Effect of dietary protein intake on serum total CO2 concentration in chronic kidney disease:: Modification of diet in renal disease study findings
Effect of dietary protein intake on serum total CO2 concentration in chronic kidney disease:: Modification of diet in renal disease study findings
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DOI：
10.2215/cjn.00060505
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发表时间：
2006-01-01
影响因子：
9.8
通讯作者：
Levey, Andrew S.
中科院分区：
文献类型：
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作者：
Gennari, F. John;Hood, Virginia L.;Levey, Andrew S.
代谢性酸中毒是慢性肾脏病（CKD）的一个特征，但血清碳酸氢盐浓度是否受饮食蛋白质摄入量变化的影响尚不清楚。为了评估饮食的影响，使用了肾脏疾病饮食改良研究中收集的数据。在本研究中，CKD患者入组基线期，然后随机分配接受低蛋白或普通蛋白饮食（研究A，入组GFR 25 - 55 ml/min）或低蛋白或极低蛋白饮食，后者补充氨基酸的酮类似物（研究B，入组GFR 13 - 24 ml/min）。在入组时（n = 1676）和随机化后1年再次评估血清[总CO2]和估计蛋白质摄入量（EPI），控制GFR和其他关键协变量的变化（n = 723）。入组时，血清[总CO2]与EPI呈负相关（蛋白质摄入量每增加1 kg体重，平均血清[总CO2]/g降低1.0 mEq/L/d; P = 0.009）。在意向性治疗分析中，低蛋白组与普通蛋白组相比（0.41 g/kg体重/d）平均EPI降低与血清[总CO2]增加0.9 mEq/L独立相关，校正协变量后（P < 0.001）。在研究B中没有明显的这种影响，在研究中，极低蛋白饮食组接受膳食补充剂。CKD患者的血清[总CO2]与膳食蛋白质摄入量呈负相关。蛋白质摄入量的减少导致血清[总CO2]的增加。
Metabolic acidosis is a feature of chronic kidney disease (CKD), but whether serum bicarbonate concentration is influenced by variations in dietary protein intake is unknown. For assessing the effect of diet, data that were collected in the Modification of Diet in Renal Disease study were used. In this study, patients with CKD were enrolled into a baseline period, then randomly assigned to follow either a low- or a usual-protein diet (study A, entry GFR 25 to 55 ml/min) or a low- or very low-protein diet, the latter supplemented with ketoanalogs of amino acids (study B, entry GFR 13 to 24 ml/min). Serum [total CO2] and estimated protein intake (EPI) were assessed at entry (n = 1676) and again at 1 yr after randomization, controlling for changes in GFR and other key covariates (n = 723). At entry, serum [total CO2] was inversely related to EPI (1.0 mEq/L lower mean serum [total CO2]/g per kg body wt increase in protein intake/d; P = 0.009). In an intention-to-treat analysis, the reduction in mean EPI in the low-protein group as compared with the usual-protein group (0.41 g/kg body wt per d) was independently associated with a 0.9-mEq/L increase in serum [total CO2], after adjustment for covariates (P < 0.001). No such effect was evident in study B, in which the very low-protein diet group received dietary supplements. Serum [total CO2] is inversely correlated with dietary protein intake in patients with CKD. A reduction in protein intake results in an increase in serum [total CO2].