Gutiérrez Orlando M, Wolf Myles
Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Semin Dial. 2010 Jul-Aug;23(4):401-6. doi: 10.1111/j.1525-139X.2010.00750.x. Epub 2010 Jun 14.
Hyperphosphatemia is an independent risk factor for mortality in patients on maintenance dialysis. Since phosphorus clearance by standard three times-weekly dialysis is insufficient to balance ongoing dietary phosphorus intake, strategies to prevent absorption of dietary phosphorus are essential for attenuating increased serum levels. Dietary phosphorus binders are used widely for this purpose but dietary phosphorus restriction is relatively underutilized, most likely because of the logistical complexity of instituting and monitoring a low phosphorus diet, and for fear of worsening protein-energy wasting, which itself is a potent risk factor for mortality. In this review, we propose sustainable strategies for reducing phosphorus intake while avoiding exacerbation of protein-energy wasting. The approach is based on recognition of the dissociation between protein and phosphorus content in phosphorus-rich processed foods and the varying phosphorus bioavailability in different dietary sources. Controlling serum phosphate levels is among the most challenging aspects of day-to-day dialysis care but integration of sensible dietary interventions will likely improve phosphorus control.
高磷血症是维持性透析患者死亡的独立危险因素。由于标准的每周三次透析对磷的清除不足以平衡持续的饮食磷摄入，因此预防饮食磷吸收的策略对于减轻血清水平升高至关重要。饮食磷结合剂广泛用于此目的，但饮食磷限制的使用相对不足，最可能的原因是制定和监测低磷饮食在后勤方面较为复杂，并且担心会加重蛋白质能量消耗，而蛋白质能量消耗本身就是死亡的一个重要危险因素。在本综述中，我们提出了可持续的策略来减少磷摄入，同时避免加重蛋白质能量消耗。该方法基于认识到富含磷的加工食品中蛋白质和磷含量之间的分离以及不同饮食来源中磷的生物利用度不同。控制血清磷酸盐水平是日常透析护理中最具挑战性的方面之一，但合理的饮食干预措施的整合可能会改善磷的控制。
