Korean Journal of Nephrology 1997;16(2):309-315.
만성혈액투석 환자에서 식이와 대사성산증과의 관계
이영기 , 권영주 , 김난희 , 윤종우 , 조상경 , 위경소 , 김용ㅅ버 , 차대룡 , 조원용 , 표희정 , 김형규 , 허인선
Abstract
Objectives: It has been known that the inci- dence of protein malnutrition is high in patients with chronic renal failure(CRF). Although the effect of uremia on protein metabolism has not been known dearly, some reports suggest that metabolic acidosis, one of the uremic manifestations, increases protein catabolism. In a steady state, acid production is ma- inly related to dietary protein intake. Also severe a- cidosis causes anorexia and may decreases protein intake. But the relationship between diet and meta- bolic acidosis in chronic dialysis patients has not been established. In order to investigate the relation between metabolic acidosis and diet in CRF patients, we analyzed the diet intake and the nutritional status in chronic dialysis patients with or without sev- ere metabolic acidosis. Methods: We selected 10 patients as an acidosis group (total CO' < 14.0mEq/L) and 10 patients with acid-base balance as control group (total C O'> 17.5mEq/L) among patients who have been receiving hemodialysis. Results - The mean ages and male to female rati- os were similar in both groups, but in the under- lying diseases of acidosis group, non-chronic glome- rular nephritis (nonCGN) was more prevalent. Wee- kly hemodialysis time of the acidosis and the control group were 10.20, 11.45hours per week, respectively. The concentrations of pre-dialysis BUN were 89,74 vs. 71.25mg/Dl and Npcr were 1.289 vs. 1.035g/kg/ day in each group.. However, the analysis of dietary protein intake showed no significant difference bet- ween both groups. The nutritional status of both groups were similar. Conclusion: In CRF patients, metabolic acidosis increases protein catabolism by stimulated amino acid oxidation and protein degradation in muscle. This study therefore suggests that patients with metabolic acidosis need to receive more adequate dialysis to correct the acidosis. And we recommend the indivisualization of protein intakes rather than the indiscriminate protein restriction in CRF patients with metabolic acidosis.
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