This study helped clarify the perspective of nutrition management conducted by nutrition support teams( NST) at hospitals in Kyoto based on a questionnaire survey for hospital managers. Questionnaires were sent to 163 hospitals managers at facilities that had more than 20 beds. Each questionnaire contained 19 questions, including questions about the state of the nutrition support team and additional medical fees for the nutrition support team in the health insurance system. Eighty-five hospitals (52 . 1%) answered the questionnaire. Forty-eight hospitals (56 . 5%) were eligible for the additional medical fees. However, only 6 hospitals( 12.5%) had already applied for the additional medical fees for the NST. Twenty hospitals( 41.7%) indicated that they intended to apply in the future. The results showed that 78 . 2% of the hospital managers considered that the activity of the NST promoted medical staff teamwork and 58.2% considered that they increased the oral intake of the patients. These results will encourage the promotion of nutrition management at hospitals in the local region.

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We report here the progress of Arginine( Arg) treatment in a female hemodialysis patient with pressure ulcer or bed sore. As the patient had inferior granuloma growth in sacral ulcer, she was administered Arg-reinforced product. Administration of Abound ^TM fortified with Arg and glutamine( Gln) promoted granuloma growth, but caused an excessive rise in BUN, 111 to 135 mg/dL. Administration of ISOCAL ® PLUS EX fortified only with Arg lowered BUN to 67 mg/dL. The result suggests that Gln is possibly responsible for BUN rise. Although ulcer was cured, the bodyweight decline was observed, which may have been due to accelerated urea production induced by Arg. Gln reinforcement, short energy supply and albumin decrease were observed. As hyperphosphatemia 6 . 8 mg/dL was observed at the time of ISOCAL ® Plus Ex administration, we recommend to take care to select an enteral nutrient with sufficient energy and electrolyte, and to monitor the bodyweight and blood parameters when administering Arg to hemodialysis patients.

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