(I) USRDS. malnutrition) (BMI) Na- CANUSA (Canada/United States Peritoneal Dialysis Study)

Μέγεθος: px

Εμφάνιση ξεκινά από τη σελίδα:

Download "(I) USRDS. malnutrition) (BMI) Na- CANUSA (Canada/United States Peritoneal Dialysis Study)"

Ἁλκυόνη Αντωνόπουλος
7 χρόνια πριν
Προβολές:

1 (I) USRDS ( pr ote in-e ner gy (United States Renal Data System malnutrition (BMI) Na- CANUSA (Canada/United States Peritoneal Dialysis Study) tional Kidney Foundation American Journal Kidney Disease (SGA: Subjective global [1] nutritional assessment (npna) ( (1) ( ) (1) ( 1) 2. (2) (1) (3) (2) (sensitivity (specificity 2. (3) (1) 2 23 (2) (4)

Journal Kidney Disease (SGA: Subjective global [1] nutritional assessment 2 1. 1 1.

2 (SGA) HD 1 (npna) PD 4 (DXA) (Creatinine Index) (5) 2. (6) (ESRD (1) 3 (albumin 1. ( (1) (2) (3) (2) ( bromcresol green method 4.0 g/ dl (4) (5) (3)

3 (positive acute-phase reactant) CRP (C-reactive protein (4) CRP α1-acid glycoprotein (α1-agferritin ceruloplasmin 5 (creatinine) α1-ag CRP (creatinine index 1. 4 (prealbumin 1. (1) ( (creatine) (1) (2) (2) ( 10 mg/dl) (3) 30 mg/dl (4) (creatinine clearance (5) ( ) 2. (1) (1) (2) a. ( b. (2) (negative acute-phase reactant c. 30 mg/dl ( ( ( ) (3) 2. ( (3) 30 mg/dl a.creatinine index (mg/24hdialysate (or

(1) ( (creatine) (1) (2) (2) ( 10 mg/dl) (3) 30 mg/dl (4) (creatinine clearance (5) ( ) 2.

4 ultrafiltrate) creatinine (mg/24h) urine creatinine (mg/24h) change in body creatinine pool (mg/24h) creatinine degradation (mg/24h) [2] b.change in body creatinine pool (mg/24h) [serum creatinine (mg/dl) f serum creatinine (mg/dl)i] [24/h] [body weight (kg0.5 (L/kg)] [3] h (time interval between i and f (Clcr 10 mg/dl 6 (cholesterol 1. ( (1) (2) ( ) ( ) i inital f final (3) ( body weight (kgi and f mg/dl) 0.5 volume of distribution of creatinine 2. in the body (1) {[serum creatinine (fbw (f0.5] [serum creatinine (ibw (i) (2) 0.5]} 24/h ( BW ) ( mg/dl c.creatinine degradation (mg/24h) 0.38 (dl/kg/24hserum creatinine (mg/ dlbw (kg) [3] d.edema-free lean body mass (kg) (kg/mg/24hcreatinine index (mg/24h7.38 (kg) [4] (3) U-shape J-shape 300 (3) mg/dl 200 mg/dl 200 mg/dl (4) (4) (5) (6) (npna) (kt/v urea) 7 (dietary interviews and diaries 1. ( ) (7) 9 11 mg/dl (

( (1) (2) ( ) ( ) i inital f final (3) ( 150 180 body weight (kgi and f mg/dl) 0.5 volume of distribution of creatinine 2. in the body (1) {[serum creatinine (fbw (f0.

5 2. (1) (3) PNA ( PCR (npna) ( (2) 3 (total nitrogen appearance; TNA TNA 24 95% 115% 16% PNA 6.25 TNA (TNA (PNA) ( DPI g/d or g/kg/d DEI kcal/d or kcal/kg/d) (guideline 12 (3) npna( 60% ) g npna (g/kg/daypna/bw BW Vurea/ glucose absorbed (g/d0.89x (g/ d43 X total amount of dialysate glucose instilled each day [5] npna (g/kg/daypna/abwef (actual ede- 90% ma-free body weight) [6] 1.5% glucose 1.3 g/dl 4.25% glucose 3.76 g/dl 0.58 BW ( (3) PNA (1) PNA (2) 0.58 npna (g/kg/day(pna)/(vurea/ 0.58 Vurea ( a. PNA 8 ( P N A ; protein equivalent of total nitrogen PNA appearance 1. (PNA ( (protein catabolic rate; PCR) 3 PNA ( (1) b. (urea nitrogen appearance; ( 0.5 g UNA ) PNA PNA PNA (2)PNA

89x (g/ d43 X total amount of dialysate glucose instilled each day [5] npna (g/kg/daypna/abwef (actual ede- 90% ma-free body weight) [6] 1.5% glucose 1.3 g/dl 4.25% glucose 3.

6 c. TNA 10% (3 5 5% (6 7 ( d. 1 g/kg/day PNA e.pna c. 90% 115% npna ( bul ge ) (abwef 12 (4) PNA d. ( te mpor alis 10 (athropometry ( 2. (1)SGA (1) (% UBW (% SBW) (2)SGA (BMI ( (3)SGA 2. SGA (1) (4) CANUSA a. [7] SGA 90 a % (1 2 5 b. (hollow) muscle ( 9 (SGA; subjective global nutritional assessment ( (MAMC (2)

(1)SGA (1) (% UBW (% SBW) (2)SGA (BMI ( (3)SGA 2. SGA (1) (4) CANUSA 4 1 7 1 2 3 5 6 7 a.

