营养状况与肾小球滤过率之间的关系：MDRD研究结果

Relationship between nutritional status and the glomerular filtration rate: results from the MDRD study.

作者信息

Kopple J D, Greene T, Chumlea W C, Hollinger D, Maroni B J, Merrill D, Scherch L K, Schulman G, Wang S R, Zimmer G S

机构信息

National Institutes of Diabetes, Digestive and Kidney Disease, National Institutes of Health, Bethesda, MD, USA.

出版信息

Kidney Int. 2000 Apr;57(4):1688-703. doi: 10.1046/j.1523-1755.2000.00014.x.

DOI:10.1046/j.1523-1755.2000.00014.x

PMID:10760105

Abstract

BACKGROUND

The relationship between the protein-energy nutritional status and renal function was assessed in 1785 clinically stable patients with moderate to advanced chronic renal failure who were evaluated during the baseline phase of the Modification of Diet in Renal Disease Study. Their mean +/- SD glomerular filtration rate (GFR) was 39.8 +/- 21.1 mL/min/1.73 m2.

METHODS

The GFR was determined by 121I-iothalamate clearance and was correlated with dietary and nutritional parameters estimated from diet records, biochemistry measurements, and anthropometry.

RESULTS

The following parameters correlated directly with the GFR in both men and women: dietary protein intake estimated from the urea nitrogen appearance, dietary protein and energy intake estimated from dietary diaries, serum albumin, transferrin, percentage body fat, skinfold thickness, and urine creatinine excretion. Serum total cholesterol, actual and relative body weights, body mass index, and arm muscle area also correlated with the GFR in men. The relationships generally persisted after statistically controlling for reported efforts to restrict diets. Compared with patients with GFR > 37 mL/min/1.73 m2, the means of several nutritional parameters were significantly lower for GFR between 21 and 37 mL/min/1.73 m2, and lower still for GFRs under 21 mL/min/1.73 m2. In multivariable regression analyses, the association of GFR with several of the anthropometric and biochemical nutritional parameters was either attenuated or eliminated completely after controlling for protein and energy intakes, which were themselves strongly associated with many of the nutritional parameters. On the other hand, few patients showed evidence for actual protein-energy malnutrition.

CONCLUSIONS

These cross-sectional findings suggest that in patients with chronic renal disease, dietary protein and energy intakes and serum and anthropometric measures of protein-energy nutritional status progressively decline as the GFR decreases. The reduced protein and energy intakes, as GFR falls, may contribute to the decline in many of the nutritional measures.

摘要

背景

在肾脏疾病饮食调整研究的基线阶段，对1785例中度至重度慢性肾衰竭临床稳定患者的蛋白质 - 能量营养状况与肾功能之间的关系进行了评估。他们的平均肾小球滤过率（GFR）为39.8±21.1 mL/min/1.73 m²。

方法

通过121I - 碘肽酸盐清除率测定GFR，并将其与根据饮食记录、生化测量和人体测量学估计的饮食和营养参数相关联。

结果

以下参数在男性和女性中均与GFR直接相关：根据尿素氮生成量估计的膳食蛋白质摄入量、根据饮食日记估计的膳食蛋白质和能量摄入量、血清白蛋白、转铁蛋白、体脂百分比、皮褶厚度和尿肌酐排泄量。血清总胆固醇、实际体重和相对体重、体重指数和上臂肌肉面积在男性中也与GFR相关。在对报告的饮食限制努力进行统计控制后，这些关系通常仍然存在。与GFR>37 mL/min/1.73 m²的患者相比，GFR在21至37 mL/min/1.73 m²之间的患者的几个营养参数均值显著降低，而GFR低于21 mL/min/1.73 m²的患者则更低。在多变量回归分析中，在控制蛋白质和能量摄入量后，GFR与一些人体测量和生化营养参数的关联要么减弱，要么完全消除，而蛋白质和能量摄入量本身与许多营养参数密切相关。另一方面，很少有患者表现出实际蛋白质 - 能量营养不良的证据。