| 特集名 | 臨床検査値から栄養管理への展開 | |
|---|---|---|
| 題名 | カルシウム，リンの異常とその栄養学的対策 | |
| 発刊年月 | 2001年 11月 | |
| 著者 | 大場 由理 | 春日部秀和病院栄養室・管理栄養士 |
| 著者 | 栗原 怜 | 春日部秀和病院腎臓内科 |
| 【 要旨 】 | 透析患者ではビタミンD(VD)欠乏による腸管からのカルシウム(Ca)吸収低下，および腎からのリン(P)排泄低下により，しばしばCa,Pの代謝異常が進行し腎性骨異栄養症や異所性石灰化を発症する．これらを予防するためにはVD製剤やP吸着剤による治療とともにCa,Pに対する栄養学的食事指導が重要である．たんぱく質やCa含有量の多い食品は通常P含有量も多いため，透析患者では適度の摂取制限が必要となる．P含有量の多い食品は乳製品，魚介類，レバー，日本そば，保存食品などである．必要量のたんぱく質が摂取されたうえでかつ血清P濃度を適正に維持するためには，ほとんどの患者でP吸着剤の服用が必要となる． 臨床検査データ，合併症の状態，服薬内容，患者の食事嗜好などをよく把握し，栄養不良状態に陥らない範囲での積極的なP摂取制限を行っていく必要がある． |
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| Theme | Expanding Clinical Experimental Findings for Nutritional Management | |
|---|---|---|
| Title | Nutrition and dietary guidance for abnormal metabolism of calcium and phosphorus in dialysis patients | |
| Author | Yuri Oba | Department of Nutrition, Kasukabe-Shuwa Hospital |
| Author | Satoshi Kurihara | Department of Nephrology, Kasukabe-Shuwa Hospital |
| [ Summary ] | In dialysis patients, abnormal metabolism of calcium(Ca) and phosphorus(P) frequently develops due to decreased excretion of P from the kidney and the decreased absorption of Ca from the intestine resulting from vitamin D deficiency. Low serum Ca and high serum P lead to renal osteodystrophy due to the overse cretion of parathyroid hormone, and high Ca-P products increase the risk of metastatic soft tissue calcifications, especially within the cardiovascular system. To prevent these serious complications, dietary guidance on Ca and P intake is very importants. Food high in protein and/or Ca contents are usually high in P and must be therefore restricted in dialysis patients. High P containing foods are dairy products, fish and shellfish, liver, buckwheat noodles, and preserved food. If protein intake is adequate, there is almost always a requirement for phosphate binders to appropriately control serum P. Based on clinical laboratory data, the status of complications, the medications taken, and the patients' food preferences, dietary P intake should be aggressively restricted in order to maintain a healthy nutritional status in dialysis patients. |
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