| 特集名 | 管理栄養士からみた透析患者の食事療法のポイント -- 新たなエビデンスにつなげるために | |
|---|---|---|
| 題名 | 外来通院症例から学ぶ (1) 血液透析 3. 長期維持期（20年） | |
| 発刊年月 | 2012年 11月 | |
| 著者 | 鈴木 正司 | 信楽園病院腎センター |
| 著者 | 梶井 由美子 | 信楽園病院・管理栄養士 |
| 【 要旨 】 | 25年以上の29例の超長期透析例では筋肉量の減少（痩せ）が特徴的であった．慢性腎炎由来の男性例では％CGR，nPCRとも良好で，BMIも正常で「痩せ」はみられなかった．同時に透析量（Kt/V）も良好で，むしろ栄養摂取過多（脂質異常症，高P血症，高K血症）を認め，栄養指導と薬物治療が有効であった．2型糖尿病由来の女性例では網膜症，ASOによる左大腿切断でQOLの低下が著明となった．惣菜・弁当中心の食事で血糖管理不良となり，体重増加による除水困難・透析時低血圧をきたしている．しかしBMIの低下はない．2例ともに「痩せ」がなく，5時間透析を継続している点が共通であった． | |
| Theme | Points of dietary therapy for national registered dietitian to establish clinical guideline for nutrition in dialysis patients | |
|---|---|---|
| Title | Long-term conservation of muscle mass for dialysis patients | |
| Author | Masashi Suzuki | Kidney Center, Shinraku-En Hospital |
| Author | Yumiko Kajii | Department of Nutrition, Shinraku-En Hospital |
| [ Summary ] | Twenty nine long-term non-diabetic hemodialysis (HD) patients were treated at our institution. Those treated for over twenty five years exhibited notable loss of muscle mass. Lower serum creatinin and BMI levels were observed, in spite of higher protein intakes. A typical male subject who was treated for 20 years did not demonstrate significant loss of muscle mass when there was a relatively high creatinin generation rate or higher protein intake levels. However, lowered protein intake levels and administration of statin drugs were necessary to reduce hyperlipidemia and hyperphosphatemia. A female diabetic HD patient who was treated for twenty three years and was dependant on insulin had an appropriate BMI. However, in the last three years she has required amputation of her left leg and has had inadequate HbA1c levels. These cases suggest that conservation of muscle mass through proper nutrition combined with appropriate dialysis techniques, may be possible for long-term dialysis patients. |
|