| 特集名 | 今日のCAPD療法 | |
|---|---|---|
| 題名 | CAPD患者の栄養管理 | |
| 発刊年月 | 2000年 12月 | |
| 著者 | 原 茂子 | 虎の門病院腎センター |
| 【 要旨 】 | 透析例の栄養障害は，社会復帰の障害，易感染性など合併症，さらには生命予後にもかかわる重要な問題である． CAPDは栄養面からみると，持続した糖負荷，蛋白喪失，長期化に伴う腹膜機能劣化による透析不足が特徴である．本稿ではCAPD例の栄養評価とそれにかかわる因子，栄養改善への対策を述べる． CAPD 45例の栄養評価をBMI，アルブミン，IGF-1でみると導入10年までは経年的に増加を示すが，10年以上例では低下を示し，10年以上例の栄養障害が明らかである．加齢に伴い有意に，IGF-1，アルブミンの低下もみられた． 栄養管理としてCAPDに対する食事療法とともに至適透析をはかる．血液透析の併用，あるいは血液透析への移行をはかる．栄養改善に対しては，アミノ酸製剤使用の再検討，rhGHの臨床応用が今後の課題である． |
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| Theme | CAPD Up-to-date 2000 | |
|---|---|---|
| Title | Nutritional management on CAPD patients | |
| Author | Shigeko Hara | Kidney Center of Toranomon Hospital |
| [ Summary ] | Malnutrition of long-term and aged dialysis patients, is a major problem, because disturbance of QOL and poor prognoses. A nutritional assessment was done for 45 cases of CAPD. BMI showed normal ranges in a patients. The values of BMI and serum alubumin levels gradualy increased after the start of dialysis therapy. However, over ten years on duration of dialysis the value of BMI, and albumin levels decreased. Over a ten year, period, levels of malnutrition in CAPD cases became apparent. Significantly, there was a negative correlation between age and IGF-1. Albumin levels were also observed in these patients. For management of states of malnutrition, adequent dialysis and diet therapy are applied for patients. Application of GH therapy has recently been reported for malnourished CAPD patients. In cases of underdialysis, changes to hemodialysis or combination therapy with hemodialysis, are nessesary. The elevation of IGF-1 levels is induced by the infusion of Arginine, and malnutritional states. Amino acid containg dialysate for CAPD, showed the improvements in Aminograms but complications of acidosis were observed. Further investigation is nesessary for management of malnutrition in CAPD cases. |
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