Urea Kinetic Modeling 을 이용한 지속적 혈액투석 환자의 영양 상태 평가 = Nutritional Assessment in Patients with Maintenance Hemodialysis by Urea Kinetic Modeling

다국어 초록 (Multilingual Abstract)

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.