The prognosis of patients with
end-stage renal disease has been improved by the recent remarkable advances in medical and engineering technology. However, there are still many unsolved problems in the clinical field. One of the problems is an intractable
malnutrition characterized by clinical manifestations including
hypoproteinemia and decrease in muscular volume, which is associated with deterioration in the quality of the patient's life.
Malnutrition in
hemodialysis patients involves abnormal energy metabolism and aberrant
amino acid metabolism. In the most malnourished patients, immunodefense mechanisms and homeostasis are disrupted, greatly influencing the prognosis. Moreover, when the performance of dialyzer used is too high, the dialysis treatment might remove a necessary nutrient for the patient. There is also a possibility that the
protein catabolism is accelerated when the biocompatibility is inferior. On the other hand, in malnutri-tion, the circulating level of
insulin-like growth factor-1 (IGF-1) falls while the level of
insulin-like growth factor binding protein-1 (IGFBP-1) is remarkably increased. It has been recognized that
IGF-1 and
IGFBP-1 are indicators reflecting the initiation of a malnutritional state in patients with
chronic renal failure, although there are many indicators such as
albumin,
prealbumin, and anthropometric measurement for nutritional assessment. We have suggested that r-hGH and
IGF-1 improve the malnutritional state by alleviating
hypoproteinemia and abnormality of serum
amino acid profile in uremic patients on
hemodialysis. The serum IGF-1/
IGFBP-1 ratio is useful not only as a nutritional parameter but also as a predicting index of responsiveness to r-hGH. It is necessary to examine the problem from various angles to improve
malnutrition in the dialysis patient, while considering the above mentioned.