Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients: a randomized, controlled trial.
Effect of prescribing a high protein diet and increasing the dose of dialysis on nutrition in stable chronic haemodialysis patients: a randomized, controlled trial.
复制标题
开高蛋白饮食和增加透析剂量对稳定的慢性血液透析患者营养的影响：一项随机对照试验。
DOI：
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发表时间：
2004
影响因子：
--
通讯作者：
R. Huisman
中科院分区：
文献类型：
--
作者：
W. Kloppenburg;C. Stegeman;T. K. Hovinga;G. Vastenburg;P. Vos;P. D. de Jong;R. Huisman
背景
目前尚不清楚稳定、充分透析的血液透析患者的蛋白质需求量，建议也各不相同。尚不清楚增加透析剂量至可接受的适当水平以上是否对营养有有利影响。本研究的目的是确定处方高蛋白饮食和增加透析剂量是否会对稳定、充分透析的血液透析患者的饮食蛋白摄入量和营养状态产生有利影响。还研究了对高磷血症和酸中毒的影响。
方法
患者被随机分配至高透析剂量（HDD）组（目标Kt/V（eq）为1.4）或常规透析剂量（RDD）组（目标Kt/V（eq）为1.0）。所有患者均接受高蛋白（HP）饮食[1.3 g/kg理想体重（IBW）/天]和常规蛋白（RP）饮食（0.9 g/kg/天），每种饮食均采用交叉设计，持续40周。在50例患者中，HDD组23例和RDD组27例随访时间≥ 10周。这些年龄为56+/-15岁的患者被纳入分析。通过人体测量、血浆白蛋白和营养指数评估营养状况。
结果
HDD组的输送Kt/V（eq）（1.26+/-0.14）显著高于RDD组（1.02+/-0.08）。根据总氮外观（PNA）测量值和食物记录（DPI）估计的蛋白质摄入量在HP饮食期间（PNA（IBW），1.01+/-0.18 g/kg/天; DPI（IBW），1.15+/-0.18 g/kg/天）显著高于RP饮食期间（PNA（IBW），0.90+/-0.14 g/kg/天; DPI（IBW），0.94+/-0.11 g/kg/天）。在HP或RP饮食期间，增加透析剂量并未增加蛋白质摄入量。血浆白蛋白（41.9+/-3.0 g/l）、瘦体重（正常值的107+/-15%）和营养指数在透析剂量组或蛋白质饮食组之间没有差异，并且随时间推移保持稳定。HDD组的干体重（97+/-14%）和总脂肪量随时间增加，但RDD组保持稳定，表明透析剂量对能量平衡有影响。蛋白质饮食对干体重或总脂肪量没有影响。HDD组的血浆磷酸盐水平和口服碳酸氢盐补充剂较低，但蛋白质饮食之间具有可比性。
结论
规定HP饮食导致实际蛋白质摄入量适度增加，但增加透析剂量没有贡献作用。HP饮食或增加透析剂量对营养状况没有有利影响。对于没有明显营养不良的充分透析血液透析患者，至少0.9 g/kg IBW/天的膳食蛋白质摄入量似乎足够。
BACKGROUND
Protein requirements in stable, adequately dialysed haemodialysis patients are not known and recommendations vary. It is not known whether increasing the dialysis dose above the accepted adequate level has a favourable effect on nutrition. The aim of this study was to determine whether prescribing a high protein diet and increasing the dose of dialysis would have a favourable effect on dietary protein intake and nutritional status in stable, adequately dialysed haemodialysis patients. Effects on hyperphosphataemia and acidosis were also studied.
METHODS
Patients were randomized to a high dialysis dose (HDD) group (target Kt/V(eq) of 1.4) or a regular dialysis dose (RDD) group (target Kt/V(eq) of 1.0). All patients were prescribed a high protein (HP) diet [1.3 g/kg of ideal body weight (IBW)/day] and a regular protein (RP) diet (0.9 g/kg/day), each during 40 weeks in a crossover design. In 50 patients, 23 in the HDD and 27 in the RDD group follow-up was > or =10 weeks. These patients, aged 56+/-15 years, were included in the analysis. Nutritional status was assessed by anthropometry, plasma albumin and a nutritional index.
RESULTS
Delivered Kt/V(eq) in the HDD group (1.26+/-0.14) was significantly higher than in the RDD group (1.02+/-0.08). Protein intake estimated from total nitrogen appearance (PNA) measurements and food records (DPI) was significantly higher during the HP diet (PNA(IBW), 1.01+/-0.18 g/kg/day; DPI(IBW), 1.15+/-0.18 g/kg/day) than during the RP diet (PNA(IBW), 0.90+/-0.14 g/kg/day; DPI(IBW), 0.94+/-0.11 g/kg/day). Increasing the dialysis dose did not increase protein intake either during the HP or RP diet. Plasma albumin (41.9+/-3.0 g/l) lean body mass (107+/-15% of normal values) and the nutritional index did not differ between the dialysis dose groups or protein diets and remained stable overtime. Dry body weight (97+/-14%) and total fat mass increased over time in the HDD group, but remained stable in the RDD group suggesting an effect of dialysis dose on energy balance. There was no effect of the protein diets on dry body weight or total fat mass. Plasma phosphate levels and oral bicarbonate supplements were lower in the HDD group, but were comparable between the protein diets.
CONCLUSIONS
Prescribing a HP diet resulted in a modest increase in actual protein intake, but increasing dialysis dose did not have a contributing effect. A HP diet or increasing the dialysis dose did not have a favourable effect on the nutritional status. A dietary protein intake of at least 0.9 g/kg IBW/day appears to be sufficient for adequately dialysed haemodialysis patients without overt malnutrition.
能量摄入对维持性血液透析患者营养状况的影响。
影响因子：
19.6
作者：
Slomowitz,LA;Monteon,FJ;Grosvenor,M;Laidlaw,SA;Kopple,JD
通讯作者：
Kopple,JD
DOI：
10.1016/s0272-6386(98)70174-x
发表时间：
1998-12-01
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Yeun, J Y;Kaysen, G A
通讯作者：
Kaysen, G A
影响因子：
158.5
作者：
OWEN, WF;LEW, NL;LAZARUS, JM
通讯作者：
LAZARUS, JM