Sehgal A R, Leon J, Soinski J A
Division of Nephrology, MetroHealth Medical Center, Cleveland, OH, USA.
J Ren Nutr. 1998 Oct;8(4):179-87. doi: 10.1016/s1051-2276(98)90016-4.
Determine the relative importance of potential medical, behavioral, and socioeconomic barriers to adequate protein nutrition among hemodialysis patients.
Cross-sectional study.
All 22 chronic hemodialysis units in northeast Ohio.
298 randomly selected chronic hemodialysis patients.
We interviewed and abstracted the chart of each patient to assess protein nutritional status (albumin and protein catabolic rate), potential medical barriers (poor appetite, inadequate dialysis, bioincompatible dialysis membrane, difficulty chewing, and comorbid conditions), potential behavioral barriers (knowledge of protein containing foods and dietary noncompliance), and potential socioeconomic barriers (expense of protein containing foods and needing help shopping and cooking).
We used logistic regression to examine the relationship between protein nutritional status and potential barriers.
Albumin levels of <35 g/L were independently associated with Kt/V of <1.2 (odds ratio, 2.4), having more than three comorbid conditions (odds ratio, 4.0), inability to name any protein-containing foods (odds ratio, 2. 3), and needing help shopping and cooking (odds ratio, 2.6). Normalized protein catabolic rate of <1.0 g/kg/d was independently associated with poor appetite (odds ratio, 3.3), Kt/V of <1.2 (odds ratio, 3.1), and dietary compliance as indicated by low interdialytic fluid gain (odds ratio, 2.2).
Three medical factors (poor appetite, inadequate dialysis, and comorbid conditions), two behavioral factors (lack of knowledge of protein containing foods and low interdialytic fluid gain), and one socioeconomic factor (needing help shopping and cooking) are independently associated with inadequate protein nutrition among hemodialysis patients. Further work is needed to develop interventions to overcome these barriers and to determine the effect of such interventions on protein nutrition and patient mortality and morbidity.
确定血液透析患者在获得充足蛋白质营养方面潜在的医学、行为和社会经济障碍的相对重要性。
横断面研究。
俄亥俄州东北部的所有22个慢性血液透析单位。
298名随机选择的慢性血液透析患者。
我们对每位患者进行访谈并查阅病历，以评估蛋白质营养状况（白蛋白和蛋白质分解代谢率）、潜在的医学障碍（食欲不佳、透析不充分、生物不相容的透析膜、咀嚼困难和合并症）、潜在的行为障碍（对含蛋白质食物的了解和饮食不依从）以及潜在的社会经济障碍（含蛋白质食物的费用以及购物和烹饪需要帮助）。
我们使用逻辑回归来研究蛋白质营养状况与潜在障碍之间的关系。
白蛋白水平<35 g/L与Kt/V<1.2（比值比，2.4）、合并症超过三种（比值比，4.0）、无法说出任何含蛋白质食物（比值比，2.3）以及购物和烹饪需要帮助（比值比，2.6）独立相关。标准化蛋白质分解代谢率<1.0 g/kg/d与食欲不佳（比值比，3.3）、Kt/V<1.2（比值比，3.1）以及透析间期液体增加少所表明的饮食依从性（比值比，2.2）独立相关。
三种医学因素（食欲不佳、透析不充分和合并症）、两种行为因素（对含蛋白质食物缺乏了解和透析间期液体增加少）以及一种社会经济因素（购物和烹饪需要帮助）与血液透析患者蛋白质营养不足独立相关。需要进一步开展工作来制定干预措施以克服这些障碍，并确定此类干预措施对蛋白质营养以及患者死亡率和发病率的影响。
