PROTEIN AND ENERGY-INTAKE, NITROGEN-BALANCE AND NITROGEN LOSSES IN PATIENTS TREATED WITH CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS
PROTEIN AND ENERGY-INTAKE, NITROGEN-BALANCE AND NITROGEN LOSSES IN PATIENTS TREATED WITH CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS
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DOI：
10.1038/ki.1993.347
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发表时间：
1993-11-01
影响因子：
19.6
通讯作者：
LINDHOLM, B
中科院分区：
文献类型：
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作者：
BERGSTROM, J;FURST, P;LINDHOLM, B
本研究的目的是分析影响稳定的持续性非卧床腹膜透析(CAPD)患者膳食蛋白质摄入量(DPI)、能量摄入量和蛋白质利用率的因素，以及不同类型氮丢失之间的关系。我们对12名CAPD患者进行了23项氮平衡(NB)研究，持续时间为6-11天。一项研究是在所有患者开始CAPD后3.4+/-1.2个月进行的(早期研究)。然后在12.1+/-2.6个月后对9名患者进行重复研究，其中两名患者分别在16个月和24个月后再次进行研究(后期研究)。在每项NB研究之前，研究前的饮食摄入量通过日记和访谈进行评估。在Nb前几天和Nb期间，每个患者都接受了个性化的饮食，在DPI和饮食能量摄入量(DEI)方面与患者自发选择的饮食相似。每日采集透析液和尿液中的总氮、蛋白质、尿素和肌酐。还分析了在整个NB期间收集的粪便中的总氮。通过校正总氮、非蛋白氮的输出，即总氮减去总蛋白损失量(PL)和尿素氮输出，计算出总氮(TNA)、非蛋白氮(NPNA)和尿素氮(UNA)。测定收集的透析液中的葡萄糖，并计算每日的葡萄糖摄取量。DPI为0.62~2.09g/kg/d，DEI为21~42kcal/kg/d，腹膜能量(葡萄糖)摄入量为4~13kcal/kg/d。DPI(而不是DEI)与Kt/V(尿素)和Kt/V(Cr)相关，与尿素和肌酐的总清除量和肾脏清除量相关。在大多数研究中，Nb(未校正未测量的氮损失)为正，并且在早期研究中与DPI和总能量摄入(TEI)相关，但在晚期研究中仅与TEI相关。DPI与TNA、NPNA、UNA、非蛋白-非尿素氮损失、粪便氮损失相关。UNA与TNA、NPNA呈高度正相关(r=0.95)。我们使用33项针对CAPD患者的NB研究的数据(我们目前的数据与文献中的数据相结合)来计算回归方程，分别描述TNA、NPNA和UNA之间的关系。推导了由直接测量的UNA计算蛋白质当量TNA(PNA)即6.25TNA和蛋白质当量NPNA(PNPNA)即6.25NPNA的公式。对于分解代谢或合成代谢不强的稳定期CAPD患者，PNA可用于估算DPI，PNPNA可用于估算蛋白质净摄入量(DPI-PL)。
The aim of this investigation was to analyze factors which influence the dietary protein intake (DPI), the energy intake and the utilization of ingested protein, and to determine the relationship between various types of nitrogen losses in stable continuous ambulatory peritoneal dialysis (CAPD) patients. We performed 23 nitrogen balance (NB) studies of 6 to 11 days duration in 12 CAPD patients. One study was performed in all patients 3.4 +/- 1.2 months after starting CAPD (early studies). The study was then repeated in nine patients after 12.1 +/- 2.6 months, and two of these patients were studied again after 16 and 24 months, respectively (late studies). Before each NB study, the dietary intakes prior to the study were assessed in diaries and interviews. During a few days preceding the NB periods and during the NB periods each patient received an individualized diet composed so as to resemble the patients' spontaneously chosen diet regarding DPI and dietary energy intake (DEI). Total nitrogen, protein, urea and creatinine were analyzed in the dialysate and urine collected daily. Total nitrogen was also analyzed in the feces, collected over the whole NB period. Total nitrogen appearance (TNA), non-protein nitrogen appearance (NPNA) and urea nitrogen appearance (UNA) were calculated by correcting total nitrogen output, non-protein nitrogen output, that is, TNA minus the total protein losses (PL) and urea nitrogen output for changes in total body urea nitrogen. Glucose was determined in the collected dialysate and the daily glucose absorption was calculated. DPI varied between 0.62 and 2.09 g/kg/day, DEI between 21 and 42 kcal/kg/day and the peritoneal energy (glucose) intake (PEI) between 4 and 13 kcal/kg/day. DPI (but not DEI) correlated with Kt/V(urea) and Kt/V(cr) and with total and renal clearances for urea and creatinine. NB (not corrected for ''unmeasured'' nitrogen losses) was positive in most studies, and it correlated with DPI and the total energy intake (TEI) in the early studies, but only with TEI in the late studies. DPI correlated with TNA, NPNA, UNA, non-protein-non-urea nitrogen loss and fecal nitrogen loss. UNA was highly correlated with TNA and NPNA (r = 0.95). We used data from 33 NB studies in CAPD patients (our present data combined with data from the literature) to calculate regression equations describing the relationship between TNA and NPNA, respectively, and UNA. Equations were derived by which the protein equivalent of TNA (PNA), that is, 6.25 TNA, and the protein equivalent of NPNA (PNPNA), that is, 6.25 NPNA, may be calculated from UNA which is directly measured. In stable CAPD patients, who are not strongly catabolic or anabolic, PNA may be used to estimate DPI and PNPNA may be used to estimate the net protein intake (DPI - PL).