Dietary restrictions in dialysis patients: is there anything left to eat?
Dietary restrictions in dialysis patients: is there anything left to eat?
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DOI：
10.1111/sdi.12348
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发表时间：
2015-03
影响因子：
1.6
通讯作者：
Kovesdy CP
中科院分区：
文献类型：
--
作者：
Kalantar-Zadeh K;Tortorici AR;Chen JL;Kamgar M;Lau WL;Moradi H;Rhee CM;Streja E;Kovesdy CP
相当多的饮食限制是传统上和统一地强加给维持性透析患者的，而很少有数据支持他们的好处。最近的研究表明，限制饮食中的磷可能会导致更差的生存和更差的营养状况。限制饮食中的钾可能会剥夺透析患者的心脏健康饮食，并导致更多致动脉粥样硬化的饮食摄入。关于限制饮食的生存益处的数据很少，限制液体摄入量可能固有地导致较低的蛋白质和卡路里消耗，而事实上，透析患者往往需要更高的蛋白质摄入量，以防止和纠正蛋白质-能量浪费。限制糖尿病透析患者的饮食碳水化合物对那些精疲力竭的糖尿病患者可能没有好处。包括omega-3脂肪酸在内的膳食脂肪可能是重要的热量来源，不应受到限制。与钙、维生素和微量元素有关的其他饮食限制的合理性数据很少，而且往往相互矛盾。在血液透析治疗期间限制饮食可能是另一种不正确的做法，可能会加剧血液透析引起的低血糖和营养紊乱。我们建议谨慎地放松大多数饮食限制，并采取更平衡和个性化的方法，从而放松一些过度热衷的限制，这些限制尚未被证明对患者及其结果有重大好处，而且实际上可能会恶化患者的生活质量和满意度。这篇手稿批判性地回顾了目前在透析患者中推荐的饮食方案的范例和实践，包括与饮食蛋白质、碳水化合物、脂肪、磷、钾、钠和钙相关的那些，并讨论了坚持严格的饮食限制的可行性和意义。
A significant number of dietary restrictions are imposed traditionally and uniformly on maintenance dialysis patients, whereas there is very little data to support their benefits. Recent studies indicate that dietary restrictions of phosphorus may lead to worse survival and poorer nutritional status. Restricting dietary potassium may deprive dialysis patients of heart-healthy diets and lead to intake of more atherogenic diets. There is little data about the survival benefits of dietary sodium restriction, and limiting fluid intake may inherently lead to lower protein and calorie consumption, when in fact dialysis patients often need higher protein intake to prevent and correct protein-energy wasting. Restricting dietary carbohydrates in diabetic dialysis patients may not be beneficial in those with burnt-out diabetes. Dietary fat including omega-3 fatty acids may be important caloric sources and should not be restricted. Data to justify other dietary restrictions related to calcium, vitamins and trace elements are scarce and often contradictory. The restriction of eating during hemodialysis treatment is likely another incorrect practice that may worsen hemodialysis induced hypoglycemia and nutritional derangements. We suggest careful relaxation of most dietary restrictions and adoption of a more balanced and individualized approach, thereby easing some of these overzealous restrictions that have not been proven to offer major advantages to patients and their outcomes and which may in fact worsen patients’ quality of life and satisfaction. This manuscript critically reviews the current paradigms and practices of recommended dietary regimens in dialysis patients including those related to dietary protein, carbohydrate, fat, phosphorus, potassium, sodium, and calcium, and discusses the feasibility and implications of adherence to ardent dietary restrictions.
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影响因子：
16.2
作者：
Kalantar-Zadeh K
通讯作者：
Kalantar-Zadeh K
DOI：
10.1053/j.ajkd.2014.04.019
发表时间：
2014-08
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Kalantar-Zadeh K;Unruh M;Zager PG;Kovesdy CP;Bargman JM;Chen J;Sankarasubbaiyan S;Shah G;Golper T;Sherman RA;Goldfarb DS
通讯作者：
Goldfarb DS
影响因子：
13.2
作者：
Fouque, Denis;Horne, Rob;Kalantar-Zadeh, Kamyar
通讯作者：
Kalantar-Zadeh, Kamyar
DOI：
10.2215/cjn.03790808
发表时间：
2009-03-01
影响因子：
9.8
作者：
Belozeroff, Vasily;Goodman, William G.;Kalantar-Zadeh, Kamyar
通讯作者：
Kalantar-Zadeh, Kamyar
DOI：
10.2215/cjn.07690910
发表时间：
2011-05-01
影响因子：
9.8
作者：
Feroze, Usama;Noori, Nazanin;Kalantar-Zadeh, Kamyar
通讯作者：
Kalantar-Zadeh, Kamyar