臨牀透析 Vol.35 No.8(13)


特集名 既存のガイドラインを透析患者にどう活用するか
題名 サルコペニア・フレイル・protein-energy wasting（PEW）
発刊年月 2019年 07月
著者 加藤 明彦 浜松医科大学医学部附属病院血液浄化療法部
【 要旨 】 サルコペニア，フレイルのガイドラインとして，「サルコペニア診療ガイドライン2017年版」と「フレイル診療ガイド2018 年版」が発刊されている．サルコペニアの診断はAsian Working Group for Sarcopenia（AWGS）基準で，身体的フレイルの定義は日本版Cardiovascular Health Study（J―CHS）基準を用いることが推奨されている．透析患者では，骨格筋量よりも握力や通常歩行速度などの身体機能のほうが生命予後と関連する．自宅での有酸素運動は，軽度～中等度強度の散歩を1日30分，非透析日を中心に週4～7日行い，当初の目標歩数は4,000 歩/dayとする．Protein―energy wasting（PEW）は，国際腎栄養代謝学会（ISRNM）の診断基準で評価する．しかし日本人透析患者では妥当性が低いため，新たな評価法が必要である．
Theme Available clinical guidelines for patients on dialysis
Title Sarcopenia, frailty and protein-energy wasting
Author Akihiko Kato Blood Purification Unit, Hamamatsu University Hospital
[ Summary ] As the Japanese guideline for sarcopenia and frailty, "Guidelines for the Management of Sarcopenia 2017" and "Clinical Guide for Frailty 2018" were published. It is recommended that the diagnosis of sarcopenia should be based on the criteria of Asian Working Group for Sarcopenia (AWGS), while physical frailty should be defined based on the criteria of Japanese version of Cardiovascular Health Study (J-CHS). In prevalent dialysis patients, physical functions, such as handgrip strength and usual walking speed, rather than skeletal muscle mass volume are more associated with survival prognosis. Therefore, as the home-based aerobic exercise, low- to moderate-intensity walks for 30 min for 4 to 7 days (mainly at non-dialysis day) a week are recommended for dialysis patients, and an initial goal recommended for the daily step count is 4,000. Protein-energy wasting (PEW) is diagnosed based on the definition of International Society of Renal Nutrition and Metabolism (ISRNM). However, this definition is not valid for Japanese dialysis patients; thus, a novel modified definition is required.
戻る