7 b. (% UBW % UBW / 100% c. (% SBW 90% 110% SBW %SBW 100% 70% 70% 90% % 130% 130% 150% 150% d. (BMI ( 23.6 kg/m 2 24 kg/m 2 30 kg/m 2 BMI [ (kg)] [ (m)] 2 e. (skinfold thickness) impedance; BIA (superiliac crest [8] f. (MAMC MAMC (cmmac ( [π TSF (cm)] [9] TSF AMA {[MAC (cmπ TSF (1) (cm) ] 2/4π} % 115% ( Durnin Wormersley [8] (fat mass; kgbw (kg[(4.95/ 115% D ( )4.5] (3) DXA D log ( ) (fat free body massbw (fat mass) 11 (DXA; dual 2. energy X-ray absorptometry ( (1) (2) DXA (1) DXA 3 (creatinine index) (bioelectrical (2)DXA 12 (abwef; actual edema-free body weight) bone-free AMA (bone-free arm muscle area ) [10] 1. AMA {[MAC(cmπ TSF (cm) ] 2/4π} 10 ( (2) 95% (1) (abwef 1. (DXA) abwef BWef ( {[SBW ( BWef] 0.25}

5 95% 115% ( Durnin Wormersley [8] (fat mass; kgbw (kg[(4.95/ 115% D ( )4.5] (3) DXA D log ( ) (fat free body massbw (fat mass) 11 (DXA; dual 2.

8 25 50 meq/day (2) (2) a. b. c. 95% 115% 1,25(OH) 2 D 3 osteoblast 13 (bicarbonate 1. ( 2. (1) a. (valine leucine isoleucine b. (PNAc. free valine neal dialysis. Kidney Int 1981; 19: Vit-D 2-microglobulin turnover rate (2) mmol/l ( 2. (1) 38 mmol/l 2 4 g/day 81. (3) 1. National Kidney Foundation K/DOQI Nutrition in chronic renal failure. Am J Kidney Dis 2000; 35: S Bhatla B, Moore H, Emerson P, et al: Lean body mass estimation by creatinine kinetics, bioimpedance, and dual energy x-ray absorptiometry in patients on continuous ambulatory peritoneal dialysis. ASAIO J 1995; 41: M Mitch WE, Collier VU, Walser M: Creatinine metabolism in chronic renal failure. Clin Sci 1980; 58: Forbes GB, Bruining GJ: Urinary creatinine excretion and lean body mass. Am J Clin Nutr 1976; 29: Grodstein GP, Blumenkrantz MJ, Kopple JD, Moran JK, Coburn JW: Glucose absorption during continuous ambulatory perito- 6. National Kidney Foundation NKF-DOQI Clinical practice guidelines: Measurement of dialysis adequate. Am J Kidney Dis 1997; 30: S Enia G, Sicuso C, Alati G, Zoccali C: Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant 1993; 8: Durnin JV, Womersley J: Body fat assessed from total body density and its estimation from skinfold thickness: Measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974; 32: Heymsfield SB, Tighe A, Wang Z-W: Nutritional assessment by arthropometric and biochemical methods. Shils ME, Olson JA, Shike M, eds Modern nutrition in health and disease. Philadelphia, PA, Lea and Febiger, 1984; Heymsfield SB, McManus C, Smith J, Stevens V, Nixon DW: Anthropometric measurement of muscle mass: Revised equations for calculating bone-free arm muscle area. Am J Clin Nutr 1982; 36: Kopple JD, Jones MR, Keshaviah PR, et al: A proposed glossary for dialysis kinetics. Am J Kidney Dis 1995; 26:

2. Bhatla B, Moore H, Emerson P, et al: Lean body mass estimation by creatinine kinetics, bioimpedance, and dual energy x-ray absorptiometry in patients on continuous ambulatory peritoneal dialysis.

Σχετικά έγγραφα

(II) ) ( ) ( ) ( ) ( [1] ) ( ) ( 22 mmol/l ) ( ) ( ) ) ( ( 20 mmol/l) [2] [3] D (MAC) (MAMC) (SDS) ( 1) (1) (2) [4] (IGF-1) IGF-1

(II) ) ( ) ( ) ( ) ( [1] ) ( ) ( 22 mmol/l ) ( ) ( ) ) ( ( 20 mmol/l) [2] [3] D (MAC) (MAMC) (SDS) ( 1) (1) (2) [4] (IGF-1) IGF-1 91 14 2 97 ( ( ( ( ( ( ( ( ( ( (SDS Z ( : (MAC (MAMC (SDS ( 1 (1 (2 [1] 22 mmol/l ( ( 20 mmol/l [2] [3] D [4] (IGF-1 IGF-1 (II 22 mmol/l ( [6-7] ( (RDA [5] ( (PNA (PCR (RDA PNA [8] ( 2 RDA 1 * + + * +