Giovannetti S
Clinica Medica 1, Università di Pisa, Italy.
Infusionsther Klin Ernahr. 1987 Oct;14 Suppl 5:4-7. doi: 10.1159/000226318.
The compliance with the low-protein, supplemented diet is facilitated or hindered by psychological, social and toxic (severe uremia) factors; however, the most important factor which induces good compliance in patients is the fear of dialysis. The early effect of poor compliance is the appearance of intoxication related to renal failure and the consequent appearance of the uremic syndrome. The assessment of compliance with the low-protein intake is done quite easily by measuring urea appearance; however, regular clinical and laboratory controls are mandatory: anthropometric measurements, evaluation of the serum concentrations of proteins (especially those having a rapid turnover), and the evaluation of thyroid function--which is depressed in a state of malnutrition and improves following nutritional therapy--are adequate for detecting a state of malnutrition following poor compliance.
心理、社会和毒性（严重尿毒症）因素会促进或阻碍患者对低蛋白补充饮食的依从性；然而，促使患者良好依从的最重要因素是对透析的恐惧。依从性差的早期影响是出现与肾衰竭相关的中毒以及随之而来的尿毒症综合征。通过测量尿素生成量很容易评估对低蛋白摄入的依从性；然而，定期的临床和实验室检查是必不可少的：人体测量、评估血清蛋白浓度（尤其是那些周转迅速的蛋白）以及评估甲状腺功能——甲状腺功能在营养不良状态下会降低，而在营养治疗后会改善——足以检测出依从性差后出现的营养不良状态。
