Wyskida Katarzyna, Wajda Jarosław, Klein Dariusz, Witkowicz Joanna, Ficek Rafał, Rotkegel Sylwia, Spiechowicz-Zatoń Urszula, Kocemba-Dyczek Joanna, Ciepał Jarosław, Olszanecka-Glinianowicz Magdalena, Więcek Andrzej, Chudek Jerzy
Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical University of Silesia, Poland.
Dialysis Center, Provincial Specialist Hospital No. 3 in Rybnik, Poland.
Adv Clin Exp Med. 2018 Feb;27(2):217-224. doi: 10.17219/acem/67050.
Diet is a key factor that determines proper alignment of calcium-phosphate and nutritional status among hemodialysis (HD) patients.
To assess the nutrient intake in relation to long-term calcium-phosphate control in HD patients with end-stage renal failure.
The study included 107 patients (66 men, 41 women) from 10 dialysis centers in the Upper Silesia region of Poland. To analyze the diet composition during the previous year, a portion-sized version of the Diet History Questionnaire II (DHQ-II) from National Institutes of Health was used. The nutrient intake was assessed in accordance with the most complex recommendations on HD patients' nutrition - K/DOQI Clinical Practice Guidelines for nutrition in chronic renal failure. Poor long-term alignment of calcium-phosphate homeostasis was defined as the presence of over 50% monthly phosphorus concentrations exceeding 5 mg/dL, and for calcium 10.2 mg/dL, during the last 6-month period.
Lower than recommended protein intake was found in 63% of HD patients (average consumption: 0.9 ±0.5 g/kg/day). Most of the patients consumed too much fat (33.5 ±6.7% of daily energy intake) and sodium (2912 ±1542 mg/day). In 42% of patients, dietary phosphorus intake was consistent with the recommendations (13.3 ±7.5 mg/kg/day). Protein intake over 1.2 g/kg/day resulted in an increased consumption of phosphorous, but did not increase the risk of misalignment of phosphorus concentrations (OR = 1.15 [0.40-3.27]); p = 0.8). Poor control of serum phosphorus concentrations was observed in 69% of patients (they were on average 8 years younger). The average intake of protein and phosphate in the groups with good or not satisfactory serum phosphorus alignment did not differ significantly.
Adequate control of protein intake is not sufficient to obtain phosphorus alignment, especially in younger HD patients.
饮食是决定血液透析（HD）患者钙磷平衡及营养状况是否良好的关键因素。
评估终末期肾衰竭HD患者的营养摄入与长期钙磷控制之间的关系。
该研究纳入了波兰上西里西亚地区10个透析中心的107名患者（66名男性，41名女性）。为分析前一年的饮食构成，采用了美国国立卫生研究院的饮食历史问卷II（DHQ-II）分量版本。根据关于HD患者营养的最全面建议——《慢性肾衰竭营养治疗的K/DOQI临床实践指南》评估营养摄入情况。钙磷稳态长期失衡的定义为在过去6个月期间，每月超过50%的磷浓度超过5mg/dL，钙浓度超过10.2mg/dL。
63%的HD患者蛋白质摄入量低于推荐水平（平均摄入量：0.9±0.5g/kg/天）。大多数患者脂肪（占每日能量摄入的33.5±6.7%）和钠（2912±1542mg/天）摄入过多。42%的患者饮食磷摄入量符合推荐水平（13.3±7.5mg/kg/天）。蛋白质摄入量超过1.2g/kg/天会导致磷摄入量增加，但不会增加磷浓度失衡的风险（比值比=1.15[0.40 - 3.27]；p = 0.8）。69%的患者血清磷浓度控制不佳（他们平均年轻8岁）。血清磷平衡良好或不理想的组中蛋白质和磷的平均摄入量无显著差异。
仅充分控制蛋白质摄入量不足以实现磷平衡，尤其是在年轻的HD患者中。
