一项针对中国 CKD 3-5 期患者低蛋白饮食合格率及其短期效果的调查：一项单中心回顾性队列研究。

An investigation of low-protein diets' qualification rates and an analysis of their short-term effects for patients with CKD stages 3-5: a single-center retrospective cohort study from China.

机构信息

Renal Division, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, Guangdong, China.

The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.

出版信息

Int Urol Nephrol. 2023 Apr;55(4):1059-1070. doi: 10.1007/s11255-022-03390-3. Epub 2022 Oct 31.

DOI:10.1007/s11255-022-03390-3

PMID:36310191

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10030416/

Abstract

BACKGROUND

The feasibility and efficacy of low-protein diets (LPD) treatment in chronic kidney disease (CKD) is controversial. Based on the characteristics of the Chinese diet, we observe the qualification rates and short-term clinical effects of LPD for CKD patients in our center.

METHODS

This is a retrospective cohort study. CKD stages 3-5 patients who were regularly followed up 5 times (over 2 years) and treated with LPD were included. We collected clinical data to observe the changes in LPD qualification rates and divided patients into LPD and non-LPD group according to the average dietary protein intake (DPI) of 5 follow-up time points and compared the changes in primary and secondary outcome measures between the two groups.

RESULTS

We analyzed data from 161 eligible CKD stages 3-5 patients. From baseline to the 5th follow-up time point, the LPD qualification rates of all patients were 11.80%, 35.40%, 47.82%, 53.43% and 54.04%, respectively. For primary outcome measures, the urine protein/creatinine ratio (UPCR) decreased more in the LPD group than in the non-LPD group [Median (interquartile range, IQR) of the difference between the 5th follow-up time point and baseline: 0.19 (- 0.01-0.73) vs. 0.10 (- 0.08-0.27), P < 0.001]. We constructed three classes of mixed linear models (model I, II, III). The UPCR slopes were all negative in the LPD group and positive in the non-LPD group (P < 0.001). Meanwhile, in model I, the estimate glomerular filtration rate(eGFR) decline slope in the LPD group was lower than that in the non-LPD group [slope (standard error): - 1.32 (0.37) vs. - 2.35 (0.33), P = 0.036]. For secondary outcome measures, body mass index (BMI) triglycerides (TG), body weight, and fat free mass (FFM) showed stable statistical differences in the comparison of LPD and non-LPD groups, with greater declines in the former.

CONCLUSION

The results of this study suggest that LPD treatment can reduce UPCR in patients with CKD stages 3-5, and may also delay the decline in eGFR. Meanwhile, it also reduces BMI, TG, body weight, and FFM, thus the need to prevent malnutrition in clinical implementation.

摘要

背景

低蛋白饮食（LPD）治疗慢性肾脏病（CKD）的可行性和疗效存在争议。基于中国人饮食的特点，我们观察了本中心 CKD 患者接受 LPD 的合格率和短期临床疗效。

方法

这是一项回顾性队列研究。纳入了定期随访 5 次（2 年以上）并接受 LPD 治疗的 CKD 3-5 期患者。我们收集了临床数据，观察 LPD 合格率的变化，并根据 5 次随访时间点的平均饮食蛋白摄入量（DPI）将患者分为 LPD 和非 LPD 组，比较两组主要和次要结局指标的变化。

结果

我们分析了 161 例符合条件的 CKD 3-5 期患者的数据。从基线到第 5 次随访时间点，所有患者的 LPD 合格率分别为 11.80%、35.40%、47.82%、53.43%和 54.04%。对于主要结局指标，LPD 组的尿蛋白/肌酐比值（UPCR）下降幅度大于非 LPD 组[第 5 次随访时间点与基线差值的中位数（四分位距，IQR）：0.19（-0.01~~0.73）比 0.10（-0.08~~0.27），P<0.001]。我们构建了三类混合线性模型（模型 I、II、III）。LPD 组的 UPCR 斜率均为负，而非 LPD 组的斜率为正（P<0.001）。同时，在模型 I 中，LPD 组的估算肾小球滤过率（eGFR）下降斜率低于非 LPD 组[斜率（标准误差）：-1.32（0.37）比-2.35（0.33），P=0.036]。对于次要结局指标，体重指数（BMI）、甘油三酯（TG）、体重和去脂体重（FFM）在 LPD 和非 LPD 组的比较中显示出稳定的统计学差异，前者下降幅度更大。