高齢者終末期腎疾患とサルコペニア

高齢者終末期腎疾患のサルコペニアのレビュー論文を紹介します。

Maciej Domański and Kazimierz Ciechanowski: Sarcopenia: A Major Challenge in Elderly Patients with End-Stage Renal Disease. Journal of Aging Research, Volume 2012 (2012), Article ID 754739, 12 pages doi:10.1155/2012/754739

下記のHPで全文見ることができます。

http://www.hindawi.com/journals/jar/2012/754739/

透析患者の低栄養は最近、protein-energy wasting (PEW)と呼ばれることが多いようです。International Society of Renal Nutrition and Metabolism (ISRNM)では、下記の4項目でPEWを判断します。

(1)low body weight, reduced body fat and weight loss,
(2)reduced muscle mass judged on the basis of mid-arm circumference, dual X-ray absorptiometry, near-infrared interactance, bioelectrical impedance, or creatinine appearance,
(3)low protein/energy intake,
(4)biochemical indicators

通常の栄養アセスメントと比較して、特別な項目はありません。CKD患者の18-75％にPEWを認めるそうです。サルコペニアやPEWへの関心や認識は、まだまだ低いようです。腎リハや食事療法は有用ですが、PEWの治療のコンセンサスはまだないようです。

人工透析患者の食事療法として、1.5g/kg/24h（要するに1日）の蛋白摂取がminimumとあります。日本腎臓学会のCKDの食事療法基準では、下記のように1.0-1.2g/kg/dayとありますので、だいぶ異なります。筋肉量・筋力を考えると、維持透析では高蛋白が好ましいですが。

http://www.daiichi-shuppan.co.jp/web/images/jintai-kouzou-kinou-sippei2-tuiho.pdf

Abstract
Sarcopenia is a condition of multifaceted etiology arising in many elderly people. In patients with chronic kidney, the loss of muscle mass is much more intensive and the first signs of sarcopenia are observed in younger patients than it is expected. It is associated with the whole-body protein-energy deficiency called protein-energy wasting (PEW). It seems to be one of the major factors limiting patient's autonomy as well as decreasing the quality of life. If it cannot be treated with the simple methods requiring some knowledge and devotion, we will fail to save patients who die due to cardiovascular disease and infection, despite proper conduction of renal replacement therapy. Many factors influencing the risk of sarcopenia development have been evaluated in number of studies. Many studies also were conducted to assess the efficacy of different therapeutic strategies (diet, physical activity, hormones). Nevertheless, there is still no consensus on treatment the patients with PEW. Therefore, in the paper we present the reasons and pathophysiology of sarcopenia as an important element of protein energy wasting (PEW) in elderly patients suffering from chronic kidney disease. We also analyze possible options for treatment according to up-to-date knowledge.