Lee Seung Woo, Yang Yu Mi, Kim Hye-Young, Cho Hyunjeong, Nam Sang Won, Kim Sun Moon, Kwon Soon Kil
Division of Nephrology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
Division of Nephrology, Chungbuk National University College of Medicine, Cheongju, Korea.
Chonnam Med J. 2022 May;58(2):69-74. doi: 10.4068/cmj.2022.58.2.69. Epub 2022 May 25.
End-stage renal disease (ESRD) patients on hemodialysis have poor nutritional status and associated problems such as inflammation and sarcopenia. Blood urea nitrogen (BUN) is an important measure of uremic toxins, and urea reduction is a marker of hemodialysis efficacy. However, a low protein diet for lower BUN could aggravate malnutrition in patients, and optimal pre-dialysis BUN is not defined. We investigated the association of pre-dialysis BUN with patients' comorbidities and the relationship between pre-dialysis BUN and serum albumin as a nutrient marker. Among the 67 patients, the average pre- and post-dialysis BUN were 59.2 and 15.0 mg/dL, respectively, serum creatinine was 10.1 mg/dL, and the average serum albumin was 4.0 g/dL. Patients' age was negatively correlated with serum creatinine (r=-0.277, p<0.05) and albumin (r=-0.453, p<0.001). Predialysis BUN showed a significant positive correlation with serum albumin (r=0.287, p<0.05) and creatinine (r=0.454, p<0.001). However, the predialysis BUN was not significantly related to diabetes, coronary artery disease, congestive heart failure, or cerebrovascular disease. Hemodialysis patients with high pre-dialysis BUN and high serum creatinine could be regarded as having good nutritional status. The significance of this study lies in the potential utility of pre-dialysis blood urea nitrogen as an indicator of the nutritional status of patients. Liberal protein intake might be recommended to adequately dialyzed patients.
接受血液透析的终末期肾病（ESRD）患者营养状况较差，并伴有炎症和肌肉减少症等相关问题。血尿素氮（BUN）是衡量尿毒症毒素的一项重要指标，尿素清除率是血液透析疗效的一个标志物。然而，低蛋白饮食以降低BUN可能会加重患者的营养不良，且尚未明确透析前BUN的最佳水平。我们研究了透析前BUN与患者合并症之间的关联，以及透析前BUN与作为营养标志物的血清白蛋白之间的关系。在67例患者中，透析前和透析后BUN的平均值分别为59.2和15.0mg/dL，血清肌酐为10.1mg/dL，血清白蛋白平均值为4.0g/dL。患者年龄与血清肌酐（r=-0.277，p<0.05）和白蛋白（r=-0.453，p<0.001）呈负相关。透析前BUN与血清白蛋白（r=0.287，p<0.05）和肌酐（r=0.454，p<0.001）呈显著正相关。然而，透析前BUN与糖尿病、冠状动脉疾病、充血性心力衰竭或脑血管疾病无显著相关性。透析前BUN和血清肌酐水平较高的血液透析患者可被视为营养状况良好。本研究的意义在于透析前血尿素氮作为患者营养状况指标的潜在效用。对于充分透析的患者，可能建议放宽蛋白质摄入量。
