Ko Gang Jee, Kalantar-Zadeh Kamyar, Goldstein-Fuchs Jordi, Rhee Connie M
Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA 92868, USA.
Department of Internal Medicine, Korea University, School of Medicine, Seoul 08308, Korea.
Nutrients. 2017 Jul 31;9(8):824. doi: 10.3390/nu9080824.
Chronic kidney disease (CKD) is one of the most prevalent complications of diabetes, and patients with diabetic kidney disease (DKD) have a substantially higher risk of cardiovascular disease and death compared to their non-diabetic CKD counterparts. In addition to pharmacologic management strategies, nutritional and dietary interventions in DKD are an essential aspect of management with the potential for ameliorating kidney function decline and preventing the development of other end-organ complications. Among DKD patients with non-dialysis dependent CKD, expert panels recommend lower dietary protein intake of 0.8 g/kg of body weight/day, while higher dietary protein intake (>1.2 g/kg of body weight/day) is advised among diabetic end-stage renal disease patients receiving maintenance dialysis to counteract protein catabolism, dialysate amino acid and protein losses, and protein-energy wasting. Carbohydrates from sugars should be limited to less than 10% of energy intake, and it is also suggested that higher polyunsaturated and monounsaturated fat consumption in lieu of saturated fatty acids, trans-fat, and cholesterol are associated with more favorable outcomes. While guidelines recommend dietary sodium restriction to less than 1.5-2.3 g/day, excessively low sodium intake may be associated with hyponatremia as well as impaired glucose metabolism and insulin sensitivity. As patients with advanced DKD progressing to end-stage renal disease may be prone to the "burnt-out diabetes" phenomenon (i.e., spontaneous resolution of hypoglycemia and frequent hypoglycemic episodes), further studies in this population are particularly needed to determine the safety and efficacy of dietary restrictions in this population.
慢性肾脏病（CKD）是糖尿病最常见的并发症之一，与非糖尿病CKD患者相比，糖尿病肾病（DKD）患者发生心血管疾病和死亡的风险要高得多。除药物治疗策略外，DKD的营养和饮食干预是治疗的一个重要方面，有可能改善肾功能下降并预防其他终末器官并发症的发生。在非透析依赖的CKD的DKD患者中，专家小组建议将饮食蛋白质摄入量降低至0.8克/千克体重/天，而对于接受维持性透析的糖尿病终末期肾病患者，建议更高的饮食蛋白质摄入量（>1.2克/千克体重/天），以抵消蛋白质分解代谢、透析液氨基酸和蛋白质损失以及蛋白质能量消耗。糖中的碳水化合物应限制在能量摄入的10%以下，也有人建议，用更高的多不饱和脂肪和单不饱和脂肪替代饱和脂肪酸、反式脂肪和胆固醇，会带来更有利的结果。虽然指南建议将饮食钠限制在每天1.5 - 2.3克以下，但钠摄入过低可能与低钠血症以及葡萄糖代谢和胰岛素敏感性受损有关。由于进展为终末期肾病的晚期DKD患者可能容易出现“糖尿病消退”现象（即低血糖症的自发缓解和频繁的低血糖发作），因此特别需要对这一人群进行进一步研究，以确定该人群饮食限制的安全性和有效性。
