Cianciaruso B
Cattedra di Nefrologia, Università degli Studi Federico II, Via Pansini 5, Naples, Italy.
G Ital Nefrol. 2008 Sep-Oct;25 Suppl 42:S29-34.
Arterial hypertension is found in almost all patients with chronic kidney disease. The US Kidney Foundation guidelines recommend a pressure target for chronic kidney disease patients (130/80 mmHg) that may be difficult to reach because of the reduced sodium excretion in these patients and the widespread use of vasodilator drugs. Reducing the dietary protein intake may help to lower the dietary sodium load. The 130/80 mmHg target has been reached in 30% of stage 4 and 5 patients only after six months of a very low-protein diet supplemented with keto-analogues and essential amino acids. However, even moderate reductions of dietary sodium intake are useful in patients with compromised renal function, as was shown by Koomans et al more than 20 years ago. Blood pressure levels are lower in vegetarians, possibly also because of the reduced sodium content of potassium-rich vegetarian diets. Diets rich in unrefined cereals, vegetables, fruit and low-fat cheese may be useful in patients with chronic kidney disease. Commercial low-protein preparations may help to design diets that are both low in sodium, potassium and phosphorus and adequate for caloric needs.
几乎所有慢性肾病患者都存在动脉高血压。美国肾脏基金会指南建议慢性肾病患者的血压目标为130/80 mmHg，但由于这些患者钠排泄减少以及血管扩张剂药物的广泛使用，这一目标可能难以实现。减少饮食中蛋白质的摄入量可能有助于降低饮食中的钠负荷。只有在采用补充了酮类似物和必需氨基酸的极低蛋白饮食六个月后，30%的4期和5期患者才达到了130/80 mmHg的目标。然而，正如库曼斯等人在20多年前所表明的，即使适度减少饮食中的钠摄入量对肾功能受损的患者也是有益的。素食者的血压水平较低，这可能也是因为富含钾的素食饮食中钠含量较低。富含未精制谷物、蔬菜、水果和低脂奶酪的饮食可能对慢性肾病患者有益。商业低蛋白制剂可能有助于设计出钠、钾和磷含量低且热量需求充足的饮食。
