持するためのたんぱく性低栄養の予防と治療は，透析患者の長期生存に重要である．
Theme Expanding Clinical Experimental Findings for Nutritional Management
Title Nutritional status evaluations of protein metabolism among chronic dialysis patients : from the aspects of Kt/V, protein catabolic rate, creatinine height index, and serum albumin or creatinine concentrations
Author Eikichi Watanabe Kidney Center, Shinraku-en Hospital
Author Masashi Suzuki Kidney Center, Shinraku-en Hospital
Author Yoshihei Hirasawa Kidney Center, Shinraku-en Hospital
[ Summary ] A state of protein manutrition has frequently been recognized in approximately half of all chronic dialysis patients. For example, deceased serum protein levels evaluated by low serum albumin(Alb) concentrations, decreased muscle protein mass through low serum creatinin(Cr) levels, low creatinine generation rates(CGR), a creatinine height index(%CHI), as well as decreased dietary protein intake along with low protein catabolic rates(dPCR). These parameters have overt correlations with each other. Furthermore, dPCR has positive correlations to predialysis serum Cr, Alb, phosphate(P), potassium(K) levels and Kt/V.
In spite of the improved dialysis efficiency, decreased dPCR, %CHI, Cr, Alb and transferrin(TF) are commonly seen in aged patients. Protein malnutrition parameters have been reported to be close predictors of poor prognoses. It is very important to maintain appropriate visceral protein parameters. Therfore, prevention and amendment of protein malnutrition is necessary for prolonged patient' survival.
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