Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Translational Research Center, Instituto Nacional de Pediatría, Mexico.
Adv Kidney Dis Health. 2023 Nov;30(6):480-486. doi: 10.1053/j.akdh.2023.06.003.
Individuals with chronic kidney disease (CKD) have an increased risk of cardiovascular disease (CVD), and the kidney function is a critical determinant of this risk. CKD is also a major cause of complications and disease progression in patients with CVD. Practice guidelines suggest that CVD risk in CKD patients can be managed through healthy lifestyle and dietary behaviors. Assessing the impact of diet on heart and kidney health is complex because numerous bioactive compounds from diet may contribute to or prevent CVD or CKD via a myriad of pathways and mechanisms. The objective of this review was to provide a discussion of the mechanisms and evidence linking protein-rich foods and CVD risk in people with CKD. This review highlights the current evidence-based strategies for primary CKD prevention that incorporate a healthy dietary pattern, while tertiary prevention strategies focus on avoiding excess protein and reducing dietary acid load. The effect of protein restriction for improving CVD and CKD outcomes is conflicting; however, these approaches show no negative effects on kidney health. Low-protein and very low-protein diets are promising interventions for reducing the progression of CKD and CVD. Animal-sourced protein may be more detrimental to kidney health than plant-sourced protein due to specific acid load, amino acid composition, generation of uremic toxins, accompanying saturated fat content, low fiber composition, and higher generation of advanced glycation end-products. There are no one-size fits all nutrition prescriptions. Personalized nutrition interventions that target the unique risk factors for CVD associated with reduced kidney function are required to improve the health of people living with CKD.
患有慢性肾脏病 (CKD) 的个体患心血管疾病 (CVD) 的风险增加，而肾功能是这种风险的关键决定因素。CKD 也是 CVD 患者并发症和疾病进展的主要原因。实践指南建议，通过健康的生活方式和饮食行为可以管理 CKD 患者的 CVD 风险。评估饮食对心脏和肾脏健康的影响很复杂，因为饮食中的许多生物活性化合物可能通过多种途径和机制促进或预防 CVD 或 CKD。本综述的目的是讨论与 CKD 患者富含蛋白质的食物与 CVD 风险相关的机制和证据。本综述强调了当前基于证据的主要 CKD 预防策略，这些策略包括健康的饮食模式，而三级预防策略则侧重于避免过量蛋白质和减少饮食酸负荷。限制蛋白质摄入对改善 CVD 和 CKD 结局的效果存在争议；然而，这些方法对肾脏健康没有负面影响。低蛋白和极低蛋白饮食是减少 CKD 和 CVD 进展的有前途的干预措施。由于特定的酸负荷、氨基酸组成、尿毒症毒素的产生、伴随的饱和脂肪含量、低纤维成分和更高的晚期糖基化终产物生成，动物源性蛋白质可能比植物源性蛋白质对肾脏健康更有害。没有一刀切的营养处方。需要针对与肾功能下降相关的降低 CVD 风险的独特危险因素进行个性化营养干预，以改善患有 CKD 的人群的健康。
