Eyre Sintra, Attman Per-Ola, Haraldsson Börje
Department of Molecular and Clinical Medicine, and Department of Nephrology, Sahlgrenska Academy, Göteborg University, Gothenburg, Sweden.
J Ren Nutr. 2008 May;18(3):269-80. doi: 10.1053/j.jrn.2007.11.013.
The potential benefit or harm of low-protein diets (LPDs) for patients with chronic kidney disease has been debated. This study sought to investigate the effects of treatment with LPDs on nutritional markers, morbidity, and survival during subsequent dialysis. A second objective was to evaluate the effect of LPDs on renal function and the start of dialysis.
This was a retrospective study of medical records.
The setting was an outpatient nephrology and dialysis clinic.
One-hundred twenty-two renal patients were recruited from the central dialysis registry of one clinic. The patients had been followed by a nephrologist for > or =6 months before dialysis. Sixty-one patients were treated with LPDs, and an equal number of control patients not treated with LPDs were matched for sex, age, dialysis modality, diabetes, and start of dialysis.
Main outcome measures included weight and weight change, serum albumin, glomerular filtration rate, morbidity, and mortality.
There was less mean weight loss in the LPD group the year before dialysis (0.14 kg/month, compared with the control group at 0.36 kg/month, P < .05). The level of serum albumin was higher in the LPD group at the start of dialysis (P < .01). The mean rate of progression during the 6 months before dialysis was lower in the LPD group (4.1 mL/min/year) than in the control group (13.4 mL/min/year) (P < .001). The LPD group had fewer days of hospitalization at the start of dialysis than the control group (8.2 vs 15.4 days, respectively, P < .01). There was no difference in mortality between groups 1, 2, or 5 years after starting dialysis.
Low-protein diets can reduce patient morbidity, preserve renal function, relieve uremic symptoms and improve nutritional status. The results suggest that LPDs can postpone the start of dialysis for 6 months, and entail substantial cost-savings. Low-protein diets should be used more generally in the renal community.
低蛋白饮食（LPD）对慢性肾病患者的潜在益处或危害一直存在争议。本研究旨在调查LPD治疗对后续透析期间营养指标、发病率和生存率的影响。第二个目的是评估LPD对肾功能和透析开始的影响。
这是一项对病历的回顾性研究。
研究地点为门诊肾病和透析诊所。
从一家诊所的中央透析登记处招募了122名肾病患者。这些患者在透析前已由肾病专家随访≥6个月。61名患者接受LPD治疗，将同等数量未接受LPD治疗的对照患者按性别、年龄、透析方式、糖尿病和透析开始时间进行匹配。
主要观察指标包括体重及体重变化、血清白蛋白、肾小球滤过率、发病率和死亡率。
透析前一年，LPD组的平均体重减轻较少（0.14千克/月，对照组为0.36千克/月，P<0.05）。透析开始时，LPD组的血清白蛋白水平较高（P<0.01）。透析前6个月，LPD组的平均进展率（4.1毫升/分钟/年）低于对照组（13.4毫升/分钟/年）（P<0.001）。透析开始时，LPD组的住院天数少于对照组（分别为8.2天和15.4天，P<0.01）。透析开始后1、2或5年，两组之间的死亡率无差异。
低蛋白饮食可降低患者发病率，保护肾功能，缓解尿毒症症状并改善营养状况。结果表明，LPD可将透析开始时间推迟6个月，并节省大量成本。低蛋白饮食应在肾病领域更广泛地应用。
