腎疾患患者の栄養障害 : Protein Energy Wasting （PEW） に対する栄養管理

Nutritional management is related to all kinds of diseases and one of the bases of medical treatment. Chronic kidney disease （CKD） is no exception. Prevalence of chronic kidney disease （CKD） in Japan is estimated to be 13.3million. In addition, the number of dialysis patients in Japan is over 300,000. Recently, because malnutrition in CKD have been paid attention, the International Society of Renal Nutrition and Metabolism （ISRNM） have proposed a new term protein energy wasting （PEW） （Kidney Int. 2008 ; 73（4） : 391‐8）. PEW refers to the multiple nutritional and catabolic alterations that occur in patients with CKD and associated with morbidity and mortality. It has been reported that PEW, which is characterized by a decline in body protein mass, muscle and fat wasting and visceral protein pool contraction, is common in patients with dialysis. Various factors such as insufficient food intake due to poor appetite, dietary restriction, increased energy expenditure, acidosis, and persistent inflammation can cause PEW. Because PEW is a factor of bad prognosis, management of PEW should be also paid attention in treatment of patients with CKD.