A reduced hemodialysis dose improved nutrient metabolism in an elderly hemodialysis patient –A study of amino acid metabolism–
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- Sano Hiroyuki
- Medical Corporation Kitaura Clinic
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- Kitagawa Yutaka
- Medical Corporation Kitaura Clinic
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- Honsho Katsuyo
- Medical Corporation Kitaura Clinic
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- Sanehiro Junko
- Medical Corporation Kitaura Clinic
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- Matsumoto Mikiko
- Medical Corporation Kitaura Clinic
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- Takeshita Sayomi
- Medical Corporation Kitaura Clinic
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- Kawabata Tomoko
- Medical Corporation Kitaura Clinic
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- Masuda Yukiko
- Medical Corporation Kitaura Clinic
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- Takami Naka
- Medical Corporation Kitaura Clinic
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- Sugihara Yoshinobu
- Medical Corporation Kitaura Clinic
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- Kitaura Keisuke
- Medical Corporation Kitaura Clinic
Bibliographic Information
- Other Title
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- 高齢透析患者に透析量の減量が栄養状態の改善に功を奏した1例—アミノ酸代謝による考察—
- 症例報告 高齢透析患者に透析量の減量が栄養状態の改善に功を奏した1例 : アミノ酸代謝による考察
- ショウレイ ホウコク コウレイ トウセキ カンジャ ニ トウセキリョウ ノ ゲンリョウ ガ エイヨウ ジョウタイ ノ カイゼン ニ コウ オ ソウ シタ 1レイ : アミノサン タイシャ ニ ヨル コウサツ
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Abstract
<p>The patient was an 81-year-old female who had been receiving hemodialysis (HD) for 21 months. The patient was obese (body mass index [BMI]: 25.1±0.1); malnourished (serum albumin level: 3.3±0.03 g/dL, percentage creatinine generation rate [%CGR]: 56.0±1.8); and exhibited reductions in her muscle strength, walking speed, and ability to perform activities of daily living (which was considered to be due to frailty rather than sarcopenia). As the patient suffered frequent cramps and intradialytic hypotension, she was forced to stop receiving HD. HD removes not only uremic toxins, but also various nutrients, including water-soluble vitamins and amino acids. Therefore, there is a possibility that the amounts of nutrients removed by HD exceed those consumed via dietary intake, even after 4 hours HD (blood flow rate [QB]=200 mL/min, dialysis fluid flow rate [QD]=500 mL/min). Human energy levels are maintained by gluconeogenesis, which involves amino acid catabolism. Most amino acid catabolism involves glutamate as a reaction intermediate. In this study, the patient’s blood glutamate concentration increased after HD; nevertheless, HD removes plenty of glutamate. However, low-efficiency HD (QD: 200 mL/min, QB: 95 mL/min from 0-30 minutes, 170 mL/min from 30 to 90 minutes, 230 mL/min from 90 to 240 minutes) suppressed the increase in the patient’s blood glutamate concentration seen after HD. In other words, it suppressed gluconeogenesis. Eventually, low-efficiency HD significantly improved the patient’s nutritional status (serum albumin level: 3.6±0.1 g/dL, p=0.020; %CGR: 81.7±11.9, p=0.0024), BMI (27.1±0.22), and catabolic status. Furthermore, the number of rounds of treatment required for cramp combined with intradialytic hypotension dramatically decreased after the introduction of low-efficiency HD.</p>
Journal
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- Nihon Toseki Igakkai Zasshi
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Nihon Toseki Igakkai Zasshi 50 (8), 519-526, 2017
The Japanese Society for Dialysis Therapy
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Keywords
Details 詳細情報について
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- CRID
- 1390282679656520448
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- NII Article ID
- 130006847760
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- NII Book ID
- AN10432053
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- ISSN
- 1883082X
- 13403451
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- NDL BIB ID
- 028528677
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- Text Lang
- ja
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- Data Source
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- JaLC
- NDL
- Crossref
- CiNii Articles
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- Abstract License Flag
- Disallowed