Chin Ho Jun, Kim Dong Ki, Park Jung Hwan, Shin Sung Joon, Lee Sang Ho, Choi Bum Soon, Kim Suhnggwon, Lim Chun Soo
Department of Internal Medicine, Seoul National University Bundang Hospital, Seong-Nam, South Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Nutrition. 2015 Nov-Dec;31(11-12):1333-8. doi: 10.1016/j.nut.2015.05.004. Epub 2015 Jun 1.
The aim of this study was to determine the role of protein intake on proteinuria in chronic kidney disease (CKD), as it is presently not conclusive.
This is a subanalysis of data from an open-label, case-controlled, randomized clinical trial on education about low-salt diets (NCT01552954). We estimated the urine excretion rate of parameters in a day, adjusted by using the equation for estimating urine creatinine excretion, and analyzed the effect of urine urea nitrogen (UUN), as well as estimating protein intake on the level of albuminuria in hypertensive patients with chronic kidney disease.
Among 174 participants from whom complete 24-h urine specimens were collected, the estimates from the Tanaka equation resulted in the highest accuracy for the urinary excretion rate of creatinine, sodium, albumin, and UUN. Among 227 participants, the baseline value of estimated urine albumin excretion (eUalb) was positively correlated with the estimated UUN (eUUN) or protein intake according to eUUN (P = 0.012 and P = 0.038, respectively). We were able to calculate the ratios of eUalb and eUUN in 221 participants and grouped them according to the ratio of eUUN during 16-wk trial period. The proportion of patients that achieved a decrement of eUalb ≥25% during 16 wk with an angiotensin II type I receptor blocker (ARB) medication was 80% (24 of 30) in group 1, with eUUN ratio ≤-25%; 82.2% (111 of 135) in group 2, with eUUN ratio between -25% and 25%; and 66.1% (37 and 56) in group 3, with eUUN ratio ≥25% (P = 0.048). The probability of a decrease in albuminuria with ARB treatment was lower in patients with an increase of eUUN or protein intake during the 16 wk of ARB treatment, as observed in multiple logistic regression analysis as well.
The estimated urine urea excretion rate showed a positive association with the level of albuminuria in hypertensive patients with chronic kidney disease. The increase of eUUN excretion ameliorated the antiproteinuric effect of ARB.
本研究旨在确定蛋白质摄入量在慢性肾脏病（CKD）蛋白尿形成中的作用，因为目前尚无定论。
这是一项对低盐饮食教育开放标签、病例对照、随机临床试验（NCT01552954）数据的亚分析。我们估计一天内各参数的尿排泄率，通过估算尿肌酐排泄的公式进行校正，并分析尿尿素氮（UUN）的影响，以及估算蛋白质摄入量对慢性肾脏病高血压患者蛋白尿水平的影响。
在收集到完整24小时尿标本的174名参与者中，田中型公式估算得出的肌酐、钠、白蛋白和UUN尿排泄率准确性最高。在227名参与者中，估算尿白蛋白排泄量（eUalb）的基线值与估算UUN（eUUN）或根据eUUN估算的蛋白质摄入量呈正相关（分别为P = 0.012和P = 0.038）。我们能够计算221名参与者的eUalb与eUUN比值，并在16周试验期内根据eUUN比值对他们进行分组。在使用血管紧张素II 1型受体阻滞剂（ARB）药物治疗的16周内，eUUN比值≤ -25%的第1组中，eUalb降低≥25%的患者比例为80%（30例中的24例）；eUUN比值在-25%至25%之间的第2组中为82.2%（135例中的111例）；eUUN比值≥25%的第3组中为66.1%（37例和56例）（P = 0.048）。在多因素逻辑回归分析中也观察到，在ARB治疗的16周内eUUN或蛋白质摄入量增加的患者中，ARB治疗使蛋白尿减少的可能性较低。
估算的尿尿素排泄率与慢性肾脏病高血压患者的蛋白尿水平呈正相关。eUUN排泄增加减弱了ARB的抗蛋白尿作用。
