著者

椿原 美治 飯田 喜俊 湯浅 繁一 河島 利広 中西 功 横川 朋子 友渕 基

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.24, no.10, pp.1127-1136, 1982-10-25 (Released:2010-07-05)

参考文献数

30

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Borah, et al, demonstrated that HD is a severe catabolic stress to N-metabolism. EAA loss during HD has been speculated as a stress. In order to study this mechanism, AMIYU® (contained 8 EAA and His. 7% solution, Morishita Pharm. Co. Ltd., ) was infused into venous line throughout 5 hrs. HD with the speed of 40 ml/hr. (study A) and during the last 1 hr. of 5 hrs. HD with the speed of 200 ml/hr. (study B) . The time courses of urea generation rate (Gu.), aminogram and N-balance were compared among control, study A and study B-HD. There were no significant changes in EAA level during control HD suggesting that EAA loss was replacedd by protein catabolism. Gu. (mg/min) during 4 hrs, after control HD (20.1±1.2) was significantly higher than predialysis value (4.7±0.1), indicating the catabolic stress due to HD. Gu. after study A-HD (17.3±1.3) was significantly lower than that after control HD. But Gu. after study B-HD (23.0±0.9) was significantly higher than that after control. HD. This shows that the high dose of EAA administered during the last 1 hr. of HD is not lost into dialysate but is degradated to urea about a half because the last 1 hr, in 5 hrs. HD may be already the catabolic phase. N-balance was -3.6±0.8 (g/day) on control HD day and improved by EAA supplementation throughout HD (-2, 1±0.8). Plasma total. EAA and nonEAA levels significantly increased during 4 hrs. after control HD, suggesting that amino acids were supplied through protein degradation. But in study A, plasma total nonEAA level significantly decreased during HD, indicating that protein catabolism was suppressed by EAA supplementation throughut HD. From these results, HD itself is shown to be the strong catabolic stress to N-metabolism. The rapid decrease in plasma EA.A level due to EAA loss during HD would be one of this factor. The low dose administration of EAA throughout HD is considered to be not only replace the EAA loss, but also suppress this catabolic stress.