Korean Journal of Nephrology 1999;18(3):445-454.

혈액투석환자에서 영양 상태를 반영하는 지표들과 요소 동력학 모형 ( Urea Kinetic Modeling)과의 비교 관찰 (Comparison of Urea Kinetic Modeling and Indices of Nutrition in Hemodialysis Patients)

김미선, 박민, 윤대현, 신용훈, 박용기, 서경덕, 장익득, 허동, 김중경, 이시래 (Mi Sun Kim, Min Park, Dae Hyun Yun, Yong Hoon Shin, Yong Ki Park, Kyung Duk Suh, Ik Deuk Jang, Dong Huh, Joong Kyung Kim and Shi Rae Lee)

Abstract

Objectives:Protein-calorie malnutrition has been shown to be prevalent among patients on long-term hemodialysis(HD) patients. And assessment of nutritional status of HD patients has assumed greater importance because of the association of protein- calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling in HD patients. Methods:We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 48 HD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling with the other parameters of nutritional status. Results:The malnutrition index classified 12(25 %) patients as normal, 28(58%) intermediately malnourished, and 8(17%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), mid-arm circumference(MAC), mid-arm muscle area(MAMA), duration of HD, total lymphocyte count,trnsferrin. The malnutrition index also showed a significant correlation with renal creatinine clearance(Ccr), alkaline phosphatase. However, malnutrition index showed no meaningful correlation with TWR-Kt/V, TW-Kt/V, BUN, cholesterol,calcium, triglyceride. The value of Ccr was significantly lower in the severely malnourished and intermediately group than in the normal group. Conclusion:In assessing the nutritional status of HD patients, body weight, MAC, MAMA, duration of HD, total lymphocyte count, transferrin, alkaline phosphatase and Ccr were considered useful parameters. No meaningful relationships between TW-Kt/V and malnutrition index or between NPCR (normalized protein catabolic rate) and malnutrition index were found in this cross-sectional study. As the number of patients with longer duration of HD or negligible Ccr has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and residual renal function may be helpful to assess dialysis adequacy to keep good nutritional status of each HD patient.