| Theme |
Emaciation in Chronic Dialysis Patients |
| Title |
Obesity and emaciation in chronic renal failure patients on dialysis |
| Author |
Eikichi Watanabe |
Department of Nutrition, Shinraku-en Hospital |
| Author |
Ichiro Nakagawa |
Clinical Engineering, Shinraku-en Hospital |
| Author |
Yutaka Koda |
Internal Medicine, Shinraku-en Hospital |
| Author |
Masashi Suzuki |
Internal Medicine, Shinraku-en Hospital |
| Author |
Yoshihei Hirasawa |
Internal Medicine, Shinraku-en Hospital |
| [ Summary ] |
Body weight loss or emaciation has been recognized to be common among chronically dialyzed patients. In deed, 49.3% of our chronic hemodialysis patients showed emaciation (i.e. body mass index=BMI<20) while, only 6.9% of them showed signs of obesity (BMI>24). This suggests that conventional diet therapy might be incomplete, and/or that chronic dialysis therapy itself might induce states of malnutrition. The common phenomena of malnutrition among chronic dialysis patients with low BMI which shows decreased muscle mass and fatty tissue, low creatinin generation rates which shows decreased muscle mass, and low serum albumin levels. These are mainly dependent on a lack of energy and protein. As many reports indicate, malnutrition produces a poor prognosis for dialysis patients. Therefore, an appropriate estimation of the nutritional status, and suitable nutritional support are indispensable. Normalized protein catabolic ratios (nPCR) have been thought to be standard markers of the daily protein intake for patients on dialysis. However, nPCR is based on actual body weight (BW), which may already show signs of emaciation. We propose the use of PCR to balance against the desirable affects of BW (dPCR) as a recommended indicator of the daily intake of protein. Because a desirable BW is usually greater than the real BW in chronically dialyzed patients, the values of nPCR will be greater than those of dPCR. Therefore, nPCR tends to show falsely "sufficient" protein intake levels. For a suitable diet therapy education for the malnurished patients, dPCR should be chosen rather than nPCR. |