Korean Journal of Nephrology 1990;9(1):58-66.

만성투석환자의 영양상태에 관한 연구

김영기 , 최규헌 , 강신욱 , 이혁우 , 이승우 , 이호영 , 한대석

Abstract

It is well known that poor nutritional status increase the mortality and morbidity in chronic dialysis patients and a large proportion of end stage renal disease (ESRD) patients undergoing maintanence dialysis treat- ment manifest various signs of protein amd calorie malnutrition because of anorexia, poor intake of nutri- ents and other causes. This study was designed to evaluate the nutritional status of dialysis patients and to clarify the problems which were encountered by these patients. Subjects were 88 hemodialysis (HD) and 48 continuous ambulatory peritoneal dialysis (CAPD) patients who were receiving maintanence treatment. Measurement included height, weight, mid-arm cir- cumference and thickenss of triceps skinfold, serum amino acid, serum vitamin and serum trace element levels were also measured. Results were as following; 1) Age and duration of dialysis of subjects were higher in HD than CAPD patients as 49.2±13.3 (Meab+ S.D.) year-old and 39.8±21.8 months in HD, and 43.1± 11.2 year-old and 21.1±17.8 months in CAPD, respective- ly. There was no difference in sex ratio. 2) Mid-arm circumference (MAC), triceps skinfold thicknes (TSF), prercent to idal body weight (PIBW) and percent body muscle (PBM) were significantly lower in HD as 25.3±2.5 cm, 8.0± 3.5 mm, 99.8±11.4%,, 32.4±4.8%, in HD male patients, and 23.4±2.9cm, 11. 6±5.6 mm, 100.8±14.5% and 30.5±4.2. In HD female patients (compared to normal control group, 29.3 ±2.1 cm, 9.7±3.0 mm, 111.1±9.6%. And 38.7±7.1 % in male, 26. 8±3.0cm, 18.8±5.3mm, 111.6±11.3% and 27.1±4.5% in female, p<0.05). MAC, PIBW and PBM were signifi- cantly 1owere in CAPD male patients as 25.2±1.5cm, 100.3±9.5% and 32.1±4.9 %, but in CAPD female patients PIBW only was significant ]y ]ower as 93.8+15. 4 p. than normal controls (p<0.05). 3) Total calorie intake was 1439±339Kcal/day in HD and 1333±323Kcal/day in CAPD patients. The composition of calorie intake was carbohydrate 72 %, fat 12 % and protein 16 % in HD, and that of CAPD were similar to HD patients as 72.8%, 11.6 % and 15.7. 4) Protein intake was 56.8±18.2%. In HD patients and 52.0±16.6 Zp in CAPD patients. 5) Percnet of vitamin A, B,, B, and C intake compar- ed to recommended daily allowance were 70.7±33.1 %, 81.8±18.2%, 61.0±22.3% and 54.6±25.0 % in HD, and 80.5±37.8%, 77.0±21.7%, 62.2±23.2%, 68.7± 17.6% in CAPD patients. 6) Five out of 9 essential amino-acid were significant- ly decreased (threonine, valine, lysine, leucine and tryptophan) in kID and CAPD patient compared with that in control group (p < 0.05). 7) Serum vitamin A and C level were significantly increased in HD as 556.7±218.9 R.E., and vitamin A, E and C were significantly increased in CAPD patients as 563.2±315.5 R.E., 888.4±298.9mg/dl and 1024±110.7 mg/dl compared that in noraml controls (p<0.05). Serum vitamin B, was increased in both HD and CAPD patients as 28.6±26.3 mg/dl, 21.6±20.6 mg/dl, re- spetively than that in norma l controls (p<0.05). 8) Serum copper level was significantly decreased in HD patients (1217.6±297.9 pg/L, p<0.05) and other trace elements levels were not different from that in controls. In conclusion HD and CAPD patients showed signifi- cantly lower va lue of anthropometric measurements, protein and calorie intake, and serum amino-acid level than those of norrnal control which suggest that chronic dialysis patients were in protein and calorie malnutri- tion. Adequate diet therapy and evaluation of the nutri- tional status in dialysis patients are needed.