지속성 외래 복막 투석 환자에서 영양 상태를 반영하는 지표들에 관한 연구

Abstract

Nutritional abnormalities such as decreased calorie intake and changes in body composition have been shown to be present in many CAPD patients. To assess the relationship between nutritional status and dialysis adequacy, we performed a cross sectional analysis on 130 CAPD patients (mean dialysis duration 29.7 months, mean age 44.5 years), measuring nutritional status by anthropometry & subjective global assessment. We also investigated dietary food intake by 24 hour recall method and compared individual nutritional nutritional status with various clinical parameters and NPCR, weekly KT/V urea and standardized creatinine clearance (SCCr). Two patients (1.5%) were severely malnourished, 25(19.2%) were mild to moderately malnourished, and 103(79.3%)didn't show evidences for malnutrition. In the group classified as malnourished, CAPD duration were significantly longer and the incidence of peritonitis was higher. Calculated arm muscle area and total body muscle (TBM0 were reduced in malnourished group. Calorie & protein intake were also reduced than wellnourished group. Hematocrit and BUN were decreased in malnourished group. Transferrin concentration was significantly decreased in malnourished group (252.2±32.9 vs. 188.3±37.4 mg/dl, p<0.05). IGF-1 was also decreeased in malnourished group (212.2±1242.9 vs. 154.3±187.4 ng/ml), but significantly lower in malnourished group (1.05±0.31 vs. 0.78±0.18, p<0.01). NPCR correlated positively with dietary protein intake (r=0.48, p<0.001), TBM (r=0.36, p<0.001), lean body mass (r=0.33, p<0.05), and less significant association was noted between SCCr between KT/V and TBM or LBM was obseved. In conclusion, NPCR is a good indicator of body protein store & nutritional status, but expressing dialysis adequacy as weekly KT/V urea may be a less sensitive marker of protein nutritional status.