Balancing Nutrition and Serum Phosphorus in Maintenance Dialysis
Balancing Nutrition and Serum Phosphorus in Maintenance Dialysis
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DOI：
10.1053/j.ajkd.2014.01.429
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发表时间：
2014-07-01
影响因子：
13.2
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
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作者：
Fouque, Denis;Horne, Rob;Kalantar-Zadeh, Kamyar
血清磷水平升高在慢性肾病患者中很常见，并与心脏和血管疾病相关，这些疾病反过来又与死亡率增加相关。通过单独限制膳食蛋白质来准确管理磷摄入量可能具有挑战性，因为来自不同来源的蛋白质可能含有不同数量的可用磷。加工食品中经常使用的添加剂无机磷含量很高，很容易被吸收，加剧了这一困难。最近的证据表明，在某些情况下，饮食蛋白质限制可能对一些接受维持性血液透析治疗的患者弊大于利，因为蛋白质限制可能导致蛋白质-能量浪费，这与死亡率增加有关。因此，磷结合剂对于管理透析患者的高磷血症是重要的。治疗晚期慢性肾脏病患者的高磷血症需要个体化的方法，包括充分的饮食建议、磷酸盐结合剂的使用和透析处方的调整。我们推测，增加磷结合剂的使用可以让患者吃更多富含蛋白质的食物，并且将此传达给患者可能会增加他们对磷结合剂需求的感知，从而提供改善依从性的激励。本综述的目的是讨论维持性血液透析治疗患者在控制磷水平的同时维持充足营养所面临的挑战。(C)2014年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Elevated serum phosphorus levels are common in patients with chronic kidney disease and are associated with heart and vascular disease, conditions that in turn are associated with increased mortality. Accurately managing phosphorus intake by restricting dietary protein alone can prove challenging because protein from different sources can contain varying amounts of available phosphorus. Additives used in processed foods frequently are high in inorganic phosphorus, which is readily absorbed, compounding this difficulty. Recent evidence suggests that dietary protein restriction in some cases may do more harm than good in some patients treated with maintenance hemodialysis because protein restriction can lead to protein-energy wasting, which is associated with increased mortality. Accordingly, phosphorus binders are important for managing hyperphosphatemia in dialysis patients. Managing hyperphosphatemia in patients with late-stage chronic kidney disease requires an individualized approach, involving a combination of adequate dietary advice, phosphatebinder use, and adjustments to dialysis prescription. We speculate that increased use of phosphate binders could allow patients to eat more protein-rich foods and that communicating this to patients might increase their perception of their need for phosphate binders, providing an incentive to improve adherence. The aim of this review is to discuss the challenges involved in maintaining adequate nutrition while controlling phosphorus levels in patients on maintenance hemodialysis therapy. (C) 2014 by the National Kidney Foundation, Inc.