透析患者のエネルギーバランス

透析患者のエネルギーバランスを7日間調査した論文を紹介します。

Bovio G, Montagna G, Brazzo S, Piazza V, Segagni S, Cena H. Energy balance in haemodialysis and peritoneal dialysis patients assessed by a 7-day weighed food diary and a portable armband device. J Hum Nutr Diet. 2012 Nov 28. doi: 10.1111/j.1365-277x.2012.01291.x. [Epub ahead of print]

対象は人工透析患者、腹膜透析患者8人ずつで、研究デザインは横断研究です。
結果ですが、両群ともエネルギーバランスはマイナス（1日当たり300kcal台）でした。CRPと1日エネルギー消費量、除脂肪体重に逆相関を認めました。

以上より、透析患者ではエネルギーバランスがマイナスで低栄養のリスクがあるという結論です。目新しいことはあまりありませんが、それでも論文にすることに意義があると感じました。このくらいの研究なら、臨床に従事している日本の医療人でも十分できますよね。

Abstract

BACKGROUND:

Energy balance (EB) is important when assessing nutritional status. EB has never been assessed in haemodialysis (HD) and peritoneal dialysis (PD) patients. The present study aimed to assess weekly EB in these patients.

METHODS:

This clinical cross-sectional study was conducted for 7 days in eight HD and eight PD patients. Nutritional status was assessed by anthropometry, bioelectrical impedance analysis and biochemical markers. Energy intake (EI per day) and total energy expenditure (TEE per day) were determined by a 7-day weighed food diary and a portable armband device, respectively.

RESULTS:

No significant differences in age, body mass index, fat free mass (FFM), parathyroid hormone were found between the two groups. EB was calculated by subtracting TEE per day from EI per day. EB was negative in HD {-1347 (1276) kJ day(-1) [-322 (305) kcal day(-1) ]}, as well as in PD patients {-427 (5338) kJ day(-1) [-102 (395) kcal day(-1) ]}. TEE per day was positively correlated with EI per day, prealbumin, FFM. EI per day was positively correlated with prealbumin. C-reactive protein was negatively correlated with TEE and FFM (P < 0.05). EB showed a positive correlation with EI per day (P = 0.012) and a negative trend with TEE.

CONCLUSIONS:

HD and PD patients have a negative EB and are at risk of malnutrition. Inflammatory status determines a lower EI per day and a reduction in TEE per day. The most important parameter in determining EB in HD and PD patients is EI per day. This topic deserves further investigation to better understand the mechanisms of impaired EB with respect to preserving patients' nutritional status.