Nutrition Guideline

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<p>() .. 2553 </p> <p>. . . . </p> <p> 1 1 2 3 4 5 6 2 7 8 9 10 3 11 12 13 14 1. 2. 3. 4. 5. </p> <p> (Metabolism) , / (Acute kidney injury) (Renal replacement therapy) (Chronic kidney disease) (Clinical practice guideline) </p> <p> 1 (Acute kidney injury, AKI) antioxidant Systemic inflammatory response oxidative stress : Acute Kidney Injury Network (AKIN) ( 48 ) 3 (stage) 3 (stage) 1 0.3 ./. 1.5-2 0.5 ././. 6 2 2-3 0.5 ././. 12 3 3 0.5 ./. 4 ./. 0.3 ././. 24 100 . 12 </p> <p> 1 1.1 20.5 ./.2 1.2 3 1.3 1.4 1 </p> <p> 2 2.1 1 1 1 ( 0-3) ( 0-3) 0 1 5 3 50-70 2 5 2 18.5-20.5 ./.. 25-60 1 3 5 1 ( 15 3 ) 18.5 ./.. 0-25 0 1 2 </p> <p> 3 (APACHE score 10)</p> <p> 70 1 </p> <p>2.2 3 2.3 3 3 3.1 60 3.2 60 (enteral nutrition) 3.3 60 (parenteral nutrition) 4 4.1 3 4.2 2 2 (Acute kidney injury: AKI) 1- 30 / 1 ./ - 0.8-1.0 / 1 ./ </p> <p> 2- 30 / 1 ./ - 0.8-1.0 / 1 ./ 1.5 / 1 ./ - 3-5 / 1 ./</p> <p> 3- 20-30 / 1 ./ ( 35) - 1.2-1.5 / 1 ./ ( 2.5) CRRT, 2.5 / 1 ./ - 3-5 / 1 ./ ( 7) - 0.8-1.2 / 1 ./</p> <p>- 3-5 / 1 ./</p> <p> = urine output + insensible loss &lt; 2.4 / 2-3 / ( ) 800-1200 ./ : CRRT = continuous renal replacement therapy - 25 ./.2 actual body weight (aBW) - 25 ./.2 dosing weight iBW + 0.25 (aBW iBW) iBW = ideal body weight</p> <p>( 1.5) </p> <p> 5 5.1 5.2 1 5.3 3 ( 2) 5.4 ( ) enteral parenteral 5.5 , (CRRT) </p> <p> 3 ( 2) 5.6 total parenteral nutrition vitamins, trace elements, micronutrient electrolytes 5.7 human albumin hemodynamic instability 6 6.1 3 3 </p> <p>Weight</p> <p> 1 </p> <p> 3 </p> <p>Intake/output</p> <p> 1 </p> <p> 1 </p> <p>Nutrition risk score Capillary glucose BUN, creatinine Electrolytes, plasma glucose</p> <p> 1 </p> <p> 1 </p> <p>( 140-180 ./.) ( 140-180 ./.</p> <p> 1 </p> <p> 2 </p> <p>Ca, P, Mg</p> <p> 1 1 2-3 / 2-3 / 1 </p> <p>Liver function test</p> <p>Triglycerides</p> <p> 1 </p> <p> 1 </p> <p> : (intradialytic parenteral nutrition) 1. Mehta R, Kellum J, Shah S, Molitoris B, Ronco C, Warnock D, Levin A, AKINetwork: Acute Kidney Injury Network: Report of an Initiative to Improve Outcomes in Acute Kidney Injury. Critical Care 2007;11(2):R31. 2. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: society of critical care medicine (SCCM) and American society for parenteral and enteral nutrition (A.S.P.E.N.). J Parenter Enteral Nutr 2009; 33(3):277-316. 3. Martindale RG, McClave SA, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: society of critical care medicine and American society for parenteral and enteral nutrition. Crit Care Med 2009;37(5):1757-61. 4. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clinl Nutr 2003;22(4):415-21. 5. Cano NJM, Aparicio M, Brunoli G, Carrero JJ, Cianciaruso B, Fiaccadori E, et al. ESPEN guidelines on parenteral nutrition: Adult Renal Failure. Clinl Nutr 2009;28:401-14.</p> <p>6.</p> <p>Wilfred Druml. Nutritional support in the critically ill with acute renal failure. In: Ronco, Belloma, Kellum, editor. Critical care nephrology. 2nd ed. Philadelphia: Saunders, 2009:727-31.</p> <p> 2 ( , ) 7 2 4 1. 25 / 1 ./ 1.1 / 1 . dietary recall nPNA 2. (Edema-free BMI) 18.5 ./.. ( 18 ideal body weight) 3. 3.5 /. 4. 