Hiroshige K, Iwamoto M, Kabashima N, Mutoh Y, Yuu K, Ohtani A
2nd Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu City, Fukuoka, Japan.
Nephrol Dial Transplant. 1998 Aug;13(8):2081-7. doi: 10.1093/ndt/13.8.2081.
The treatment of malnutrition, frequently present in elderly dialysis patients, is important to promote better quality of life and rehabilitation. The aim of this study was to assess the impact of prolonged use of intradialysis parenteral nutrition (IDPN) as a strategy for malnutrition in elderly haemodialysis patients.
Twenty-eight elderly patients (non-diabetic, age over 70) on chronic haemodialysis for at least 2 years were evaluated. Ten consenting patients were treated with IDPN containing glucose, essential amino acids, and lipid emulsion during the course of regularly scheduled dialysis treatments for approximately 1 year. Nutritional evaluation using seven parameters (anthropometric measurements such as body mass index, triceps skinfold thickness, mid-arm circumference, mid-arm muscle circumference, and albumin, transferrin, and total lymphocyte count) was performed at various intervals on patients with IDPN and 18 patients without IDPN. The plasma amino-acid profile and dietary protein calorie intake were also determined.
In patients receiving IDPN, significant increases in serum albumin and transferrin concentrations and total lymphocyte count in peripheral blood smears paralleled increases in protein-calorie intake beginning after 3 months of treatment and remained favourable throughout the study period. Anthropometric data started to improve significantly after 6 months of treatment. Patients without IDPN had gradual decreases in all parameters during the study period. A significant increase in essential amino acids and a significant decrease in 3-methyl-histidine were observed in patients with IDPN and a further decrease in essential amino acids was observed in patients without IDPN.
Prolonged use of IDPN prevents muscle protein catabolism and promotes body protein and fat accumulation. IDPN appears to be effective in malnourished elderly haemodialysis patients.
老年透析患者常伴有营养不良，对其进行治疗对于提高生活质量和促进康复至关重要。本研究旨在评估长期使用透析期间胃肠外营养（IDPN）作为老年血液透析患者营养不良治疗策略的效果。
对28例年龄超过70岁、非糖尿病、接受慢性血液透析至少2年的老年患者进行评估。10例同意参与研究的患者在定期血液透析治疗过程中接受含葡萄糖、必需氨基酸和脂肪乳剂的IDPN治疗，为期约1年。对接受IDPN治疗的患者和18例未接受IDPN治疗的患者在不同时间间隔进行营养评估，评估指标包括7项参数（人体测量指标，如体重指数、三头肌皮褶厚度、上臂围、上臂肌肉围，以及白蛋白、转铁蛋白和淋巴细胞总数）。同时还测定了血浆氨基酸谱和膳食蛋白质热量摄入量。
接受IDPN治疗的患者，血清白蛋白和转铁蛋白浓度显著升高，外周血涂片淋巴细胞总数增加，与治疗3个月后开始的蛋白质热量摄入增加相平行，且在整个研究期间保持良好。人体测量数据在治疗6个月后开始显著改善。未接受IDPN治疗的患者在研究期间所有参数逐渐下降。接受IDPN治疗的患者必需氨基酸显著增加，3-甲基组氨酸显著减少；未接受IDPN治疗的患者必需氨基酸进一步减少。
长期使用IDPN可防止肌肉蛋白质分解代谢，促进机体蛋白质和脂肪蓄积。IDPN似乎对营养不良的老年血液透析患者有效。
