血液透析患者之營養評估 - tnna.org.tw

1 95 6 5 1 95 3 3 95 4 17 95 5 27 2 201 02 28757472 - - - - protein-energy malnutrition, PEM - 1998 Cianciaruso, Brunori, Kopple, Traverso, Panarello, & Enia, 1995 Hakim & Levin, 1993 Kalantar-Zadeh & Kopple, 2001 - (malnutrition-inflammation complex syndrome , MICS) Allison, 2000 Hakim & Levin, 1993 Kalantar-Zadeh & Kopple, 2001 2002 hemo- dialysis , HEMO Kt/V Kt/V Eknoyan, Beck, Cheung, Daugirdas, Greene, Kusek, et al.

2 , 2002 - 95 6 5 1 - - - 2000 national kidney foundation, NKF K/DOQI Kidney Disease Outcomes Quality Initiative Kopple, 2001 4 6 ( ) 6 protein equivalent of total nitrogen appearance normalized to body weight nPNA protein catabolic rate normalized to body weight, nPCR X dual energy x-ray ab-sorptiometry, DEXA NKF-K/DOQI serum ferritin total iron binding capacity.

3 TIBC iron saturation ratio total cholesterol triglyceride LDL-C HDL-C 6 CRP 3-6 total homocysteine 95 6 5 1 anthropometry somatic protein body mass index, BMI [BMI ( ) 2( )] 1998 Leavey 3,607 BMI Leavey, Strawderman, Jones, Port, & Held, 1998 BMI Mei, Grummer-Strawn, Pietrobelli, Goulding, Goran, & Dietz, 2002 BMI skinfold thickness TSF biceps triceps subscapular suprailiac mid-arm circumference, MAC mid-arm muscle area, MAMA diameter MAMA [MAC TSF ]

4 2 Katy & Katherine, 1992 bioelectrical impedance analysis, BIA BIA X fat mass, FM fat-free mass, FFM 5 mrem subjective global as-sessment, SGA 1984 1987 Detsky ABC 5 7 Steiber, Kalantar-Zadeh, Secker, McCarthy, Sehgal, & MeCann, 2004 SGA 95 6 5 1 Cooper, Bartlett, Aslani, Allen, Ibels, & Pollock, 2002 Duerksen, Yeo, Siemens, & O connor, 2000 SGA SGA Duerksen, Yeo, Siemens, & O connor, 2000 McCann, 1999 Kalantar-Zadeh Kalantar-Zadeh, Kopple, Block, & Humphreys, 2001 malnutrition inflammation score, MIS 10 3-6 TIBC SGA MIS 12 biochemical tests albumin 20 hypoalbuminemia 3 g/dL g/dL ~ g/dL 20 Lowrie & Lew, 1990 g/dL bromcresol green.

5 BCG serum prealbumin Prealbumin retinol-binding protein thyroxin prealbumin albumin negative acute-phase reactant Chertow, Ackert, Lew, Lazarus, & Lowrie, 2000 albumin prealbumin 2 3 visceral protein Prealbumin Chertow et al., 2000; Mittman, Avram, Oo, & Chattopadhyay, 2001 95 6 5 1 30 m/dL Sreedhara, Avram, Blanco, Batish, & Mittman, 1996 - blood urea nitrogen, BUN 1. BUN BUN glucocorticoid ( KT/V ) ( nPNA ) 2. BUN creatinine creatinine index ( ) Keshaviah, 1994 Leavey, Strawderman, Jones, Port, & Held, 1998.

6 Lowrie & Lew, 1990 ( 10 mg/dL) ( 150 180 mg/dL) Avram,, Mittman, Bonomini, Chattopadhyay, & Fein, 1995 Lowrie, Huang, & Lew, 1995 Lowrie & Lew, 1990 4 g/dL 30 mg/dL 10 mg/dL 150 mg/dL nPNA nPCR nPNA nPNA total nitrogen ap-pearance, TNA Kopple, Jones, Keshaviah, Bergstrom, Lindsay, & Moran, 1995 TNA 95 6 5 1 16% PNA TNA PNA PNA ( PCR)

7 PNA nPNA nPNA gm/day /kg nPNA nPNA nPNA PNA PCR 1. PNA PNA 2. PNA 3. PNA 4. 1 gm/kg/ PNA nPNA 90% 115% nPNA adjusted edema-free body weight [ ] / / Brookhyser, Harvey, McCorry, & Wilkins, 2002 1.

8 / 2. 3. 4. % % 5. 6. 95 6 5 1 7. urea kinetics 8. 1. 2. 3. 4. 5. ( ) 6. 7. 8. 1. 2. 3. 4. 1. 2. 3. 1. 2. 3. 4. 1. 2. 3.

9 4. 5. 6. 7. 8. 1. 2. 3. 1. 2. 1. 95 6 5 1 2. 3. 4. 5. 6. 7. 8. 1. 2. x 1998 23 2 123-131 Allison, S.

10 P. (2000). Malnutrition, disease, and outcome. Nutrition, 16, 590-593. Avram, M. M., Mittman, N., Bonomini, L., Chattopadhyay, J., & Fein, P. (1995). Markers for survival in dialysis: A seven-year prospective study. American Journal of Kidney Disease, 26, 209-219. Brookhyser, J., Harvey, K. S., McCorry, C., & Wilkins, K. (2002). Nutrition care of adult dialysis patients. In Wiggins, K. L. (ed), Guidelines for nutrition care of renal patients (pp. 19-35). United States of America: American Dietetic Associa-tion. Chertow, G. M., Ackert, K., Lew, N. L., Lazarus, J. M., & Lowrie, E. G. (2000). Prealbumin is as important as albumin in the nutritional assessment of hemodi-alysis patients. Kidney International, 58, 2512-2517. 95 6 5 1 Cianciaruso, B., Brunori, G, Kopple, J. D. Traverso, G., Panarello, G.