Yoshie Kanazawa

Body Protein Index Based on Bioelectrical Impedance Analysis Is a Useful New Marker Assessing Nutritional Status: Applications to Patients with Chronic Renal Failure on Maintenance Dialysis

BACKGROUND Evaluation and monitoring of nutritional status is a fundamental concept in providing nutritional care to patients with end-stage renal failure. There have been, however, few practically available indices assessing whole body protein stores of patients. METHODS We enrolled 448 end-stage renal disease patients, 394 on maintenance hemodialysis (HD) and 54 on continuous ambulatory peritoneal dialysis (PD) in this study. 83 Age- and sex-matched subjects (controls) whose creatinine clearance was more than 70 ml/min and urinary protein excretion was less than 1.0 g/day were also recruited for comparison. To assess whole body somatic protein stores, we devised the body protein index (BPI). The volume of body protein mass was measured by multifrequency bioelectrical impedance analysis and then BPI was calculated as body protein mass (kg) divided by height in meters (m2). Based on BPI, we defined the nutritional status of the patients as normal if the value was within -10% of the mean value of control subjects, -10 to -14% as mild malnutrition, -15 to -19% as moderate malnutrition, and <-20% as severe malnutrition. RESULTS The required time for measurement was 5.2 +/- 1.3 min and coefficient of variation of measurements was 0.8 +/- 0.2%. Among men the mean BPI in both HD and PD patients was significantly lower than those of control subjects (4.25 +/- 0.37, 4.38 +/- 0.34 vs. 4.72 +/- 0.37 kg/m2, p < 0.001). In women, BPI was significantly lower in HD patients than in control subjects (3.65 +/- 0.34 vs. 4.00 +/- 0.34 kg/m2, p < 0.033), whereas only a nonsignificant lower tendency was found in PD patients (3.83 +/- 0.39 kg/m2, p = 0.067). There were no significant differences in BPI values between diabetic and non-diabetic subjects, both in men (4.26 +/- 0.41 vs. 4.25 +/- 0.36 kg/m2) and women (3.69 +/- 0.36 vs. 3.65 +/- 0.34 kg/m2). Based on BPI nutritional categories, 113 (28.7%) of all HD patients were classified as having mild malnutrition, 57 (14.5%) as having moderate malnutrition, 40 (10.1%) as having severe malnutrition, and 184 (46.7%) were classified as normal. The patients of longer dialysis history groups showed a tendency of lower BPI compared to those of shorter dialysis history groups (p < 0.05), although the ages of the patients of the two groups did not significantly differ. No correlations were found between BPI and serum albumin or transferrin concentrations. Only weak correlations were found with albumin in male and transferrin in female HD patients. CONCLUSION BPI calculated from measurement of multifrequency bioelectrical impedance analysis could evaluate whole body somatic protein stores, and is a potentially useful new marker assessing nutritional status in patients with chronic renal failure. Decreased body somatic protein stores, mainly due to muscle wasting, was prevalent in end-stage renal failure patients on maintenance dialysis.

Diagnosis and prevalence of protein‐energy wasting and its association with mortality in Japanese haemodialysis patients

The International Society of Renal Nutrition and Metabolism (ISRNM) has proposed the diagnostic criteria for protein‐energy wasting (PEW). We studied Japanese haemodialysis (HD) patients to verify the diagnostic method, especially with respect to the body mass index (BMI) criterion, as well as the prevalence of PEW and its association with mortality.

Alchohol intake and dietary management in patients on hemodialysis.

社会復帰血液透析患者の飲酒状況と食事管理について検討を加えた. 対象は外来維持血液透析患者86名, 平均年齢55.3±13.5歳, 平均透析歴45.8±39.2か月である. 対象者に対し飲酒に関するアンケートを実施し, 食事管理, 塩分, 水分管理, 血液生化学値を合せて評価した. 現在飲酒の習慣がある者は26名 (30.2%) で, 毎日飲酒する者は10名 (38%) 週に1-2回飲酒する者は11名 (43%) であった. 1週間のアルコール摂取量は平均114.1±183.5gで, 一番良く摂取するアルコールの種類はビール (73%) であった. 飲酒者の食事療法遵守率は, 非飲酒者と有意差を認めなかった. 尿量で補正した1日平均体重増加量は, 飲酒者1.44±0.33kg, 非飲酒者1.37±0.53kgで有意差を認めなかった. 血液生化学値 (BUN, Alb, Ht, K, P, Na) も飲酒者と非飲酒者に有意差を認めなかった. 以上より, 社会復帰透析患者では, 適切な食事管理下での適量飲酒は, 許容できるものと考えられた.

Studies on diet therapy in diabetic dialysis patients

糖尿病性腎不全による透析患者の適正なエネルギー, タンパク質の摂取量について, 血液透析20例, CAPD 22例を対象に食事摂取量調査を行い, その調査を行った3ヵ月間における体重変化および血清アルブミン濃度の変化をもとに検討を行った.その結果安定維持透析患者のエネルギー摂取量は, 血液透析31±2.6kcal/kg・日, CAPD 30±3.4kcal/kg・日 (食事+腹膜吸収量), タンパク質摂取量は血液透析1.23±0.14g/kg・日, CAPD 1.18±0.20g/kg・日であった, エネルギー摂取量は, 血液透析では標準体重あたり27kcal/kg・日以下では体重減少あるいは血清アルブミン濃度の低下を認める症例が多く, 35kcal/kg・日以上では肥満傾向となる可能性を認めた. CAPDでは標準体重あたり28-30kcal/kg・日 (食事+腹膜吸収量) 以下では体重減少あるいは血清アルブミン濃度の低下を認め, 35kcal/kg・日以上では急速に肥満を認める症例が多かった. タンパク質摂取量は, 血液透析では標準体重あたり0.9-1.1g/kg・日以下では体重減少や血清アルブミン濃度の低下を認めたが, 1.4g/kg・日以上摂取した症例でも血清アルブミン濃度の上昇傾向を期待し得なかった. CAPDでは標準体重あたり0.7-1.2g/kg・日以下の症例では高頻度に体重減少や血清アルブミン濃度の減少を認めたが, 1.4g/kg・日以上摂取した症例においても血清アルブミン濃度の上昇を認めなかった.以上より, 標準体重あたりの1日のエネルギー摂取量は血液透析患者では31-33kcal/kg・日, CAPD患者は30-32kcal/kg・日 (食事+腹膜吸収量), タンパク質摂取量は血液透析患者, CAPD患者とも1.2-1.3g/kg・日を目安とするのが適当と考えられた.