| 特集名 | 合併症を伴う透析患者の栄養指導 | |
|---|---|---|
| 題名 | 運動障害 | |
| 発刊年月 | 1998年 12月 | |
| 著者 | 桜井 俊宏 | 小山市民病院内科 |
| 著者 | 宮本 佳代子 | 自治医科大学附属病院栄養部 |
| 【 要旨 】 | 透析患者の運動障害のうち神経系，骨・関節障害は直接，運動障害の原因となりうる．神経系障害としては尿毒症性神経障害，脳血管障害などがあり，前者は不十分な透析や中分子量物質の蓄積で生じる．適切なたんぱく質摂取や十分な透析が必要となる．後者は透析患者では脳出血が多く，体重管理，血圧のコントロールが重要であり，食塩摂取量を1日5～7gに制限するべきである．骨・関節障害としては二次性副甲状腺機能亢進症(2°HPT)，アルミニウム(Al)骨症，無形成骨(ABD)，アミロイドーシスなどがある．2°HPTの進行の予防としては，食事中のリン(P)制限が必要でintact-PTHをモニターし，P吸着薬やビタミンD剤を投与する．Al蓄積の予防には，Al含有胃薬や著しく傷ついたAl鍋の使用を避ける．ABDの予防には，intact-PTHのモニターにより適切なP吸着薬やビタミンD剤を投与する．アミロイドーシスの予防には，high performance membraneの使用が有用である． | |
| Theme | Nutritional Guidance for Hemodialysis Patients with Complications | |
|---|---|---|
| Title | Disturbances in motor function in dialysis patients and nutritional education of dialysis patients | |
| Author | Toshihiro Sakurai | Department of Internal Medicine, Oyama Municipal Hospital |
| Author | Kayoko Miyamoto | Department of Nutrition, Jichi Medical School |
| [ Summary ] | Disturbances in motor function of dialysis patients are often associated with neurological disorders, as well as bone and joint disorders associated with renal osteodystrophy. Uremic neuropathy and cerebrovascular diseases (CVD) are main the contributors to neurological disorders. Uremic neuropathy often occurs in underdialysis states but may be corrected with adequate protein intake and dialysis. Cerebral hemorrhaging is more frequent than cerebral infarction in dialysis patients, because high blood pressure due to overhydration sometimes reaches an extreme degree. To reduce the risk of CVD and heart failure, weight gains between each dialysis session must be controled to within 5% of dry body weight, and dietary salt intake should be restricted to 5-7g per day. Secondary hyperparathyroidism (2°HPT) occurs in patients with poor phosphate control. Medications with phosphate binders, vitamin D parathyroidectomy, and protein restriction to less than 60g per day are quite important in preventing 2°HPT. Aluminum osteopathy may be prevented by avoiding aluminum-containing medicines and cooking aluminum pans. Dialysis with high performance membranes may slow down the progression of amyloidosis. Once patients develop these complications, they suffer from a poor quality of life. Since adequate dietary habit can reduce these complications in dialysis patients, nutrition education should be emphasized and repeated. |
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