慢性肾脏病的低蛋白饮食：肾病病房8年临床经验

The low-protein diet for chronic kidney disease: 8 years of clinical experience in a nephrology ward.

作者信息

Baragetti Ivano, De Simone Ilaria, Biazzi Cecilia, Buzzi Laura, Ferrario Francesca, Luise Maria Carmen, Santagostino Gaia, Furiani Silvia, Alberghini Elena, Capitanio Chiara, Terraneo Veronica, Milia Vicenzo La, Pozzi Claudio

机构信息

Division of Nephrology and Dialysis, Bassini Hospital, ASST Nord Milano, Cinisello Balsamo, Milan, Italy.

Division of Nephrology and Dialysis, Legnano Hospital, ASST Ovest Milanese, Legnano, Milan, Italy.

出版信息

Clin Kidney J. 2019 Nov 8;13(2):253-260. doi: 10.1093/ckj/sfz141. eCollection 2020 Apr.

DOI:10.1093/ckj/sfz141

PMID:32296529

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7147315/

Abstract

BACKGROUND

Guidelines indicate that a low-protein diet (LPD) delays dialysis in severe chronic kidney disease (CKD). We assessed the value of these guidelines by performing a retrospective analysis in our renal clinical practice.

METHODS

The analysis was performed from 1 January 2010 to 31 March 2018 in 299 CKD Stage 4 patients followed for 70 months in collaboration with a skilled nutritionist. The patients included 43 patients on a controlled protein diet (CPD) of 0.8 g/kg/day [estimated glomerular filtration rate (eGFR) 20-30 mL/min/1.73 m body surface (b.s.)], 171 patients on an LPD of 0.6 g/kg/day and 85 patients on an unrestricted protein diet (UPD) who were not followed by our nutritionist (LPD and UPD, eGFR <20 mL/min/1.73 m b.s.).

RESULTS

eGFR was higher in CPD patients than in UPD and LPD patients (21.9 ± 7.4 mL/min/1.73 m versus 17.6 ± 8.00 mL/min/1.73 m and 17.1 ± 7.5 mL/min/1.73 m; P = 0.008). The real daily protein intake was higher in UPD patients than in LPD and CDP patients (0.80 ± 0.1 g/kg/day versus 0.6 ± 0.2 and 0.63 ± 0.2 g/kg/day; P = 0.01). Body mass index (BMI) was stable in the LPD and CPD groups but decreased from 28.5 ± 4.52 to 25.4 ± 3.94 kg/m in the UPD group (P < 0.001). The renal survival of UPD, LPD and CPD patients was 47.1, 84.3 and 90.7%, respectively, at 30 months (P < 0.001), 42.4, 72.0 and 79.1%, respectively, at 50 months (P < 0.001) and 42.4, 64.1 and 74.4%, respectively, at 70 months (P < 0.001). The LPD patients started dialysis nearly 24 months later than the UPD patients. Diet was an independent predictor of dialysis [-67% of RR reduction (hazard ratio = 0.33; confidence interval 0.22-0.48)] together with a reduction in BMI.

CONCLUSIONS

An LPD recommended by nephrologists in conjunction with skilled dietitians delays dialysis and preserves nutritional status in severe CKD.

摘要

背景

指南指出，低蛋白饮食（LPD）可延缓重度慢性肾脏病（CKD）患者进入透析阶段。我们通过对肾脏临床实践进行回顾性分析，评估了这些指南的价值。

方法

分析时间为2010年1月1日至2018年3月31日，共纳入299例CKD 4期患者，与一名专业营养师合作对其进行了70个月的随访。患者包括43例接受0.8 g/kg/天控制蛋白饮食（CPD）的患者[估计肾小球滤过率（eGFR）为20 - 30 mL/min/1.73 m²体表面积（b.s.）]，171例接受0.6 g/kg/天LPD的患者，以及85例未接受我们营养师随访的非限制蛋白饮食（UPD）患者（LPD和UPD组，eGFR <20 mL/min/1.73 m² b.s.）。

结果

CPD组患者的eGFR高于UPD组和LPD组患者（分别为21.9 ± 7.4 mL/min/1.73 m²、17.6 ± 8.00 mL/min/1.73 m²和17.1 ± 7.5 mL/min/1.73 m²；P = 0.008）。UPD组患者实际每日蛋白质摄入量高于LPD组和CDP组患者（分别为0.80 ± 0.1 g/kg/天、0.6 ± 0.2 g/kg/天和0.63 ± 0.2 g/kg/天；P = 0.01）。LPD组和CPD组患者的体重指数（BMI）保持稳定，但UPD组患者的BMI从28.5 ± 4.52降至25.4 ± 3.94 kg/m²（P < 0.001）。在30个月时，UPD组、LPD组和CPD组患者的肾脏生存率分别为47.1%、84.3%和90.7%（P < 0.001）；在50个月时，分别为42.4%、72.0%和79.1%（P < 0.001）；在70个月时，分别为42.4%、64.1%和74.4%（P < 0.001）。LPD组患者开始透析的时间比UPD组患者晚近24个月。饮食与BMI降低是透析的独立预测因素[RR降低67%（风险比 = 0.33；置信区间0.22 - 0.48）]。