Bawazir Abdullah, Topf Joel M, Hiremath Swapnil
University of Ottawa, Ottawa Hospital, Department of Medicine, Division of Nephrology, Ottawa, ON, Canada.
Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Department of Medicine, Division of Nephrology, Riyadh, Saudi Arabia.
J Bras Nefrol. 2025 Jan-Mar;47(1):e2024PO03. doi: 10.1590/2175-8239-JBN-2024-PO03en.
Chronic kidney disease (CKD) management has traditionally emphasized dietary protein restriction to slow disease progression and delay end-stage renal disease (ESRD). However, evidence from trials questions the supposed efficacy of this approach and also highlights potential risks such as malnutrition and reduced quality of life. This review discusses the rational for protein restriction in CKD, critiques the existing evidence, and advocates for personalized care that focuses on nutritional adequacy and effective pharmacotherapy. Important advances in CKD treatment, including ACE inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists, are discussed to propose a comprehensive strategy that optimizes patient outcomes.
慢性肾脏病（CKD）的管理传统上一直强调限制饮食中的蛋白质摄入，以减缓疾病进展并延缓终末期肾病（ESRD）。然而，试验证据对这种方法的所谓疗效提出了质疑，同时也凸显了营养不良和生活质量下降等潜在风险。本综述讨论了CKD患者蛋白质限制的理论依据，对现有证据进行了批判，并倡导以营养充足和有效药物治疗为重点的个性化护理。文中还讨论了CKD治疗的重要进展，包括血管紧张素转换酶抑制剂、钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂，以提出一种优化患者治疗效果的综合策略。
