Ideura Terukuni, Shimazui Miyuki, Higuchi Kumiko, Morita Hiroyuki, Yoshimura Ashio
Department of Internal Medicine, Division of Nephrology, Showa University Fujigaoka Hospital, Aoba-ku, Yokohama-city, Kanagawa, Japan.
Am J Kidney Dis. 2003 Mar;41(3 Suppl 1):S31-4. doi: 10.1053/ajkd.2003.50080.
There are few reports of the effect of a low-protein diet on very late-stage chronic renal failure (CRF), eg, serum creatinine level greater than 10 mg/dL (884 micromol/L). In this retrospective study, we examined the effects of a very low-protein diet in patients with very late-stage CRF.
A very low-protein diet (0.25 to 0.54 g/kg body weight/d [0.39 +/- 0.01g/kg body weight/d]) without supplementation of essential amino acids or keto analogues was administered to 76 patients with very late-stage CRF who had serum creatinine levels greater than 10 mg/dL (884 micromol/L). Twenty-one patients with the same serum creatinine level and protein intake of 0.55 to 1.2 g/kg body weight/d (0.68 +/- 0.03 g/kg body weight/d) were observed in lieu of controls.
Blood urea nitrogen was significantly suppressed to 43.1 +/- 1.9 g/dL (15.4 +/- 0.7 mmol/L) in the low-protein group compared with 111.2 +/- 7.0 mg/dL (39.7 +/- 2.5 mmol/L; P < 0.001) in the control group. The rate of decline in glomerular filtration rate (creatinine clearance) was 36-fold slower with the low-protein diet (-7.1 +/- 1.0 versus -0.2 +/- 0.4 mL/mon, respectively; P < 0.001). Nutritional state in the low-protein group exceeded that of the control group. Consequently, the renal survival rate improved significantly (P < 0.0001). All patients in the control group were initiated on dialysis treatment within 6 months from a serum creatinine level of 10 mg/dL (884 micromol/L). Conversely, 58% of the low-protein group are still on predialysis treatment.
A severe low-protein diet is effective not only in preventing deterioration in renal function, but also in maintaining nutritional state despite no supplementation of essential amino acids or keto analogues, even as serum creatinine level is more than 10 mg/dL (884 micromol/L).
关于低蛋白饮食对极晚期慢性肾衰竭（CRF），如血清肌酐水平大于10mg/dL（884微摩尔/升）的影响，报道较少。在这项回顾性研究中，我们研究了极低蛋白饮食对极晚期CRF患者的影响。
对76例血清肌酐水平大于10mg/dL（884微摩尔/升）的极晚期CRF患者给予极低蛋白饮食（0.25至0.54克/千克体重/天[0.39±0.01克/千克体重/天]），不补充必需氨基酸或酮类似物。观察21例血清肌酐水平相同、蛋白质摄入量为0.55至1.2克/千克体重/天（0.68±0.03克/千克体重/天）的患者作为对照。
低蛋白组血尿素氮显著降至43.1±1.9mg/dL（15.4±0.7毫摩尔/升），而对照组为111.2±7.0mg/dL（39.7±2.5毫摩尔/升；P<0.001）。低蛋白饮食组肾小球滤过率（肌酐清除率）下降速度慢36倍（分别为-7.1±1.0与-0.2±0.4毫升/月；P<0.001）。低蛋白组的营养状况超过对照组。因此，肾脏生存率显著提高（P<0.0001）。对照组所有患者在血清肌酐水平达到10mg/dL（884微摩尔/升）后的6个月内开始接受透析治疗。相反，低蛋白组58%的患者仍在进行透析前治疗。
即使血清肌酐水平超过10mg/dL（884微摩尔/升），严格的低蛋白饮食不仅能有效预防肾功能恶化，而且在不补充必需氨基酸或酮类似物的情况下也能维持营养状况。
