Cupisti Adamasco, Aparicio Michel, Barsotti Giuliano
Nephrology Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy.
Ren Fail. 2007;29(5):529-34. doi: 10.1080/08860220701391670.
Dietary manipulation, including protein, phosphorus, and sodium restriction, when coupled with the vegetarian nature of the renal diet and ketoacid supplementation can potentially exert a cardiovascular protective effect in chronic renal failure patients by acting on both traditional and nontraditional cardiovascular risk factors. Blood pressure control may be favored by the reduction of sodium intake and by the vegetarian nature of the diet, which is very important also for lowering serum cholesterol and improving plasma lipid profile. The low protein and phosphorus intake has a crucial role for reducing proteinuria and preventing and reversing hyperphosphatemia and secondary hyperparathyroidism, which are major causes of the vascular calcifications, cardiac damage, and mortality risk of uremic patients. The reduction of nitrogenous waste products and lowering of serum PTH levels may also help ameliorate insulin sensitivity and metabolic control in diabetic patients, as well as increase the responsiveness to erythropoietin therapy, thus allowing greater control of anemia. Protein-restricted diets may have also anti-inflammatory and anti-oxidant properties. Thus, putting aside the still debatable effects on the progression of renal disease and the more admitted effects on uremic signs and symptoms, it is possible that a proper nutritional treatment early in the course of renal disease may be useful also to reduce the cardiovascular risk in the renal patient. However, conclusive data cannot yet be drawn because quality studies are lacking in this field; future studies should be planned to assess the effect of renal diets on hard outcomes, as cardiovascular events or mortality.
饮食调控，包括限制蛋白质、磷和钠的摄入，再加上肾脏疾病饮食的素食性质以及补充酮酸，通过作用于传统和非传统的心血管危险因素，可能对慢性肾衰竭患者产生心血管保护作用。减少钠的摄入以及饮食的素食性质可能有利于控制血压，这对于降低血清胆固醇和改善血脂谱也非常重要。低蛋白和低磷摄入对于减少蛋白尿、预防和逆转高磷血症及继发性甲状旁腺功能亢进起着关键作用，而这些正是尿毒症患者血管钙化、心脏损害及死亡风险的主要原因。减少含氮废物产物以及降低血清甲状旁腺激素水平也可能有助于改善糖尿病患者的胰岛素敏感性和代谢控制，以及提高对促红细胞生成素治疗的反应性，从而更好地控制贫血。限制蛋白质的饮食可能还具有抗炎和抗氧化特性。因此，暂且不谈对肾脏疾病进展仍有争议的影响以及对尿毒症体征和症状较为公认的影响，在肾脏疾病病程早期进行适当的营养治疗也有可能降低肾病患者的心血管风险。然而，由于该领域缺乏高质量研究，目前还无法得出确凿数据；未来应计划开展研究，以评估肾脏疾病饮食对诸如心血管事件或死亡率等硬性结局的影响。
