혈액투석환자의 식이조사 및 Protein Catabolic Rate에 관한 연구

장유경(Chang Yu-Kyung),진윤경(Jin Yun-Gyung),박한철(Park Han-Chul) 韓國營養學會 1992 Journal of Nutrition and Health Vol.25 No.3

Urea Kinetic Modeling 을 이용한 지속적 혈액투석 환자의 영양 상태 평가

최규복(Gyu Bog Choi),변정란(Jung Lan Byun),박정은(Jeong Eun Park),이은영(Eun Young Lee),이지수(Ji Soo Lee),편욱범(Wook Bum Pyun),고영엽(Young Youp Koh),윤견일(Kyun Ill Yoon) 대한내과학회 1994 대한내과학회지 Vol.46 No.2

N/A Objectives: Nutritional factors play a role in the morbidity and mortality of patients in maintenance hemodialysis as well as in their quality of life and ultimate rehabilitative potential. It was reported that if the deviation of urea distribution volume calculated by Urea Kinetic Modeling(UKM) (Vol-Dev) from Anthropometric volume exceeded the acceptable range, clinical application of the NPCR (normalized protein catabolic rate) as nutritional index might be inappropriate. And it was also reported that if the KT/Vurea without consideration of residual renal function (D-KT/V) was above 1.5 or below 0.8, the NPCR might be inaccurate. So we selected patients whose Vol-Dev was within the acceptable range and grouped according to the D-KT/V. Then we analyzed the relationship between the NPCR and other nutritional parameters. Methods: We selected 17patients undergoing maintenance hemodialysis with adequate Vol-Dev level and grouped as group 1 if D-KT/V was between 0.8 and 1. 5, as group 2 if D-KT/V was below 0.8 or over l.5, We measured the mean level of albumin, calcium, phosphorus and hematocrit and calculated midarm muscle area (MAMA), midarm fat area (MAFA) as anthropometric measurements. Results: 1) Nutritional Index: There were no differences in serum albumin, calcium, phosphorus and hematocrit between two groups. The mean MAMA of group 1 (37.4cm2) was not different from that of group 2(27.9cm2), but mean MAFA of group 1(19.2cm2) was significantly higher than that of group 2(14.3cm2). The NPCR of group 1 (1.00) was not different from that of group 2(1.12). 2) UKM Parameter: The mean level of D-KT/V as single dialysis dose in group 1 (1.23) was significantly lower than that of group 2(1.69) and the mean level of TW-KT/V as weekly dialysis dose in Group 1 (3.17) was significantly lower than that of Group 2(4.05). The mean level of TWR-KT/V as weekly dialysis dose with consideration of residual renal function in Group 1(3.24) was significantly lower than that of Group 2(4.07) also. 3) Correlation between NFCR and dialysis dose: There was no correlation between D-KT/V and NPCR in both Group. In group 1, there was positive correlation between NPCR and TW-KT/V or TWR-KT/V. But in group 2, there was no correlation between NPCR and TW-KT/V or TWR-KT/U. 4) Correlation between NPCR and Nutritional Index: There was no correlation between NPCR and serum nutritional index (albumin, calcium, phosphorus, hematocrit). There was also no correlation between NPCR and anthropometric parameter (MAMA, MAFA). Conclusions: It is not likely that the NPCR reflects the protein catabolic rate accurately in case of D-KT/V exceeded adequate level (0.8≤, ≤1.5). Although the protein catabolic rate might be increased due to the effect of dialysis itself, there was no significant change in the nutritional status of patients. Even though the D-KT/V was within the adequate level, it is difficult to evaluate the patients nutritional status with NPCR only.

