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| 유지혈액 투석을 받고 있는 만성신부전 환자의 영양 장애에 영향을 미치는 인자 (Factors Influencing Malnutrition in Maintenance Hemodialysis Patients) |
| 이재홍(Jae Hong Lee),안선호(Sun Ho An),송주흥(Joo Heung Song) |
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| Abstract |
Background
Malnutrition in maintenance hemodialysis(HD) patients has been referred to underdialysis with low protein intake and to metabolic acidosis. However, the respective effects of underdialysis, protein intake and metabolic acidosis have not been clearly demonstrated. To evaluate the role of the dialysis dose, protein intake and metabolic acidosis on nutrition, we measured the predialysis serum HCO₃, pH, serum albumin, PCRn, Kt/V, and BMI in 41 uremic patients on maintenance bicarbonate HD for 66.93±51.86 months. Patients with chronic liver diseases, malignancies, diabetes and cachexia were excluded. Results: Mean age was 46±13 years; Kt/V, 1.22±0.27; PCRn, 0.90±0.16g/kg/day; serum albumin, 4.2±0.21g/dL; BMI, 20.47±2.09kg/m²; HCO₃, 18.4±2.9mEq/L; Serum albumin showed a significant direct correlation with PCRn(p=0.001), and a significant inverse correlation with serum HCO₃(r=0.43, p<0.01) but no correlation with Kt/V and BMI. PCRn showed a significant inverse correlation with serum HCO₃(p<0.01), and a direct correlation with Kt/V(p<0.05). Multiple regression analysis confirmed the significant role of protein intake but not of Kt/V and serum bicarbonate, on serum albumin concentrations. Dividing patients into two groups, serum albumin was 4.05±0.34g/dL in those with HCO₃<20mEq/L and 3.95±O.24g/dL in those with HCO₃>20mEq/L. PCRn in the former was 0.94±0.6g/kg/day and in the latter 0.80±0.14g/kg/day(p<0.05). The role of PCRn appeared to be more important than metabolic acidodsis in determining the serum albumin levels. Conclusions: In patients hemodialyzed with relatively adequate Kt/V and whose serum bicarbonate levels maintained within mild acidosis range, PCRn may exert a detrimental effect on serum albumin concentration. |
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