-1 [6] (malnutrition) (inflammation) 10~20 [11] (atherosclerosis) Malnutrition-Inflammation- Atherosclerosis syndrome (MIA syndrome) MIA (endothelium)

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あいぞうかたづ
5 years ago
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1 1993 Owen WF Jr New England Journal of Medicine (albumin) [1] 40 70% [2-4] (1) (2) (3) [5] ( 1 ) (2) (3) (4) 1931 Lyon et al [6] [7-10] (1) (2) (3) (4) (5) leptin -1 (insulin-like growth factor-1) [6] (pro-inflammatory cytokines) (acute phase reactants)

-1 [6] (malnutrition) (inflammation) 10~20 [11] (atherosclerosis) Malnutrition-Inflammation- Atherosclerosis syndrome (MIA syndrome) MIA (endothelium) [12] X-ray [14] (Subjective Global Nutritional

2 -1 [6] (malnutrition) (inflammation) 10~20 [11] (atherosclerosis) Malnutrition-Inflammation- Atherosclerosis syndrome (MIA syndrome) MIA (endothelium) [12] X-ray [14] (Subjective Global Nutritional Assessment, SGA) ( ) ( 1) (Anthropometry) (Anthropometry) ( 1) National Health and Nutrition Examination Surveys (NHANES II) [13] (Dual Energy X-ray Absorptiometry, DEXA) X-ray SGA (A B C )

3 死亡勝算 [15] [16] protein equivalent of nitrogen appearance (npna) (95%) [17] (Daily protein intake) (1) (albumin) (21 ) ( ) 3 g/dl ( 2) [1] (2) (pre-albumin) (2 ) (3) (transferrin) [18] (4) (cholesterol) 200 mg/dl [19] 比6 3 0 < g/dl 2. ( 1)

4 [20-24] (Low Protein Diet, LPD)0.6 (0.6 g/kg/day) Walser Trevino-Becerra (0.3 g/kg/day) (ketoacids) (ketosteril) [25-26] (National Kidney Foundation, NKF) Kidney/Disease Outcomes Quality Initiative (K/DOQI) GFR 20 ml/min (1) (2) (edema-free weight) (NHANES II) (SGA) (3) (PNA) (1) (2) (3) (GFR 15 ml/min) GFR 25 ml/min 0.6 g/kg/day 0.75 g/kg/day GFR 25 ml/min 6035 kcal/kg/ day kcal/kg/ day GFR ml/min

5 1. Owen WF Jr, Lew NL, Liu Y, et al: The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993; 329: Thunberg BJ, Alagiri PS, Cestero RV: Cross-sectional and longitudinal nutritional measurements in maintenance hemodialysis patients. Am J Clin Nutr 1981; 34: Schoenfeld PY, Henry RR, Laird NM, et al: Assessment of nutritional status of the National Cooperative Dialysis Study population. Kidney Int Suppl 1983: S Marckmann P: Nutritional status of patients on hemodialysis and peritoneal dialysis. Clin Nephrol 1988; 29: Guarnieri G, Toigo G, Fiotti N: Mechanism of malnutrition in uremia. Kidney Int Suppl 1997; 62: S Mehrotra R, Kopple JD, Wolfson M: Metabolic acidosis in maintenance dialysis patients: Clinical considerations. Kidney Int Suppl 2003; 88: S Lim VS, Yarasheski KE, Flanigan MJ: The effect of uremia, acidosis, and dialysis treatment on protein metabolism: A longitudinal leucine kinetic study. Nephrol Dial Transplant 1998; 13: Reaich D, Channon SM, Scrimgeour CM, et al: Correction of acidosis in humans with CRF decreases protein degradation and amino acid oxidation. Am J Physiol 1993; 265: E Graham KA, Reaich D, Channon SM, et al: Correction of acidosis in CAPD decreases whole body protein degradation. Kidney Int 1996; 49: Graham KA, Reaich D, Channon SM, et al: Correction of acidosis in hemodialysis decreases whole-body protein degradation. J Am Soc Nephrol 1997; 8: Foley RN, Parfrey PS, Sarnak MJ: Clinical epidemiology of cardiovascular disease in chronic renal failure. Am J Kidney Dis 1998; 32: S Bergstrom J, Lindholm B: Malnutrition, cardiac disease, and mortality: An integrated point of view. Am J Kidney Dis 1998; 32: Nelson EE, Hong CD, Pesce AL, et al: Anthropometric norms for the dialysis population. Am J Kidney Dis 1990; 16: Vanitallie TB, Yang MU, Heymsfield SB, et al: Heightnormalized indices of the body s fat-free mass and fat mass: Potentially useful indicators of nutritional status. Am J Clin Nutr 1990; 52: Wolfson M: Management of protein and energy intake in dialysis patients. J Am Soc Nephrol 1999; 10: Dialysis Outcomes Quality Initiative Guidelines. Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2000; 35: S Hakim RM, Levin N: Malnutrition in hemodialysis patients. Am J Kidney Dis 1993; 21: Kopple JD, Swendseid ME: Vitamin nutrition in patients undergoing maintenance hemodialysis. Kidney Int Suppl 1975; Iseki K, Yamazato M, Tozawa M, et al: Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients. Kidney Int 2002; 61: Mitch WE: Dietary protein restriction in chronic renal failure: Nutritional efficacy, compliance, and progression of renal insufficiency. J Am Soc Nephro 1991; 2: Kopple JD, Levery AS, Greene t, et al: Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study. Kidney Int 1997; 52: Walser M, Mitch WE, Maroni BJ, et al: Should protein intake be restricted in predialysis patients? Kidney Int 1999; 55: Aparicio M, Chauveau P, De Precigout VD, et al: Nutrition and outcome on renal replacement therapy of patients with chronic renal failure treated by a supplemented very low protein diet. J Am Soc Nephrol 2000; 11: Bernhard J, Beaufrere B, Laville M, et al: Adaptive response to a low-protein diet in predialysis chronic renal failure patients. J Am Soc Nephrol 2001; 12: Walser M, Hill S: Can renal replacement be deferred by a supplemented very low protein diet? J Am Soc Nephrol 1999; 10: Trevino-Becerra A, Lopez JR, Alanis LM: Ketoanalogues and a very low protein diet diminish serum cholesterol in pre-dialysis patients. Daily Transplant 2002; 31: 25-6 &

Nutrition and hemodialysis status of long-surviving hemodialysis patients Hiroshi Watanabe1, Yoshiko Okada2, Masahiro Mori1, Takashi2, Hidehiro Ta

Nutrition and hemodialysis status of long-surviving hemodialysis patients Hiroshi Watanabe*1, Yoshiko Okada*2, Masahiro Mori*1, Takashi*2, Hidehiro Tanji*2, Naohisa Ibuki*2, Yorimitsu Tatsukawa*2, Yoshihiko