Korean Journal of Nephrology 1995;14(3):317-327.

혈액 투석 환자에서 영양상태와 요소 동력학 모형과의 상관관계

송민경 , 이승우 , 강신욱 , 최규헌 , 이호영 , 한대석 , 김영기 , 조미경 , 이종호

Abstract

Protein-calorie malnutrition is a common problem in patients undergoing maintenance hemodialysis due to multiple factors. It is well known that optimal nutritional support and adequacy of hemodialysis are the most important factors to determine the morbidity and mortality of these patients. To assess the relationship between nutritional status and dialysis adequacy, the present cross-sectional study was carried out assessing nutritional status by subjective global assessment and dietary food intake by 24 hour recall method as well as by anthropometric measurernent in 82 stable heodialy- sis patients. Individual nutritional status was compared with various biochemical and urea kinetic variables such as normalized protein catabolic rate, Kt/V and standardized creatinine clearance. 1) There were 57 men and 25 women with mean hernodialysis duration of 30.5 months and the most common causative disease was chronic glomeru- lonephritis in 42 cases(57.2%). The mean concentra- tion of albumin was 4.3±0.4 g/dl, normalized protein catabolic rate(NPCR) 1.04±0.24 g/kg/day, Kt/Vurea 1.30±0.31 and standardized creatinine clearance (SCCr) 66.56±10.69 Vwk/1.73m2. 2) Thirteen patients(15.9%) were classified as malnourished by subjective global assessment and the remaining sixty-nine patients(84.196) didnt show the evidences of malnutrition. 3) Malnourished patients had significantly longer hemodialysis duration and lower values in blood urea nitrogen concentration, residual renal funtion, normalized protein catabolic rate and Kt/Vurea than normal nutritional patients. 4) Normalized protein catabolic rate showed no correlation with serum albumin value, total body muscle, lean body mass and Kt/Vurea. But it revealed a weak positive correlation with residual renal funtion, TW-Kt/V and TWR-Kt/V. In conclusion, nutritional support and adequate dialysis should be emphasized in patients with longer hemodialysis duration and lower blood urea nitrogen. NPCR and KT/Vurea provide a rnore sensitive measure of nutritional status assessed by SGA in hemodialysis patients than anthropometry and other biochemical parameters such as serum albumin concentration. Therefore regular follow-up of NPCR and Kt/Vurea with an adequate adjustment of dialysis prescription may contribute to improve the nutritional status of patients. Further prospective study is needed to evaluate the exact relationship between dialysis dose and nutritional status of hemodialysis patients.