Doqi guidelines for nutrition in long-term peritoneal dialysis patients: a dissenting view.
Doqi guidelines for nutrition in long-term peritoneal dialysis patients: a dissenting view.
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DOI：
10.1053/ajkd.2001.24542
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发表时间：
2001-06
期刊：
影响因子：
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通讯作者：
J. Uribarri
中科院分区：
文献类型：
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作者：
J. Uribarri
DOQI指南建议长期腹膜透析患者的膳食蛋白质摄入量为1.2 - 1.3 g/kg/d。对高蛋白质摄入和高磷摄入之间关系的定量分析表明，这种每日蛋白质负荷很可能导致透析清除率达到临界水平的无尿患者出现高磷血症。目前可用的磷粘合剂的效率不足以完全抵消富磷饮食的不利影响。在透析患者中，血清磷与预后呈负相关，可能是由钙×磷产物的增加介导的。缺乏理论或实验证据表明，如此高的蛋白质摄入本身对透析患者有益。因为高蛋白摄入可能会增加每日磷负荷，易发生高磷血症，可能导致有害后果，应加以修改。根据对正常受试者的一般建议，再加上腹膜透析过程中常见的过量氮流失，在不使患者暴露于过量磷负荷的情况下，0.9 - 1 g/kg/d最可能是合适的蛋白质摄入量。
The DOQI guidelines recommend a dietary protein intake of 1.2 to 1.3 g/kg/d in long-term peritoneal dialysis patients. A quantitative analysis of the relationship between this high protein intake and phosphorus intake shows that this daily load of protein is likely to lead to hyperphosphatemia in anuric patients with borderline dialysate clearance. Currently available phosphorus binders are not efficient enough to offset completely the adverse effects of a phosphorus-rich diet. An inverse correlation has been shown between serum phosphorus and outcome among dialysis patients, probably mediated by an increase in the Ca x P product. Evidence, theoretic or experimental, that such a high protein intake is by itself beneficial to dialysis patients is lacking. Because high protein intake may increase the daily load of phosphorus and predispose to hyperphosphatemia, it may lead to harmful consequences, and it should be modified. Using the general recommendation for normal subjects plus the usual excessive nitrogen loss during peritoneal dialysis, between 0.9 and 1 g/kg/d most likely would be an appropriate protein intake without exposing the patient to excessive phosphorus load.