Bellizzi V, Di Iorio B R, De Nicola L, Minutolo R, Zamboli P, Trucillo P, Catapano F, Cristofano C, Scalfi L, Conte G
Nephrology Unit, A Landolfi Hospital, Solofra, Italy.
Kidney Int. 2007 Feb;71(3):245-51. doi: 10.1038/sj.ki.5001955. Epub 2006 Oct 11.
Blood pressure (BP) is hardly controlled in chronic kidney disease (CKD). We compared the effect of very low protein diet (VLPD) supplemented with ketoanalogs of essential amino acids (0.35 g/kg/day), low protein diet (LPD, 0.60 g/kg/day), and free diet (FD) on BP in patients with CKD stages 4 and 5. Vegetable proteins were higher in VLPD (66%) than in LPD (48%). LPD was prescribed to 110 consecutive patients; after run-in, they were invited to start VLPD. Thirty subjects accepted; 57 decided to continue LPD; 23 refused either diet (FD group). At baseline, protein intake (g/kg/day) was 0.79+/-0.09 in VLPD, 0.78+/-0.11 in LPD, and 1.11+/-0.18 in FD (P<0.0001). After 6 months, protein intake was lower in VLPD than LPD and FD (0.54+/-0.11, 0.78+/-0.10, and 1.04+/-0.21 g/kg/day, respectively; P<0.0001). BP diminished only in VLPD, from 143+/-19/84+/-10 to 128+/-16/78+/-7 mm Hg (P<0.0001), despite reduction of antihypertensive drugs (from 2.6+/-1.1 to 1.8+/-1.2; P<0.001). Urinary urea excretion directly correlated with urinary sodium excretion, which diminished in VLPD (from 181+/-32 to 131+/-36 mEq/day; P<0.001). At multiple regression analysis (R2=0.270, P<0.0001), BP results independently related to urinary sodium excretion (P=0.023) and VLPD prescription (P=0.003), but not to the level of protein intake. Thus, in moderate to advanced CKD, VLPD has an antihypertensive effect likely due to reduction of salt intake, type of proteins, and ketoanalogs supplementation, independent of actual protein intake.
慢性肾脏病（CKD）患者的血压很难得到控制。我们比较了极低蛋白饮食（VLPD，补充必需氨基酸酮类似物，0.35克/千克/天）、低蛋白饮食（LPD，0.60克/千克/天）和自由饮食（FD）对4期和5期CKD患者血压的影响。VLPD中植物蛋白含量（66%）高于LPD（48%）。连续110例患者采用LPD治疗；经过导入期后，邀请他们开始VLPD治疗。30名受试者接受了；57名决定继续LPD治疗；23名拒绝任何一种饮食（FD组）。基线时，VLPD组、LPD组和FD组的蛋白质摄入量（克/千克/天）分别为0.79±0.09、0.78±0.11和1.11±0.18（P<0.0001）。6个月后，VLPD组的蛋白质摄入量低于LPD组和FD组（分别为0.54±0.11、0.78±0.10和1.04±0.21克/千克/天；P<0.0001）。仅VLPD组的血压降低，从143±19/84±10降至128±16/78±7毫米汞柱（P<0.0001），尽管抗高血压药物减少（从2.6±1.1降至1.8±1.2；P<0.001）。尿尿素排泄与尿钠排泄直接相关，VLPD组尿钠排泄减少（从181±32降至131±36毫当量/天；P<0.