4 4 () () 1 1 &gt;1 1 5 &gt;5 3 7 &gt;7 6 10 &gt;10</p> <p> 8 7 8.1 medical foods essential amino acid (EAA) 8.2 (Tube enteral feeding) 8.3 (Parenteral nutrition) (Intradialytic parenteral nutrition, IDPN) 9 9.1 Essential amino acid ketoamino acid ( 30-35 / 1 ./) Medical foods Water soluble vitamins Trace elements 9.2 ( Parenteral nutrition) - Dextrose water plus amino acids - Dextrose water plus amino acids and intravenous fat emulsion 9.3 human albumin hemodynamic (expert opinion)</p> <p> 10 10.1 9 3.5 /. ( ; pre-dialysis serum albumin) . 25 / 1 . 1.1 / 1 . dietary recall nPNA . (Increased dry weight) 18.5 ./.. ( 18 ideal body weight) 3 10.2 10.3 10.1 1. Page CP. Nutritional assessment and support: A Primer, Williams &amp; Wilkins, 1994 2. Blackburn G. Nutrition &amp; metabolic assessment of the hospitalized patient. J Parenter Enteral Nutr 1977;1:11-22 1:11-22. 3. Mitch WE. Mechanisms causing muscle wasting in uremia. J Ren Nutr 1996;6(2):75-8, 4. Kopple JD The National Kidney Foundation K/DOQI clinical practice guidelines for dietary protein intake for chronic dialysis patients. Am J Kidney Dis. 2001;38(4 Suppl 1):S68-73.</p> <p> 3 (Chronic Kidney Disease, CKD) keto amino acids essential amino acids () : 1. 3 (glomerular filtration rate, GFR) 1.1 microalbuminuria proteinuria 500 ./ (hematuria) 1.2 1.3 2. (Glomerular filtration rate, GFR) 60 .//1.73 .. 3 </p> <p> : 5 5 1 2 3 4 5 GFR* GFR GFR GFR * GFR = glomerular filtration rate</p> <p>GFR (.//1.73 ..) &gt; 90 60 89 30 59 15 29 &lt; 15 ()</p> <p> 11 11.1 1-2 30-35 /1 ./ 0.8-1.0 /1 ./ 11.2 3 (eGFR = 3059 .//1.73 ..) 30-35 /1 ./ 0.6-0.8 / 1 ./ 50 0.3-0.6 / 1 ./ (Slow progression of CKD) </p> <p>ketoamino acids essential amino acids 0.6 / 1 ./ 11.3 4-5 (eGFR &lt; 30 .//1.73 ..) 30-35 /1 ./ 0.6 / 1 ./ 50 0.3-0.4 / 1 / ketoamino acids essential amino acids 0.6 / 1 / 11.4 5 (eGFR &lt; 15 .//1.73 ..) 30-35 /1 ./ 0.6 / 1 ./ 50 0.3-0.4 / 1 ./ ketoamino acids </p> <p> 12 12.1 (assessment of protein intake) ketoamino acids essential amino acids 24 normalized protein nitrogen appearance (nPNA) dietary recall (dietitian) 12.2 normalized protein nitrogen appearance (nPNA) UNA = UUN + NUN NUN = 0.031g N x body weight in Kg PNA = UNA x 6.25 N = nitrogen UNA = urea nitrogen appearance (g N/day) UUN = 24-hour urinary urea nitrogen (g N/day) NUN = non-urea nitrogen (g N/day) PNA = protein equivalent of total nitrogen appearance (g protein/day) 12.3 13 13.1 ketoamino acid essential amino acid 13.2 ketoamino acids 0.6 / 1 ./ ketoamino acids 0.1 / 1 ./ 13.3 essential amino acid EAA 4.8 /</p> <p> 14 14.1 13 3 normalized protein catabolic rate (nPCR) dietary recall 14.2 0.6 / 1 ./ amino acids ketoamino acids 1. Teschan PE, Beck GJ, Dwyer JT, Greene T, Klahr S, Levy AS, et al. Effect of a ketoacidaminoacid-supplemented very low protein diet on the progression of advanced renal disease: a reanalysis of the MDRD feasibility study. Clin Nephrol. 1998;50:273-83. 2. Aparicio M, Cano NJ, Cupisti A, Ecder T, Fouque D, Garneata L, et al. Keto-acid therapy in predialysis chronic kidney disease patients: consensus statements. J Ren Nutr. 2009;19(5 Suppl):S33-5. 3. Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2001;37(1 Suppl 2):S66-70. PubMed PMID: 11158865. 4. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis. 2000;35(6 Suppl 2):S1-140. Erratum in: Am J Kidney Dis 2001 Oct;38(4):917. PubMed PMID: 10895784. 5. Clinical Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients, 2009. J Parenter Enteral Nutr. 2009;33(3):255-9. 6. Fouque D, Vennegoor M, ter Wee P, et al. EBPG guideline on nutrition. Nephrol Dial Transplant. 2007;22(Suppl 2):45-87. 7. Carol Ballentine. The essential guide to amino acids. FDA Consumer 1985.</p>