Dietary Protein and Physical Activity Interventions to Support Muscle Maintenance in End-Stage Renal Disease Patients on Hemodialysis
Dietary Protein and Physical Activity Interventions to Support Muscle Maintenance in End-Stage Renal Disease Patients on Hemodialysis
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DOI：
10.3390/nu11122972
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发表时间：
2019-12-01
期刊：
影响因子：
5.9
通讯作者：
van Loon, Luc J. C.
中科院分区：
文献类型：
--
作者：
Hendriks, Floris K.;Smeets, Joey S. J.;van Loon, Luc J. C.
终末期肾病患者的肾脏清除能力不足以充分排泄代谢废物。这些患者通常采用血液透析（HD）来部分替代肾脏清除。然而，在开始慢性 HD 治疗后，骨骼肌质量和力量开始加速下降。维持肌肉的重要合成代谢刺激是膳食蛋白质的摄入。慢性 HD 患者通常无法达到推荐的蛋白质摄入水平，特别是在透析日。除了透析日的蛋白质摄入量较低外，HD 期间还从循环中提取了相当于膳食的蛋白质。除了蛋白质摄入之外，体力活动对于维持肌肉也至关重要。不幸的是，大多数慢性 HD 患者都有久坐的生活方式。然而，在常规患者护理中通常不会实施支持肌肉维持的体力活动和营养干预措施。为了支持慢性 HD 患者的肌肉维持，应优化蛋白质摄入量和时间，特别是在透析期间。此外，在 HD 训练期间或之间进行体力活动可能会改善肌肉蛋白质合成对蛋白质摄入的反应。精心策划的体力活动和营养干预组合将有助于保持慢性 HD 患者的肌肉质量。
End-stage renal disease patients have insufficient renal clearance capacity left to adequately excrete metabolic waste products. Hemodialysis (HD) is often employed to partially replace renal clearance in these patients. However, skeletal muscle mass and strength start to decline at an accelerated rate after initiation of chronic HD therapy. An essential anabolic stimulus to allow muscle maintenance is dietary protein ingestion. Chronic HD patients generally fail to achieve recommended protein intake levels, in particular on dialysis days. Besides a low protein intake on dialysis days, the protein equivalent of a meal is extracted from the circulation during HD. Apart from protein ingestion, physical activity is essential to allow muscle maintenance. Unfortunately, most chronic HD patients have a sedentary lifestyle. Yet, physical activity and nutritional interventions to support muscle maintenance are generally not implemented in routine patient care. To support muscle maintenance in chronic HD patients, quantity and timing of protein intake should be optimized, in particular throughout dialysis days. Furthermore, implementing physical activity either during or between HD sessions may improve the muscle protein synthetic response to protein ingestion. A well-orchestrated combination of physical activity and nutritional interventions will be instrumental to preserve muscle mass in chronic HD patients.