혈액투석 환자에서 영양 지표로서의 투석 간 체중 증가

신호식,정연순,임학 KOSIN UNIVERSITY COLLEGE OF MEDICINE 2006 高神大學校 醫學部 論文集 Vol.21 No.1

Background: Interdialytic weight gain (IDWG) is mainly resulted from salt and water retension between two dialysis sessions. The consequences of IDWG have been interpreted in two different ways. While a high interdialytic weight gain is considered to be an indicator of noncompliance, it could also be interpreted as an index of appetite. Water and salt retension give rise to a volume overload, which may lead to high blood pressure and left ventricle hypertrophy. On the other hand, the water and saline intake can be done along with caloric and protein foods, which may result in a better nutritional status. In the latter case, the interdialytic weight gain (IDWG) can be an index of appetite. The objective of the this study was to investigate the relationships between the IDWG and indicators of malnutrition, and hypertension in hemodialysis (HD) patients. Methods: We conducted a retrospective study in which 74 HD patients with ages between 22 and 74 were involved (36 males and 38 females) and collected average values of %IDWG accordings to dry weight (%IDWG/DW), nutritional parameters, and mean blood pressure (MBP) during the initial 4 week-period of dialysis. Patients were divided into 2 groups according to %IDWG/DW (group Ⅰ%IDWG/DW ≥3, group Ⅱ %IDWG/DW <3). Student t test, linear regression analysis, and Kaplan-Meier survival curves compared with log-rank test were used for statistical evaluation of data. Results: In group Ⅰ, blood urea nitrogen (BUN) (P=0.037), plasma K+(P=0.025), and normalized protein catabolic rate (nPCR) (P=0.024) were significantly higher than those of group Ⅱ. MBP, albumin, hemoglobin, phosphate, calcium and total cholesterol levels in the plasma showed no significant difference between the two groups. Survival rate showed no statistical difference between the two groups. Survival rate in diabetic group tended to be lower than the non-diabetic group. Conclusion: These results suggest that a greater IDWG may be associated with a better nutritional status as reflected by a higher nPCR, BUN and serum K level, although it is not associated with albumin, hemoglobin and total cholesterol levels. This, in turn, suggest a possible risk developing a malnutrition in HD patients with low IDWG.

혈액투석 환자에서 영양 지표로서의 투석 간 체중 증가

신호식,정연순,임학 고신대학교(의대) 고신대학교 의과대학 학술지 2006 고신대학교 의과대학 학술지 Vol.21 No.1

Background: Interdialytic weight gain (IDWG) is mainly resulted from salt and water retension between two dialysis sessions. The consequences of IDWG have been interpreted in two different ways. While a high interdialytic weight gain is considered to be an indicator of noncompliance,it could also be interpreted as an index of appetite. Water and salt retension give rise to a volume overload,which may lead to high blood pressure and left ventricle hypertrophy. On the other hand, the water and saline intake can be done along with caloric and protein foods, which may result in a better nutritional status. In the latter case, the interdialytic weight gain (IDWG) can be an index of appetite. The objective of the this study was to investigate the relationships between the IDWG and indicators of malnutrition, and hypertension in hemodialysis (HD) patients. Method$> We conducted a retrospective study in which 74 HD patients with ages between 22 and 74 were involved (36 males and 38 females) and collected average values of %IDWG accordings to dry weight (%IDWG/DW), nutritional parameters, and mean blood pressure (MBP) during the initial 4 week,period of dialysis. Patients were divided into 2 groups according to %IDWG/DW (group I %IDWG/DW ^3, group II %IDWG/DW <3). Student t test,linear regression analysis,and Kaplan-Meier survival curves compared with log-rank test were used for statistical evaluation of data. Results: In group I,blood urea nitrogen (BUN) (P=O,O37),plasma K+ (P=0.025),and normalized protein catabolic rate (nPCR) (P=0.024) were significantly higher than those of group II. MBP, albumin,hemoglobin, phosphate,calcium and total cholesterol levels in the plasma showed no significant difference between the two groups. Survival rate showed no statistical difference between the two groups. Survival rate in diabetic group tended to be lower than the non-diabetic group. Conclusion: These results suggest that a greater IDWG may be associated with a better nutritional status as reflected by a higher nPCR,BUN and serum K level, although it is not associated with albumin,hemoglobin and total cholesterol levels. This,in turn, suggest a possible risk developing a malnutrition in HD patients with low IDWG,