腎不全保存期の低蛋白食遵守が血液透析導入後予後へ与える影響

抄録

To clarify whether a protein restriction diet in the pre-dialysis period affects the overall prognosis after initiating hemodialysis therapy, we compared the survival between patients with and without a protein restriction diet. Among 310 patients in whom hemodialysis was introduced between 1997 and 2000 at Toride Kyodo General Hospital, two hundred and ten patients were excluded due to an insufficient observation period ( < 6 months) or the lack of records estimating their protein intake. One hundred patients were finally included in this study. All of these patients were followed at the hospital with their estimated protein intake using repeated (three times or more) urea nitrogen appearance in 24-hour collected urine samples over 6 months prior to the initiation of dialysis therapy. The patients were divided into a protein restriction diet group (PRD 61 cases) and non restriction diet group (NRD 39 cases), according to their estimated protein intake less or above 0.7 g/kg/day. Among the patient profile items, gender, cause of renal failure, and serum albumin did not differ between the two groups, but the age was higher in NRD (p < 0.01) . Nineteen patients (PRD 8, NRD 11 cases) died during the observation period (0-65 months) . On the analysis of their survival, PRD showed a better survival ratio by the Kaplan-Meier method (p < 0.01) . Among the variables examined by Cox's proportional hazard test, age, PRD, and their combination showed significant risk ratios (1.06, 0.30, and 0.39 respectively) on survival after the initiation of hemodialysis. Hence a protein restriction diet in the pre-dialysis period does not deteriorate the prognosis even after the initiation of hemodialysis therapy.