Hara Hiroaki, Nakamura Yumiko, Hatano Minoru, Iwashita Takatsugu, Shimizu Taisuke, Ogawa Tomonari, Kanozawa Koichi, Hasegawa Hajime
Contrib Nephrol. 2018;196:243-249. doi: 10.1159/000485729. Epub 2018 Jul 24.
As the aging of the population progresses in Japan, the nutritional problems in dialysis patients are being highlighted. Frailty is a clinical concept including body weight loss, muscle weakness, fatigability, decreased walking speed, and decreased physical activity, which means an intermediate concept between healthy subjects and disability subjects, indicating that their activities of daily living are not decreased but they cannot smoothly perform housework or exercise. Morbidity of dialysis patients is known to be high, and mortality of dialysis patients with frailty is 3 times higher. Sarcopenia is one of the principal reasons for or triggers of frailty. It is a disease setting showing decreased muscle volume and quality associated with decreased physical function or quality of life. Recent mean age at dialysis therapy induction is getting near to 70 years old in Japan. Japanese dialysis patients who are elderly and present organ failure would have a double risk for sarcopenia. Patients with advanced stages of CKD are generally given protein diet, and it has been reported that a low protein intake in dialysis patients would be a significant risk for developing sarcopenia and increasing mortality. Recently, the focus has been on protein energy wasting (PEW) - an underlying disease condition in sarcopenia or frailty. PEW is an energy wasting condition occurring in dialysis patients, and the cause of PEW is principally decreased food intake and increased catabolism. It has recently been revealed that decreased protein intake would be a risk factor for increased mortality in dialysis patients. The incidence of PEW in dialysis patients is reported to be 14%. To avoid sarcopenia and PEW leading to frailty, we should pay much more attention to an appropriate protein and calorie intake rather than restriction in dialysis patients.
随着日本人口老龄化的加剧，透析患者的营养问题日益凸显。衰弱是一个临床概念，包括体重减轻、肌肉无力、易疲劳、步行速度下降和身体活动减少，这意味着它是健康受试者和残疾受试者之间的一个中间概念，表明他们的日常生活活动并未减少，但无法顺利进行家务或锻炼。已知透析患者的发病率较高，而衰弱的透析患者的死亡率高出3倍。肌肉减少症是衰弱的主要原因或触发因素之一。它是一种疾病状态，表现为肌肉体积和质量下降，伴有身体功能或生活质量下降。在日本，近期开始透析治疗的平均年龄接近70岁。老年且存在器官衰竭的日本透析患者发生肌肉减少症的风险会加倍。慢性肾脏病晚期患者通常采用蛋白质饮食，据报道，透析患者蛋白质摄入量低是发生肌肉减少症和死亡率增加的重大风险。最近，人们的关注点集中在蛋白质能量消耗（PEW）——肌肉减少症或衰弱的一种潜在疾病状态。PEW是透析患者中发生的一种能量消耗状态，PEW的主要原因是食物摄入量减少和分解代谢增加。最近有研究表明，蛋白质摄入量降低是透析患者死亡率增加的一个风险因素。据报道，透析患者中PEW的发生率为14%。为避免肌肉减少症和PEW导致衰弱，我们应更加关注透析患者摄入合适的蛋白质和热量，而不是限制摄入。
