만성 신부전 환자에서 투석 시작 당시의 잔여 신기능 평가

Abstract

The decision to initiate Eialysis in a patient with progressive renal disease often depends on the physician's assessment of the patient's subjective symptoms of urernia. Decreased residual renal function and malnutrition at the initiation of dialysis is a strong predictor of subsequent increased relative risk of death on dialysis. In this context, to investigate the residual renal function and nutritional parameters of chronic renal failure patients at the initiation of dialysis, 103 patients with chronic renal failure patients were studied. The residual renal function(estimated GFR) was ascertained by measuring simultaneously the 24-h creatinine and urea clearances and averaging the two values and Krt/V. Nutritional parameters were ascertained by measuring the nPNA, %LBM and serum albumin. The mean estimated GFR was 5.97±2.88ml/min, the mean weekly Krt/V was 124±0.80, the mean %LBM was 61.66±22.41 and the mean nPNA was 0.89±0.30g/day/kg. We knew that the time of initiation of dialysis, which was based on the manifestation of symptoms of certain patients in conjunction with selected laboratories indices, was delayed than that of NKF-DOQI recommendation. This study suggests that the timely initiation of dialysis is determined by not clinical symptoms and signs but estimated GFR, krt/V ancl nPNA.