CKD-Associated Complications: Progress in the Last Half Century. Группа авторов

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      Masayoshi Nanami, MD, PhD

      Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine

      1-1 Mukogawa-cho

      Nishinomiya 663-8501 (Japan)

      E-Mail [email protected]

      Nakanishi T, Kuragano T (eds): CKD-Associated Complications: Progress in the Last Half Century.

      Contrib Nephrol. Basel, Karger, 2019, vol 198, pp 12–20 (DOI: 10.1159/000496304)

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Malnutrition-Wasting Conditions in Older Dialysis Patients: An Individualized Approach

      Norio Hanafusa^a · Ken Tsuchiya^a · Kosaku Nitta^b

      ^aDepartment of Blood Purification, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan; ^bDepartment of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan

      ______________________

      Abstract

      Background: The dialysis population is growing and aging worldwide. The aging dialysis population exhibits specific conditions, including sarcopenia, protein-energy wasting, and frailty, that are associated with worse outcomes. Thus, strategies to address these conditions are indispensable to improving prognosis, quality of life, and ability to perform activities of daily living in older patients. Summary: Several strategies have been employed to manage these conditions. The two major approaches are nutritional therapy and exercise training. These correlate strongly with each other and each is necessary to maintain the health of patients. Ensuring adequate protein and energy intake is the mainstay of nutritional therapy. However, older dialysis patients often have reduced appetite, and appropriate nutritional therapy can enhance appetite. Conversely, nutritional therapy without an appropriate exercise training system will fail to enhance physical function. Thus, the focus of attention has been on exercise training both during dialysis treatment and while at home. The Japanese Society of Renal Rehabilitation has issued a guideline for exercise training in patients with kidney disease. It encourages using the time during dialysis treatment for performing both nutritional intake measures and exercise training. Nutritional care in dialysis patients has previously focused on restriction of dietary intake. However, patients with these malnutrition-wasting conditions should be encouraged to improve their dietary intake and physical activity. Older dialysis patients have heterogenic characteristics in terms of frailty, so their nutritional and exercise plans should be individualized. Key Messages: Individualized management should be used in the heterogeneous older dialysis population, with special considerations for malnutrition-wasting conditions.

      © 2019 S. Karger AG, Basel

      Introduction

The world over, the dialysis population is becoming older. The average age of the dialysis population in Japan has exceeded 65 years old and the proportion of patients aged 70 years or older is contributing to the growth of the entire dialysis population [1]. Thus, more attention should be paid to the management of the older dialysis population. This population has a set of distinct phenotypes characterized by malnutrition-wasting conditions that include sarcopenia, dynapenia, protein-energy wasting (PEW), and frailty [2, 3]. Therefore, these conditions need to be addressed in the management of their care. In this review, we discuss the significance СКАЧАТЬ