臨牀透析 Vol.25 No.13(1-2)


特集名 CKD患者の輸液と経腸栄養の指針 -- ステージ4・5患者への対策
題名 ［総論 -- CKDステージ4・5における低栄養の現状と対策］II. 栄養摂取状況および問題点
発刊年月 2009年 12月
著者 金澤 良枝 東京家政学院短期大学・管理栄養士／東京医科大学腎臓内科
著者 中尾 俊之 東京医科大学腎臓内科
【 要旨 】 慢性腎臓病のステージ4・5の保存期から透析期の栄養管理は，食事療法の遵守度が腎機能低下の進行度や透析量に大きく反映する．保存期の低たんぱく食事療法では，たんぱく質摂取量に差が大きく，またエネルギー管理が適正に実行されない場合は栄養状態の悪化も懸念される．透析期では，患者の年齢，合併症の有無，透析歴，活動量や意欲，食欲により食事摂取量に差が生じていることを経験する．長期に食事摂取エネルギー量が不足すると，低栄養状態となるので患者個々の摂取状況を把握し管理することが大切である．
Theme Strategies of Parenteral and Enteral Nutrition in Patients with Chronic Kidney Disease Especially at Stages 4 and 5
Title Nutrient intake in patients with chronic renal failure while receiving conservative therapy and dialysis
Author Yoshie Kanazawa Department of Life Science, Tokyo Kaseigakuin College / Department of Nephrology, Tokyo Medical University
Author Toshiyuki Nakao Department of Nephrology, Tokyo Medical University
[ Summary ] In patients receiving conservative therapy in pre-dialysis stages, restriction of salt and protein intake, concomitant with sufficient energy intake, can postpone the initiation of dialysis therapy. However, the actual intake of salt, protein and energy varies over a wide range in relation to differences in patient adherence to prescribed diet therapy. In patients receiving dialysis, individual differences in actual protein intake and energy consumption are great even though diet similar therapies have been prescribed. Protein-energy wasting (PEW) may possibly occur in cases where there is insufficient energy intake. Phosphate intake is closely correlated with protein intake. Unintentionally low nutrient intake contributing to PEW is primarily caused by anorexia in patients with chronic renal failure.
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