臨牀透析 Vol.21 No.13(2-2)


特集名 年齢・病態に見合った腎不全患者の栄養管理
題名 栄養量の設定はどうあるべきか (2) 妊婦
発刊年月 2005年 12月
著者 出浦 照國 昭和大学藤が丘病院内科
【 要旨 】 頻度は低いが,透析患者の妊娠率が上昇し,分娩の成功率も上昇している.ところが,透析療法における適切な食事がどのような内容であるべきか確定しておらず,妊娠時の適正な食事についてもまだ確定していない.したがって当然,透析妊婦の食事を語ることはきわめて困難であるが,これまでの蓄積から方向性は見えてきつつある.栄養の基本はエネルギー摂取であるが,妊婦ではわずかな過不足が問題となる.たんぱく質もわずかな過不足が問題となる.いずれも正常妊婦の食事基準とほぼ同一量でよいと思われる.栄養摂取量の評価を聞き取りで検討するのではなく,食事記録とPCRで正確性を維持しなくてはいけない.微量元素と各種ビタミンへの配慮も必要である.
Theme Nutritional Management of Patients with Renal Failure -- Suitable for Ages and Clinical Conditions
Title Proper nutritional therapy for pregnant dialysis patients
Author Terukuni Ideura Department of Internal Medicine, Showa University Fujigaoka Hospital
[ Summary ] Although the number of successful pregnancies in dialysis patients has increased, it is uncommon for dialysis to become pregnant. Therefore, few hospitals have enough experience to make decisions on conception or to develop adequate care for patients who do become pregnant. Consequently, few studies on the untritional care of pregnant dialysis patients have been reported on. In addition, the guidelines for dietary treatment of regular non-pregnant dialysis patients have not been established. However, it is generally accepted that pregnant women receiving dialysis can usually be prescribed more liberal diets because of the increased frequency of dialysis treatment usually prescribed such as 1.2 g / kgBW / day for hemodialysis and 1.4 g / kgBW / day for peritoneal dialysis. Recomended energy requirements are as 35 - 40 kcal / kgBW / day. The adequate requirement of salt is 5 - 8 g / day, phosphate is 1,200 mg / day and calcium 1,200 mg / day. The majority of vitamins needed can be provided by supplements which should be provided on an individualized basis.
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