Tan S H, Lee E J, Tay M E, Leo B K
Department of Medicine, National University Hospital, Singapore.
Adv Perit Dial. 2000;16:291-3.
Malnutrition is an important determinant of outcome in patients on dialysis. Its cause is multifactorial and its detection is important when patients embark on dialysis. In this study, we used various indices to assess the prevalence of malnutrition as reflected in protein intake, anthropometric effect, and serum protein level. To avoid the effect that dialysis has on malnutrition, we studied 37 patients who had just started continuous ambulatory peritoneal dialysis (CAPD). Of these new patients, 42% had a residual urea clearance below 1.0 mL/min. In 51% of the patients, serum albumin level was below 33 g/L; in 14%, body mass index was below 19; and in 39%, dietary protein intake was below 0.8 g per kilogram of body weight per day. A total of 76% of our patients had at least one of these three indices. In 8% of the patients, lean body mass was below 60%. We conclude that protein malnutrition is a significant problem in our patients starting CAPD. Dialysis-dependent factors were not implicated, as the patients were studied at the start of dialysis. Low intake of protein was a major problem and may have contributed significantly to malnutrition. The low residual urea clearance implied that dialysis was started relatively late and may have contributed to the low protein intake.
营养不良是透析患者预后的一个重要决定因素。其病因是多方面的，在患者开始透析时对其进行检测很重要。在本研究中，我们使用了各种指标来评估营养不良的患病率，这些指标反映在蛋白质摄入量、人体测量结果和血清蛋白水平上。为避免透析对营养不良的影响，我们研究了37例刚开始持续性非卧床腹膜透析（CAPD）的患者。在这些新患者中，42%的患者残余尿素清除率低于1.0 mL/分钟。51%的患者血清白蛋白水平低于33 g/L；14%的患者体重指数低于19；39%的患者每日饮食蛋白质摄入量低于0.8 g/千克体重。我们的患者中共有76%至少存在这三项指标中的一项。8%的患者瘦体重低于60%。我们得出结论，蛋白质营养不良在开始CAPD的患者中是一个重大问题。由于这些患者是在透析开始时进行研究的，因此未涉及依赖透析的因素。蛋白质摄入量低是一个主要问题，可能是导致营养不良的重要原因。残余尿素清除率低意味着透析开始得相对较晚，可能导致了蛋白质摄入量低。
