LONG-TERM EFFECTS OF PROTEIN-RESTRICTED DIET ON ALBUMINURIA AND RENAL-FUNCTION IN IDDM PATIENTS WITHOUT CLINICAL NEPHROPATHY AND HYPERTENSION
LONG-TERM EFFECTS OF PROTEIN-RESTRICTED DIET ON ALBUMINURIA AND RENAL-FUNCTION IN IDDM PATIENTS WITHOUT CLINICAL NEPHROPATHY AND HYPERTENSION
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DOI：
10.2337/diacare.16.2.483
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发表时间：
1993-02-01
期刊：
影响因子：
16.2
通讯作者：
SLUITER, WJ
中科院分区：
文献类型：
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作者：
DULLAART, RPF;BEUSEKAMP, BJ;SLUITER, WJ
研究设计和方法-我们选择了31例患者的白蛋白尿过夜10和200克/分钟之间，没有高血压的糖尿病诊所，以确定长期的影响，LPD对蛋白尿和肾血流动力学的IDDM患者无nephropathy.RESEARCH设计和方法。一名参与者退出。对14例分配至LPD（0.6 g - kg-1）的患者进行了为期2年的随机前瞻性研究。第-1天）和16名患者被分配继续他们的UPD。蛋白质摄入量采用尿尿素排泄量进行评估。在基线和此后7次测量白蛋白尿（3次过夜采集）。GFR和ERPF分别用[I-125]碘酞酸盐和[I-131]马尿酸每年测量一次.结果-在LPD组，蛋白质摄入量从1.05 +/- 0.32下降到0.79 +/- 0.16 g。kg-1 . d-1（P < 0.005），但只有7名参与者的摄入量< 0.8 g。kg-1 .第1天。蛋白质摄入量在UPD组中没有改变（P < 0.001 vs. LPD）。基线白蛋白尿和肾脏血流动力学在各组之间没有差异。LPD组蛋白尿从36 μ g/min（95% CI，16-83）降至30 μ g/min（95% CI，14-67）（P < 0.05）。调整MAP和糖尿病病程后，LPD组蛋白尿减少26%（95%CI，13-36）（P < 0.001），与UPD组5%（95%CI，-10-22）的变化有显著差异（P < 0.005 vs. LPD）。多元回归分析显示，蛋白质摄入量的实际减少量减少（P < 0.005），而MAP的存在加速了蛋白尿（P < 0.001）。1年后，低蛋白摄入独立降低ERPF（P = 0.009）和GFR（间接通过ERPF，P < 0.001）。只有轻微的变化，肾血流动力学发生在第二年。结论-这项研究表明，长期的饮食蛋白质限制有利于减少蛋白尿和肾血流动力学轻度升高的蛋白尿的IDDM患者。即使在没有高血压的情况下，全身血压也会抵消这些影响。次优的依从性限制了饮食功效。
OBJECTIVES - To determine the long-term effects of an LPD on albuminuria and renal hemodynamics in IDDM patients without nephropathy.RESEARCH DESIGN AND METHODS - We selected 31 patients with overnight albuminuria between 10 and 200 g/min and without hypertension from a referral-based diabetic clinic. One participant dropped out. A 2-yr randomized prospective study was conducted on 14 patients assigned to an LPD (0.6 g - kg-1 . day-1) and 16 patients assigned to continue their UPD. Protein intake was assessed by using urinary urea excretion. Albuminuria (three overnight collections) was measured at baseline and on seven occasions thereafter. GFR and ERPF were measured annually using [I-125]iothalamate and [I-131]hippuran, respectively.RESULTS - In the LPD group, protein intake decreased from 1.05 +/- 0.32 to 0.79 +/- 0.16 g . kg-1 . day-1 (P < 0.005), but only seven participants consumed < 0.8 g . kg-1 . day-1. Protein intake was unaltered in the UPD group (P < 0.001 vs. LPD). Baseline albuminuria and renal hemodynamics were not different in the groups. In the LPD group albuminuria decreased from 36 (95% CI, 16-83) to 30 mug/min (95% Cl, 14-67) (P < 0.05). After adjustment for MAP and diabetes duration, the decrease in albuminuria in the LPD group was 26% (95% CI, 13-36) (P < 0.001), which was significantly different from the 5% (95% Cl, - 10-22) change in the UPD group (P < 0.005 vs. LPD). Multiple regression analysis showed the actual decrease in protein intake lessened (P < 0.005), whereas prevailing MAP accelerated albuminuria (P < 0.001). Low-protein intake independently reduced ERPF (P = 0.009) and GFR (indirectly via ERPF, P < 0.001) after 1 yr. Only minor changes in renal hemodynamics occurred in the second yr.CONCLUSIONS - This study suggests that long-term dietary protein restriction beneficially reduces albuminuria and renal hemodynamics in IDDM patients with mildly elevated albuminuria. Systemic BP counteracts these effects even in the absence of hypertension. Suboptimal compliance limits diet efficacy.