臨牀透析 Vol.26 No.13(2-2)


特集名 身体所見からのCKD患者の栄養評価の重要性
題名 [各論]血圧の評価
発刊年月 2010年 12月
著者 草場 哲郎 京都第一赤十字病院腎臓内科・腎不全科
【 要旨 】 慢性腎不全患者では腎臓からのナトリウム排泄が障害された結果,食塩感受性高血圧,夜間高血圧となる.夜間高血圧は腎機能障害の進展,心血管系疾患発症の強力な危険因子であり,血圧を適切に管理するためには,家庭血圧を指標に降圧療法を行うのが望ましい.塩分の過剰摂取は体液量の増加から高血圧を誘発し,透析患者にあっては過度の透析間体重増加の原因となる.したがって,生活変容として塩分制限を行う必要があり,その成否には多職種による介入が重要である.一方で,慢性腎不全患者では味覚異常を有する頻度が高く,減塩を困難にしている.味覚異常の原因の一つが食塩摂取過剰であり,短期間でも減塩とすることでその異常は改善する.
Theme Importance of Nutritional Assessment by Physical Examination in CKD
Title Management of hypertension in chronic kidney disease patients
Author Tetsuro Kusaba Division of Nephrology, Kyoto First Red Cross Hospital
[ Summary ] Chronic kidney disease (CKD) patients experience disturbances in sodium excretion from the kidneys, frequently lead to non-dipper, salt-sensitive type or nocturnal hypertension. In addition, nocturnal hypertension is a powerful predictor for both the progression of CKD and cardiovascular diseases. Because of this, appropriate blood pressure control is vital. In home blood pressure monitoring should be carried out. Sodium restriction is also beneficial and reasonable treatments for salt sensitive individuals such as CKD patients should be provided. Moreover, especially in hemodialysis patients, appropriate sodium intake is required for prevention of excessive interdialytic weight gain.
However, sodium restriction is sometimes difficult to achieve. One contributing factor relevant to difficulties in sodium restriction is salt taste dysfunction, which is commonly observed in CKD patients. Excessive salt intake and zinc deficiencies induce taste disturbances in salt perception. Even over short periods, sodium restriction will improve salt taste acuity. To restrict sodium easily and effectively for hypertension treatment, physicians should be more concerned with taste disturbances in CKD patients.
戻る