Koulouridis E, Koulouridis I
Nephrology Department, General Hospital of Corfu, Greece.
Hippokratia. 2011 Jan;15(Suppl 1):3-7.
The possible deleterious effect of meet consumption upon deterioration of renal disease was speculated from Lionel Beale as early as 1869. The first attempt to apply a very low protein diet in humans is attributed to Millard Smith who prescribed a diet consisting of 300 mg protein per day in a volunteer medical student for 24 days. Unfortunately, in early 20(th) century, prescribing very low protein diets among patients suffering from renal disease complicated with malnutrition and the medical practice of this era turned to the recommendation of high protein diets because it was believed that protein consumption is coupled with the strength of civilized man. In mid sixties Giordano and Giovanetti introduced low protein diets in the treatment of uremic patients but their efforts did not accepted from the medical community. Meanwhile the evolution of haemodialysis, peritoneal dialysis and transplantation as effective methods of treating end stage renal disease guided doctors and patients far from privative diets in the era of plenty. The rapidly increasing number of end stage renal disease patients needed substitution of renal function produced a tremendous increase of financial burden upon public health system expenditure and alternative measures of therapy, prevention and delaying chronic kidney disease searched. Unfortunately MDRD study failed to show convincing results of food protein restriction and blood pressure lowering in ameliorating deterioration of renal function and the majority of physicians turned to the practice of early dialysis in an attempt to avoid malnutrition. Despite the increasing knowledge and the appliance of certain guidelines in treating end stage renal disease patients, the morbidity and mortality remain high among this population. The search toward other possible toxic substances showed that phosphorus consumption with diet is another dangerous element exerting its deleterious effect in deteriorating renal function as well as increasing morbidity and mortality. Recently published epidemiological data suggest a very poor outcome of elderly patients, older than 80 years of age, undergoing substitution of renal function by dialysis or peritoneal dialysis and a lot of skepticism arise concerning the beneficial effect of diet and a rigorous effort of rehabilitation of these patients instead of substitution of renal function by either method.
早在1869年，莱昂内尔·比尔就推测肉类消费可能对肾脏疾病的恶化产生有害影响。首次尝试在人类中应用极低蛋白饮食的是米勒德·史密斯，他为一名志愿医学生规定了一种每天含300毫克蛋白质的饮食，为期24天。不幸的是，在20世纪初，在患有肾病并伴有营养不良的患者中开极低蛋白饮食的处方，而这个时代的医学实践转向了推荐高蛋白饮食，因为人们认为蛋白质的摄入与文明人的力量相关。20世纪60年代中期，乔达诺和乔瓦内蒂引入了低蛋白饮食来治疗尿毒症患者，但他们的努力未被医学界接受。与此同时，血液透析、腹膜透析和移植作为治疗终末期肾病的有效方法的发展，使医生和患者在物质丰富的时代远离了限制性饮食。终末期肾病患者数量的迅速增加需要替代肾功能，这给公共卫生系统支出带来了巨大的经济负担，于是人们开始寻找治疗、预防和延缓慢性肾病的替代措施。不幸的是，MDRD研究未能显示食物蛋白限制和降低血压在改善肾功能恶化方面有令人信服的结果，大多数医生转向早期透析的做法以避免营养不良。尽管在治疗终末期肾病患者方面知识不断增加且应用了某些指南，但该人群的发病率和死亡率仍然很高。对其他可能的有毒物质的研究表明，饮食中摄入磷是另一个危险元素，它在恶化肾功能以及增加发病率和死亡率方面发挥着有害作用。最近公布的流行病学数据表明，80岁以上的老年患者通过透析或腹膜透析替代肾功能的结果非常糟糕，人们对饮食的有益效果以及对这些患者进行严格康复努力而非通过任何一种方法替代肾功能产生了很多怀疑。
