Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
Institute for Translational Medicine, University of Chicago Medicine, Chicago, Illinois.
J Ren Nutr. 2021 Jul;31(4):351-360. doi: 10.1053/j.jrn.2020.08.007. Epub 2020 Sep 25.
Nutrition plays a critical role in delaying the progression of chronic kidney disease (CKD); however, adherence to nutrition recommendation in patients with non-dialysis-dependent CKD (NDD-CKD) has been underexplored. The objective of this research is to determine patients with NDD-CKD adherence to nutrition recommendation, and whether knowledge of dietary recommendations impacts adherence.
Patients with NDD-CKD and a glomerular filtration rate <45 mL/min were recruited from an urban, outpatient nephrology clinic. To assess adherence, patients completed an online Food Frequency Questionnaire. Knowledge of renal diet restrictions and food sources of sodium, potassium, and phosphorus was assessed by a CKD Knowledge Questionnaire.
A total of 63 patients completed both the Food Frequency Questionnaire and CKD Knowledge Questionnaire. Patients were consuming excess protein (average intake of 1.16 g/kg; 65-81% of patients' intake above goal), sodium (average intake of 3,117 mg, 67-91% of patients' intake above goal), and phosphorus (average intake of 1,153 mg, 59-70% of patients' intake above goal). In patients without hyperkalemia, only 32-43% of patients consumed adequate potassium. People with hyperkalemia did not consume less potassium than those without hyperkalemia (2,327 vs. 2,564 mg, P = .36). Awareness of diet restriction was not associated with reduced intake of phosphorus (785 vs. 907 mg, P = .21), protein (54.4 vs. 57.0 g, P = .71), or potassium (1,793 vs. 2,076 mg, P = .27). Greater knowledge of nutrient food sources did not correlate to reduced intake of sodium (r = -0.078, P = .54) or phosphorus (r = -0.053, P = .68), or potassium in people with hyperkalemia (r = 0.025, P = .92).
Patients with NDD-CKD consume excess sodium, phosphorus, and protein, whereas potassium intake is inadequate in people without hyperkalemia. Greater knowledge of the renal diet was not associated with increased adherence to dietary restrictions. Instruction efforts should go beyond providing nutrient-based diet information, and instead emphasize healthy food patterns and incorporate counseling to promote behavior change.
营养在延缓慢性肾脏病（CKD）进展方面起着至关重要的作用；然而，非透析依赖性 CKD（NDD-CKD）患者对营养建议的依从性尚未得到充分探索。本研究旨在确定 NDD-CKD 患者对营养建议的依从性，以及对饮食建议的了解是否会影响依从性。
从一家城市门诊肾病诊所招募肾小球滤过率<45mL/min 的 NDD-CKD 患者。为了评估依从性，患者完成了在线食物频率问卷。通过 CKD 知识问卷评估患者对肾脏饮食限制和钠、钾、磷食物来源的了解。
共有 63 名患者完成了食物频率问卷和 CKD 知识问卷。患者摄入过量的蛋白质（平均摄入量为 1.16g/kg；65-81%的患者摄入量超过目标）、钠（平均摄入量为 3117mg，67-91%的患者摄入量超过目标）和磷（平均摄入量为 1153mg，59-70%的患者摄入量超过目标）。在没有高钾血症的患者中，只有 32-43%的患者摄入了足够的钾。有高钾血症的患者摄入的钾并不比没有高钾血症的患者少（2327 与 2564mg，P=0.36）。对饮食限制的认识与磷摄入的减少无关（785 与 907mg，P=0.21）、蛋白质摄入（54.4 与 57.0g，P=0.71）或钾摄入（1793 与 2076mg，P=0.27）。对营养素食物来源的更多了解与钠（r=-0.078，P=0.54）或磷（r=-0.053，P=0.68）或高钾血症患者的钾摄入（r=0.025，P=0.92）减少无关。
NDD-CKD 患者摄入过多的钠、磷和蛋白质，而无高钾血症的患者钾摄入不足。对肾脏饮食的更多了解与对饮食限制的依从性增加无关。指导工作不应仅停留在提供基于营养的饮食信息上，而应强调健康的饮食模式，并纳入咨询以促进行为改变。
