Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete y Instituto Médico Ricart, Alicante, Spain.
Servicio de Dermatología, Instituto Médico Ricart, Alicante, Spain.
Nefrologia (Engl Ed). 2022 Jul-Aug;42(4):448-459. doi: 10.1016/j.nefroe.2022.11.001. Epub 2022 Nov 16.
Patients with advanced chronic kidney disease (ACKD) have a high prevalence of malnutrition. The dietary restrictions that we usually apply in terms of macro and micronutrients force our patients to follow dietary guidelines that deviate from healthy patterns.
To determine if a personalized nutritional intervention program, minimizing the usual restrictions would be justified in case it improved the evolution of kidney disease compared to standard treatment.
To determine changes in nutrient intakes and in anthropometric and biochemical parameters, as well as quantify episodes of hyperkalemia.
A single-center, randomized and controlled educational intervention clinical trial was conduct in patients from the ERCA outpatients clinic at the Complejo Hospitalario Universitario de Albacete. 75 patients were included, assigning 35 to a Control group and 40 to the Intervention group with 1-year follow-up. The nutritional status was determined using anthropometric data, body composition by Bioimpedance, blood and urine biochemical parameters and a 24-h recall questionnaire. The nutritional intervention was carried out in three different ways: individual, collective and telephone recall.
At the beginning of the study, the BMI showed a situation of weight excess with a mean of 28.83 kg/m (5.4) in men and 26.96 kg/m (4.09) in women. 70% of our patients had overweight. The abdominal circumference was 105.3 cm (10.2) and 92.3 cm (13.7) for men and women respectively without significant changes throughout the study. The percentage of fat mass (FM) was high in both groups for men and women throughout the study. We did not find biochemical parameters of malnutrition and only significant differences were observed in glomerular filtration rate (GFR), which increased in the intervention group. No patient presented any episodes of hyperkalemia during the study. The energy intake in both groups showed an inadequate distribution of macronutrients with a poor intake of carbohydrates (CH) that was supplemented with an excess of fat. In the case of micronutrients, we did observe an increase in potassium and fiber intakes with a decrease in sodium and phosphorus in the intervention group.
Malnutrition is not exclusively an intake defficit and encompasses both the problems derived from a deficit and an excess of nutrients intake. Un to 70% of our patients showed weight excess and a fat mass higher than desirable. The implementation of an individualized nutritional education program, including a vegetables and fiber rich diet, less atherogenic, not only did not cause electrolyte alterations but also slowed the progression of kidney disease.
患有晚期慢性肾病（ACKD）的患者营养不良的患病率很高。我们通常在宏量和微量营养素方面施加的饮食限制迫使我们的患者遵循偏离健康模式的饮食指南。
确定个性化营养干预计划是否合理，如果与标准治疗相比能改善肾脏疾病的进展。
确定营养素摄入量以及人体测量和生化参数的变化，并量化高钾血症发作的情况。
在阿利坎特综合医院的 ERCA 门诊进行了一项单中心、随机对照教育干预临床试验。纳入了 75 名患者，将 35 名患者分配到对照组，40 名患者分配到干预组，随访 1 年。使用人体测量数据、生物电阻抗法测定身体成分、血液和尿液生化参数以及 24 小时回顾性问卷来确定营养状况。营养干预以三种不同方式进行：个体、集体和电话回顾。
在研究开始时，BMI 显示出超重的情况，男性平均为 28.83kg/m（5.4），女性平均为 26.96kg/m（4.09）。我们的 70%的患者超重。男性和女性的腰围分别为 105.3cm（10.2）和 92.3cm（13.7），整个研究过程中没有明显变化。男性和女性在整个研究过程中脂肪量（FM）百分比都很高。我们没有发现营养不良的生化参数，只有肾小球滤过率（GFR）有显著差异，干预组的 GFR 增加。整个研究过程中没有患者出现高钾血症发作。两组的能量摄入均显示出宏量营养素的分配不足，碳水化合物（CH）摄入不足，而脂肪摄入过多。就微量营养素而言，我们确实观察到干预组钾和纤维的摄入量增加，而钠和磷的摄入量减少。
营养不良不仅是摄入不足，还包括营养素摄入不足和过量引起的问题。我们的 70%的患者超重，脂肪量高于理想水平。实施个性化营养教育计划，包括富含蔬菜和纤维、少摄入致动脉粥样硬化的饮食，不仅不会引起电解质改变，而且还会减缓肾脏疾病的进展。
