Guida B, Parolisi S, Coco M, Ruoppo T, Veccia R, di Maro M, Trio R, Memoli A, Cataldi M
Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy; Federico II University Hospital, Naples, Italy.
Department of Clinical Medicine and Surgery, Physiology Nutrition Unit, Federico II University of Naples, Italy.
Nutr Metab Cardiovasc Dis. 2019 Jan;29(1):45-50. doi: 10.1016/j.numecd.2018.09.010. Epub 2018 Sep 28.
Here we describe a dietary intervention for hyperphosphatemia in dialysis patients based on the partial replacement of meat and fish, which are one of the main sources of alimentary phosphorous, with egg white, a virtually phosphorous-free protein source. This intervention aims to reduce phosphorous intake without causing protein wasting.
As many as 23 hyperphosphatemic patients (15 male and 8 female, mean age 53.0 ± 10.0 years) on chronic standard 4 h, three times weekly, bicarbonate hemodialysis were enrolled in this open-label, randomized controlled trial. Patients in the intervention group were instructed to replace fish or meat with egg white in three meals a week for three months whereas diet was unchanged in the control group.
Serum phosphate concentrations were significantly lower in the intervention group than in controls after three (4.9 ± 1.0 vs 6.6 ± 0.8; p < 0.001) but not after one month of treatment. Phosphate concentrations decreased more from baseline in the intervention than in the control group both after one (-1,2 ± 1,1 vs 0,5 ± 1,1; p = 0.004) and after three (-1,7 ± 1,1 vs -0,6 ± 1,1; p < 0.001) months of follow-up. No change either in body weight or in body composition assessed with bioelectrical impedance analysis or in serum albumin concentration was observed in either group.
The partial replacement of meat and fish with egg white induces a significant decrease in serum phosphate without causing protein malnutrition and could represent a useful instrument to control serum phosphate levels in hemodialysis patients. CLINICALTRIALS.
NCT03236701.
在此，我们描述一种针对透析患者高磷血症的饮食干预措施，即使用几乎不含磷的蛋白质来源蛋清，部分替代作为膳食磷主要来源之一的肉类和鱼类。该干预旨在减少磷摄入，同时不导致蛋白质消耗。
本开放标签、随机对照试验纳入了23例接受慢性标准4小时、每周三次碳酸氢盐血液透析的高磷血症患者（15例男性和8例女性，平均年龄53.0±10.0岁）。干预组患者被指导在三个月内每周三餐用蛋清替代鱼类或肉类，而对照组饮食不变。
治疗三个月后，干预组血清磷酸盐浓度显著低于对照组（4.9±1.0 vs 6.6±0.8；p<0.001），但治疗一个月后无显著差异。随访一个月（-1.2±1.1 vs 0.5±1.1；p=0.004）和三个月（-1.7±1.1 vs -0.6±1.1；p<0.001）后，干预组磷酸盐浓度较基线的下降幅度均大于对照组。两组患者的体重、通过生物电阻抗分析评估的身体成分或血清白蛋白浓度均未发生变化。
用蛋清部分替代肉类和鱼类可使血清磷酸盐显著降低，且不会导致蛋白质营养不良，可能是控制血液透析患者血清磷酸盐水平的一种有用方法。临床试验。
NCT03236701。
