Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy.
Nutrients. 2023 Jun 12;15(12):2715. doi: 10.3390/nu15122715.
Nutritional and pharmacological therapies represent the basis for non-dialysis management of CKD patients. Both kinds of treatments have specific and unchangeable features and, in certain cases, they also have a synergic action. For instance, dietary sodium restriction enhances the anti-proteinuric and anti-hypertensive effects of RAAS inhibitors, low protein intake reduces insulin resistance and enhances responsiveness to epoetin therapy, and phosphate restriction cooperates with phosphate binders to reduce the net phosphate intake and its consequences on mineral metabolism. It can also be speculated that a reduction in either protein or salt intake can potentially amplify the anti-proteinuric and reno-protective effects of SGLT2 inhibitors. Therefore, the synergic use of nutritional therapy and medications optimizes CKD treatment. Quality of care management is improved and becomes more effective when compared to either treatment alone, with lower costs and fewer risks of unwanted side effects. This narrative review summarizes the established evidence of the synergistic action carried out by the combination of nutritional and pharmacological treatments, underlying how they are not alternative but complementary in CKD patient care.
营养和药理治疗是慢性肾脏病（CKD）非透析患者治疗的基础。这两种治疗方法都有其特定的、不可改变的特点，在某些情况下，它们还具有协同作用。例如，饮食中钠的限制增强了肾素-血管紧张素-醛固酮系统抑制剂的抗蛋白尿和降压作用，低蛋白摄入可减少胰岛素抵抗并增强对促红细胞生成素治疗的反应性，而磷酸盐限制与磷酸盐结合剂协同作用可减少净磷酸盐摄入及其对矿物质代谢的影响。还可以推测，减少蛋白质或盐的摄入可能会潜在地放大 SGLT2 抑制剂的抗蛋白尿和肾保护作用。因此，营养治疗和药物治疗的协同使用可以优化 CKD 的治疗。与单独治疗相比，护理管理的质量得到改善，并且更有效，同时降低了成本和不良副作用的风险。本综述总结了营养和药物治疗联合应用的协同作用的既定证据，阐明了它们在 CKD 患者护理中不是替代而是互补的关系。
