Effect of nonsupplemented low-protein diet on very late stage CRF
Effect of nonsupplemented low-protein diet on very late stage CRF
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DOI：
10.1053/ajkd.2003.50080
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发表时间：
2003-03-01
影响因子：
13.2
通讯作者：
Yoshimura, A
中科院分区：
文献类型：
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作者：
Ideura, T;Shimazui, M;Yoshimura, A
背景：关于低蛋白饮食对极晚期慢性肾衰竭（CRF）（例如血清肌酐水平大于10 mg/dL（884 mumol/L））的影响的报道很少。在这项回顾性研究中，我们研究了极低蛋白饮食对极晚期 CRF 患者的影响。方法：对 76 名血清肌酐水平大于 10 mg/dL (884 mumol/L) 的极晚期 CRF 患者进行极低蛋白饮食（0.25 至 0.54 g/kg 体重/天 [0.39 +/- 0.01 g/kg 体重/天]），不补充必需氨基酸或酮类似物。 21 名具有相同血清肌酐水平且蛋白质摄入量为 0.55 至 1.2 g/kg 体重/天（0.68 +/- 0.03 g/kg 体重/）的患者代替对照进行观察。结果：低蛋白组的血尿素氮显着抑制至 43.1 +/- 1.9 g/dL (15.4 +/- 0.7 mmol/L)，而对照组为 111.2 +/- 7.0 mg/dL (39.7 2.5 mmol/L；P < 0.001)。低蛋白饮食的肾小球滤过率（肌酐清除率）下降速度慢了 36 倍（分别为 -7.1 +/- 1.0 与 -0.2 +/- 0.4 mL/月；P < 0.001）。低蛋白组的营养状况超过对照组。因此，肾脏存活率显着提高（P < 0.0001）。对照组的所有患者均在血清肌酐水平达到10 mg/dL（884 μmol/L）后6个月内开始透析治疗。相反，58% 的低蛋白组仍在接受透析前治疗。结论：严重低蛋白饮食不仅能有效预防肾功能恶化，而且在不补充必需氨基酸或酮类似物的情况下，即使血清肌酐水平超过10 mg/dL，也能维持营养状态。
Background: There are few reports of the effect of a low-protein diet on very late-stage chronic renal failure (CRF), eg, serum creatinine level greater than 10 mg/dL (884 mumol/L). In this retrospective study, we examined the effects of a very low-protein diet in patients with very late-stage CRF. Methods: A very low-protein diet (0.25 to 0.54 g/kg body weight/d [0.39 +/- 0.01 g/kg body weight/d]) without supplementation of essential amino acids or keto analogues was administered to 76 patients with very late-stage CRF who had serum creatinine levels greater than 10 mg/dL (884 mumol/L). Twenty-one patients with the same serum creatinine level and protein intake of 0.55 to 1.2 g/kg body weight/d (0.68 +/- 0.03 g/kg body weight/) were observed in lieu of controls. Results: Blood urea nitrogen was significantly suppressed to 43.1 +/- 1.9 g/dL (15.4 +/- 0.7 mmol/L) in the low-protein group compared with 111.2 +/- 7.0 mg/dL (39.7 2.5 mmol/L; P < 0.001) in the control group. The rate of decline in glomerular filtration rate (creatinine clearance) was 36-fold slower with the low-protein diet (-7.1 +/- 1.0 versus -0.2 +/- 0.4 mL/mon, respectively; P < 0.001). Nutritional state in the low-protein group exceeded that of the control group. Consequently, the renal survival rate improved significantly (P < 0.0001). All patients in the control group were initiated on dialysis treatment within 6 months from a serum creatinine level of 10 mg/dL (884 μmol/L). Conversely, 58% of the low-protein group are still on predialysis treatment. Conclusion: A severe low-protein diet is effective not only in preventing deterioration in renal function, but also in maintaining nutritional state despite no supplementation of essential amino acids or keto analogues, even as serum creatinine level is more than 10 mg/dL.