Cupisti Adamasco, Morelli Ester, D'Alessandro Claudia, Lupetti Surio, Barsotti Giuliano
Department of Internal Medicine, University of Pisa, Pisa, Italy.
J Nephrol. 2003 Jan-Feb;16(1):29-33.
Control of the phosphate balance is a major concern for chronic dialysis patients and it depends on dietary intake, intestinal binding and dialytic removal. Phosphorus mass transfer through dialysis and new phosphorus binders have been widely investigated, but negligible attention has been given to dietary phosphorus management, because of the problems of poor compliance and conflict with the recommended high protein intake. The nutritional target in dialysis patients should be a diet supplying adequate protein but limited phosphate intake, without dramatic changes of dietary habits and lifestyle. It is important to educate patients regarding phosphorus content of current foods so that foods providing less phosphorus with the same protein content can be selected, thus preventing dietary phosphate overload. On the basis of a three-day dietary record, dieticians should give the patient personalised advice in order to reduce phosphorus intake while ensuring the desired protein and energy intake. Dietary manipulation may have little impact on the dialysis population but in individual patients dietary counselling can greatly improve phosphate control. Close co-operation between nephrologists and dieticians is needed to motivate patients and ensure compliance, if dietary intervention is to succeed. All patients should be given dietary education and counselling, especially young-adults, because dietary phosphate control is an important component of an integrated therapeutic approach to phosphate retention and hyperphosphatemia in end-stage renal disease.
磷平衡的控制是慢性透析患者的主要关注点，它取决于饮食摄入、肠道结合和透析清除。通过透析的磷质量传递和新型磷结合剂已得到广泛研究，但由于依从性差以及与推荐的高蛋白摄入存在冲突等问题，饮食磷管理受到的关注却微乎其微。透析患者的营养目标应该是一种既能提供足够蛋白质又能限制磷摄入的饮食，且不会导致饮食习惯和生活方式发生巨大改变。对患者进行当前食物磷含量的教育很重要，这样就可以选择蛋白质含量相同但磷含量较低的食物，从而防止饮食中磷过载。基于三天的饮食记录，营养师应给予患者个性化建议，以减少磷摄入，同时确保达到所需的蛋白质和能量摄入量。饮食调整对透析人群的影响可能较小，但在个体患者中，饮食咨询可大大改善磷的控制。如果饮食干预要取得成功，肾病学家和营养师之间需要密切合作，以激励患者并确保其依从性。所有患者都应接受饮食教育和咨询，尤其是年轻患者，因为饮食磷控制是终末期肾病中磷潴留和高磷血症综合治疗方法的重要组成部分。
