Pisani Antonio, Riccio Eleonora, Bellizzi Vincenzo, Caputo Donatella Luciana, Mozzillo Giusi, Amato Marco, Andreucci Michele, Cianciaruso Bruno, Sabbatini Massimo
Chair of Nephrology, Department of Public Health, University Federico II of Naples, Via S. Pansini 5, 80131, Naples, Italy.
Division of Nephrology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
Clin Exp Nephrol. 2016 Jun;20(3):433-42. doi: 10.1007/s10157-015-1172-5. Epub 2015 Oct 9.
The beneficial effects of dietary restriction of proteins in chronic kidney disease are widely recognized; however, poor compliance to prescribed low-protein diets (LPD) may limit their effectiveness. To help patients to adhere to the dietary prescriptions, interventions as education programmes and dietary counselling are critical, but it is also important to develop simple and attractive approaches to the LPD, especially when dietitians are not available. Therefore, we elaborated a simplified and easy to manage dietary approach consisting of 6 tips (6-tip diet, 6-TD) which could replace the standard, non-individualized LPD in Nephrology Units where dietary counselling is not available; hence, our working hypothesis was to evaluate the effects of such diet vs a standard moderately protein-restricted diet on metabolic parameters and patients' adherence.
In this randomized trial, 57 CKD patients stage 3b-5 were randomly assigned (1:1) to receive the 6-TD (Group 6-TD) or a LPD containing 0.8 g/kg/day of proteins (Group LPD) for 6 months. The primary endpoint was to evaluate the effects of the two different diets on the main "metabolic" parameters and on patients' adherence (registration number NCT01865526).
Both dietary regimens were associated with a progressive reduction in protein intake and urinary urea excretion compared to baseline, although the decrease was more pronounced in Group 6-TD. Effects on serum levels of urea nitrogen and urinary phosphate excretion were greater in Group 6-TD. Plasma levels of phosphate, bicarbonate and PTH, and urinary NaCl excretion remained stable in both groups throughout the study. 44 % of LPD patients were adherent to the dietary prescription vs 70 % of Group 6-TD.
A simplified diet, consisting of 6 clear points easily managed by CKD patients, produced beneficial effects either on the metabolic profile of renal disease and on patients' adherence to the dietary plan, when compared to a standard LPD.
蛋白质饮食限制对慢性肾脏病的有益作用已得到广泛认可；然而，对规定的低蛋白饮食（LPD）依从性差可能会限制其效果。为帮助患者坚持饮食规定，诸如教育项目和饮食咨询等干预措施至关重要，但开发简单且有吸引力的低蛋白饮食方法也很重要，尤其是在没有营养师的情况下。因此，我们制定了一种简化且易于管理的饮食方法，包括6个小贴士（6小贴士饮食，6-TD），在没有饮食咨询的肾脏病科病房，它可以替代标准的、非个体化的低蛋白饮食；因此，我们的工作假设是评估这种饮食与标准适度蛋白限制饮食对代谢参数和患者依从性的影响。
在这项随机试验中，57例3b - 5期慢性肾脏病患者被随机分配（1:1）接受6-TD（6-TD组）或含0.8 g/kg/天蛋白质的低蛋白饮食（LPD组），为期6个月。主要终点是评估两种不同饮食对主要“代谢”参数和患者依从性的影响（注册号NCT01865526）。
与基线相比，两种饮食方案均与蛋白质摄入量和尿尿素排泄的逐渐减少有关，尽管6-TD组的减少更为明显。6-TD组对血清尿素氮水平和尿磷排泄的影响更大。在整个研究过程中，两组的血浆磷酸盐、碳酸氢盐和甲状旁腺激素水平以及尿氯化钠排泄均保持稳定。LPD组44%的患者遵守饮食规定，而6-TD组为70%。
与标准低蛋白饮食相比，一种由慢性肾脏病患者易于管理且包含6个明确要点的简化饮食，对肾脏疾病的代谢状况和患者对饮食计划的依从性均产生了有益影响。
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