Ikizler T A, Wingard R L, Hakim R M
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-2372, USA.
Am J Kidney Dis. 1995 Jul;26(1):256-65. doi: 10.1016/0272-6386(95)90181-7.
Protein and calorie malnutrition often starts before initiation of dialysis, and reflects the anorexia and the catabolic state of chronic renal failure. In the face of inadequate dialysis, which perpetuates the uremic state, malnutrition often worsens. Several studies, though not all, suggest that optimal dialysis improves nutritional status of dialysis patients. Such optimal dialysis now must include the use of biocompatible membranes to deliver Kt/V > 1.4 (urea reduction ratio > 65%). Additional interventions can include the use of enteral or intravenous hyperalimentation, and recombinant growth factors such as growth hormone or insulin-like growth factor-1. Importantly, studies to document the improvement in the morbidity and mortality of patients with these interventions are still needed and require large multicenter trials.
蛋白质和热量营养不良通常在开始透析之前就已出现，反映了慢性肾衰竭患者的厌食和分解代谢状态。在透析不充分从而使尿毒症状态持续存在的情况下，营养不良往往会恶化。多项研究（并非全部）表明，优化透析可改善透析患者的营养状况。目前，这种优化透析必须包括使用生物相容性膜，以使Kt/V>1.4（尿素清除率>65%）。其他干预措施可包括使用肠内或静脉高营养，以及使用重组生长因子，如生长激素或胰岛素样生长因子-1。重要地是，仍需要开展研究以证明这些干预措施能够改善患者的发病率和死亡率，而这需要大型多中心试验。
