Korean Journal of Nephrology 2001;20(4):654-662.

논평 : 지속성 외래 복막투석 환자에서 영양상태와 투석의 적절도 (Editorial : Dialysis Adequacy and Nutritional Status in Patients with Continuous Ambulatory Peritoneal Dialysis ( CAPD ))

박미정(Mi Jung Park),이균상(Kyun Sang Lee),조민석(Min Seok Cho),김정기(Jeong Ki Kim),박병석(Byoung Seok Park),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),나명윤(Myong Yun Nah),염충호(chung Ho Yeum),정권(Jung Gwon),김수완(Soo Wan Kim),김남호(Nam Ho Kim),최기

Abstract

Purpose
- Malnutrition is common in CAPD patients and depends on many factors such as dialysis-related and nondialysis-related factors. The present study aimed to assess nutritional status, dialysis adequacy and their relationships with overall mortality and morbidity. Methods - We studied 102 patients who had been receiving CAPD for at least 6 months. Dialysis adequacy was assessed by parameters derived from urea kinetic modeling(UKM) and nutritional status was assessed by serum biochemical measurement, normalized protein catabolic rate(nPCR), normalized protein equvalent of total nitrogen appearance(nPNA) and urea kinetic studies. Spearman's simple correlation and multiple linear stepwise regression analysis were used to assess correlation between dialysis adequacy and nutritional status in CAPD patients. We compared the differences between patients who suffered morbid events, defined as either an infectious complication or hospitalization, and patients who remained well. Results : The results showed that the total dialysis dose(total weekly Kt/Vurea ) has statistically significant correlation with nPCR(r=0.234, p=0.028), nPNA (r=0.246, p=0.021), total weekly creatinine clearance (WCC)(r=0.479, p=0.0001), serum albumin levels(r= 0.233, p=0.029), serum cholesterol(r=0.266, p=0.013), serum BUN(r=-0.290, p=0.006) and serum creatinine levels(r=-0408, p-0.0001). nPNA was positively correlated with serum cholesterol(r=0.217, p=0.045), serum transferrin(r=0.218, p=0.042) and serum ferritin levels(r=0.220, p=0.043). Patients who suffered morbid events had an old age(p=0.001), long duration of CAPD(p=0.0001), higher CRP(p=0.021), lower serum albumin level(p=0.020), lower hematocrit(p=0.049) and lower WCC(p=0.017). Conclusions: These results indicate that adequate dialysis is very important for the maintenance of adequant nutrition because nutritional status positively correlated with dialysis dose, which is best assessed by UKM. In addition, assessment of nutritional status and dialysis adequacy are important in predicting clinical outcomes in CAPD patients.