リハビリテーション栄養コミュのASPENの腎障害の栄養管理ガイドライン

ASPENの腎障害（急性腎不全、慢性腎不全）の最新の栄養管理ガイドラインの全文を、下記のHPで見ることができます。

A.S.P.E.N. Clinical Guidelines: Nutrition Support in Adult Acute and Chronic Renal Failure

http://pen.sagepub.com/content/34/4/366.full.pdf

英語のままで申し訳ありませんが、ガイドラインの概要を引用します。エビデンスレベルはAが最も高く、Eが最も低いのですが、残念ながらCからEのエビデンスしかありません。

1. Patients with renal disease should undergo formal nutrition assessment, including evaluation of inflammation, with development of a nutrition care plan. D

2. Standard amino acid parenteral nutrition formulations should be used in acute kidney injury. C

3. Intradialytic parenteral nutrition should not be used as a nutritional supplement in malnourished chronic kidneydisease-V hemodialysis patients. C

4. Patients with renal failure who require nutrition support therapy should receive enteral nutrition if intestinal function permits. E

5. Energy requirements in patients with renal disease should be evaluated using indirect calorimetry when possible. If indirect calorimetry is not possible, individualized assessment of energy intake goals, as with other nutrition support patients, is recommended. D

6. To promote positive nitrogen balance in patients with acute kidney injury, protein intake should be adjusted according to catabolic rate, renal function, and dialysis losses. D

7. Electrolyte intake in patients should be adjusted by monitoring serum concentrations of K, Mg, P, and Ca. D