特集名 | 慢性腎臓病における食事療法を再考する -- ガイドライン (1997年) は適正か? | |
---|---|---|
題名 | 慢性腎臓病のステージ別にみた食事療法 (1) 保存期慢性腎不全 (非糖尿病) | |
発刊年月 | 2006年 12月 | |
著者 | 椎貝 達夫 | 総合病院取手協同病院腎臓内科 |
【 要旨 】 | 保存期腎不全の治療に食事療法 (DT) が必要なことは論じるまでもないが,レニン・アンジオテンシン系 (RAS) 阻害薬という新たな腎保護薬を手に入れた状態でのDTのあり方を調べる必要はある.筆者らは,JAPAN-KD試験でRAS阻害下のDTの意義を多施設のランダム下比較試験にて検討している. また,わが国には食事たんぱく摂取量 (DPI) 0.58g/標準体重kg以下の極端な低たんぱく食しか腎不全進行抑制に効果がないという説がある.筆者らが全国から訪れる腎不全患者の24時間蓄尿の分析によりDPIを調べると,51.1%で極端な低たんぱく食が行われていた.DPI 0.75 - 0.85g/標準体重kgの低たんぱく食で有効なことは文献上明らかである.また0.6g/標準体重kgでさえ栄養障害の危険が高く,非糖尿病性腎不全には0.7 - 0.8g/標準体重kgのDPIが推奨される. |
Theme | Reconsidering of Diet Therapy for Patients with Chronic Kidney Disease -- Is the clinical guideline for diet therapy edited by Japanese Society of Nephrology at 1997 valid? | |
---|---|---|
Title | Diet therapy for treatment of progressive renal failure due to non-diabetic nephropathy | |
Author | Tatsuo Shiigai | Department of Nephrology, Toride Kyodo General Hospital |
[ Summary ] | The role of diet therapy (DT) in delaying the progression of chronic renal failure remains important. However, the necessity of DT has decreased somewhat since the introduction of renin-angiotensin system blocking therapy (RASBT). Attempts were made to check the effects of DT with the RASBT through a multi-centered, randomized trial. Meanwhile, one school of thought insists that a very low protein diet (VLPD) is only effective in delaying progression of the condition. There is concern over the prevalent use of treatments such as VLPD, because their use presents a great risk of malnutrition. Protein intake in the 0.75 - 0.85 g / st Wt kg level has been seen to be effective in the current literature. If target of protein intake is roughly 0.6 g / st Wt kg, the patient may be at risky, falling into the 0.58 g / st Wt kg category. Therefore, a 0.75 - 0.85 g protein intake is recommended for renal failure patients with non-diabetic kidney disease. |