Kopple J D
Department of Medicine, Harbor-UCLA Medical Center, and the School of Medicine, Torrance, CA 90509, USA.
Am J Kidney Dis. 1998 Dec;32(6 Suppl 4):S97-104. doi: 10.1016/s0272-6386(98)70171-4.
The published reports of dietary protein and energy intake and protein and energy requirements for maintenance hemodialysis (MHD) patients and chronic peritoneal dialysis (CPD) patients are reviewed. Evidence indicates that the dietary energy intake of patients undergoing MHD or continuous ambulatory peritoneal dialysis (CAPD) is less than normal. Dietary protein intake in various surveys averages approximately 1.0 g/kg/d. The energy expenditure of MHD patients appears to be normal or slightly increased during resting and normal during various other daily activities. Energy expenditure in CAPD patients appears normal. Nitrogen balance and anthropometric studies in MHD or CAPD patients ingesting controlled diets in a metabolic unit research ward also indicate that dietary energy requirements are normal and are approximately 35 to 38 kcal/kg/d in MHD patients. For CAPD patients, total energy requirements (from diet and dialysate) also appear to be 35 to 38 kcal/kg/d. These recommended energy intakes are for adult patients aged approximately 60 years or younger. Thus, the low dietary energy intakes of MHD and CPD patients are maladaptive. Nitrogen balance studies indicate that a safe dietary allowance for protein is approximately 1.2 g/kg/d for MHD patients and 1.2 to 1.3 g/kg/d for CAPD patients. Because the nutritional status of patients at the onset of chronic dialysis therapy is a strong predictor of both their nutritional status during the course of chronic dialysis treatment and their subsequent morbidity and mortality, it is important to maintain good nutritional status in patients with chronic renal failure before their development of end-stage renal disease (ESRD) and establishment on chronic dialysis. Evidence indicates that there is a reduction in dietary protein and energy intake and a gradual deterioration of nutritional status in patients with chronic renal insufficiency as the glomerular filtration rate (GFR) decreases progressively to less than 50 to 60 mL/min/1.73 m2. More studies are needed to assess dietary protein and energy requirements both for MHD and CPD patients who are clinically stable and for those who have sustained comorbid conditions that increase energy expenditure or protein nitrogen appearance.
本文回顾了已发表的关于维持性血液透析（MHD）患者和慢性腹膜透析（CPD）患者的膳食蛋白质和能量摄入以及蛋白质和能量需求的报告。有证据表明，接受MHD或持续非卧床腹膜透析（CAPD）的患者膳食能量摄入低于正常水平。在各项调查中，膳食蛋白质摄入量平均约为1.0 g/kg/d。MHD患者在静息时的能量消耗似乎正常或略有增加，在其他日常活动中也正常。CAPD患者的能量消耗似乎正常。在代谢单元研究病房中，对摄入控制饮食的MHD或CAPD患者进行的氮平衡和人体测量学研究也表明，膳食能量需求正常，MHD患者约为35至38 kcal/kg/d。对于CAPD患者，总能量需求（来自饮食和透析液）似乎也为35至38 kcal/kg/d。这些推荐的能量摄入量适用于年龄约60岁或以下的成年患者。因此，MHD和CPD患者较低的膳食能量摄入是不适应的。氮平衡研究表明，MHD患者蛋白质的安全膳食摄入量约为1.2 g/kg/d，CAPD患者为1.2至1.3 g/kg/d。由于慢性透析治疗开始时患者的营养状况是其慢性透析治疗过程中营养状况以及随后发病率和死亡率的有力预测指标，因此在慢性肾衰竭患者发展为终末期肾病（ESRD）并开始慢性透析之前，维持良好的营养状况非常重要。有证据表明，随着肾小球滤过率（GFR）逐渐降至低于50至60 mL/min/1.73 m2，慢性肾功能不全患者的膳食蛋白质和能量摄入会减少，营养状况会逐渐恶化。需要更多研究来评估临床稳定的MHD和CPD患者以及患有增加能量消耗或蛋白质氮排出的持续性合并症患者的膳食蛋白质和能量需求。
