Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China.
J Ren Nutr. 2013 May;23(3):214-7. doi: 10.1053/j.jrn.2013.01.020.
The optimal dietary protein requirements in maintenance hemodialysis (HD) patients and how to balance the treatments between the nutritional intervention and other approaches are still controversies among nephrologists. In China, excessive dietary intake, low dose of dialysis, and lack of non-calcium-containing phosphorus binders are the main causes of hyperphosphatemia among HD patients. If the daily protein intake reached the recommended dose of 1.2 g/kg body weight per the Kidney Disease Outcomes Quality Initiative guidelines, the net accumulation of phosphorus in patients receiving conventional thrice-weekly low-flux HD may reach 1550 mg per week on the basis of our studies on the assessment of phosphorus removal by HD and residual renal function. In fact, a relatively low-protein diet supplemented with keto-analogues could maintain the stable nutritional status in dialysis patients and provide additional beneficial effects. An individualized nutritional intervention is worth trying to treat hyperphosphatemia in HD patients.
在维持性血液透析（HD）患者中，最佳的膳食蛋白质需求是多少，以及如何在营养干预和其他方法之间平衡治疗，这些仍然是肾病学家之间的争议。在中国，HD 患者高磷血症的主要原因是饮食摄入过多、透析剂量低以及缺乏不含钙的磷结合剂。如果根据肾脏病预后质量倡议指南，每日蛋白质摄入量达到推荐的 1.2 g/kg 体重剂量，那么根据我们对 HD 磷清除和残余肾功能评估的研究，每周接受常规每周三次低通量 HD 的患者磷的净积累可能达到 1550mg。实际上，补充酮酸类似物的低蛋白饮食可以维持透析患者的稳定营养状况，并提供额外的有益效果。个性化营养干预值得尝试用于治疗 HD 患者的高磷血症。
