慢性肾病患者对肾病饮食的顺应性、生化指标及营养摄入
2010-03-12 20:16:50   来源：   作者：  评论：0 点击：

目的：慢性肾脏疾病患者必须遵循复杂的饮食方案，限制蛋白质、钠盐、钾盐和磷的摄入。遵循肾脏饮食方案可减少高钾血症和肾性骨病等并发症，可以减慢肾功能不全进程及延迟透析治疗。但是，为了摄入足够的营养，多重饮食限制可能导致很难坚持饮食方案。本研究的目的是评估肾病饮食的顺应性、生化指标的可接受范围和饮食摄入的充足性。

　　方法：入选了46位慢性肾脏疾病患者。所有患者先前受过肾病饮食教育并已建立肾病饮食习惯，且不接受透析治疗。入选者建立一份记录72小时内所有食物和饮料的日常饮食档案。采用计算机软件进行分析。饮食顺从性和生化指标与K./D.O.Q.I.（肾病生存质量倡议）临床实践指南相比。统计分析采用S.P.S.S.软件（第14版）进行。

　　结果：钠和钾限制的顺应性较蛋白质和磷酸盐限制的顺应性理想。蛋白质和磷酸盐限制顺应性相当，因为它们共有饮食来源。部分患者（9%）蛋白质摄入低于推荐量。表2与当前推荐比较了生化指标。严格坚持所有限制的患者血清钾和磷酸盐水平处于正常范围。但是，顺应性差的患者血清钾和磷酸盐水平也是正常的，尤其是那些4期慢性肾脏疾病患者。这提出了少数非晚期患者饮食限制是否过于严格的问题。尽管83%的患者没有满足能量需求，其中仅有11%（n=4）的患者BMI<20kg/m2，而61%（n=23）的患者BMI>25kg/m2。65%（n=30）患者及62%（n=8）糖尿病患者纤维（NSP）摄入不足。钾和磷酸盐限制的顺应性明显影响纤维摄入（P分别为0.001和0.038），同时影响B族维生素、叶酸、铁、钙和锌的足量摄入。

　　结论：绝大部分患者生化指标处于可接受范围。但是，部分患者饮食中摄入的部分营养素低于推荐剂量，使他们处于营养不良风险中。首要措施是强化饮食干预促进坚持肾病饮食限制，同时预防营养缺乏。因此，当患者生化指标处于可接受范围或处于营养风险时，我们提倡更加自由和个体化的饮食方案。

Clinical Nutrition Week 2010 Nutrition Practice Abstracts

Abstracts of Distinction

Nutr Clin Pract. 2010 Feb;25(1):97.

P8 - Investigation of Compliance with the Renal Diet, Biochemical Parameters and Adequacy of Nutrient Intakes in a Group of Patients with Chronic Kidney Disease (Stages 4 and 5).

Laura Brennan, BSc (Human Nutrition), Senior Clinical Nutritionist1; Tracey Waldron, BSc (Human Nutrition), Senior Clinical Nutritionist1; George J. Mellotte, MB, FRCPI, MSc., Consultant Nephrologist and Senior Lecturer in Medicine2,3

1Clinical Nutrition, St. James's Hospital, Dublin, Ireland; 2St. James's Hospital, Dublin, Ireland; 3The Adelaide and Meath Hospital, Dublin, Ireland.

Introduction: Patients with C.K.D. must follow a complex diet, which can restrict protein, sodium, potassium and phosphorus. Compliance with the renal diet can reduce complications such as hyperkalaemia and renal bone disease, can slow progression of renal dysfunction and delay need for dialysis. However, the multiple dietary restrictions can make it difficult to adhere to the diet while maintaining adequate nutritional intake. The purpose of this investigation was to assess compliance with renal dietary restrictions, acceptability of biochemical parameters and adequacy of dietary intakes. Methods: Forty-six patients with C.K.D. were recruited. All patients had been previously educated and established on a renal diet and were not receiving dialysis. The participants completed a food diary documenting all foods and drinks consumed over a 72-hour period. Diaries were analysed using Microdiet for Windows (Version 2). Dietary compliance and biochemical indices were compared to K./D.O.Q.I. (Kidney Disease Outcomes Quality Initiative) Clinical Practice Guidelines. Statistical analysis was conducted using S.P.S.S. for Windows (Version 14.0). Results: Compliance was higher with sodium and potassium restrictions than with protein and phosphate restrictions. Compliance with protein and phosphate restrictions was similar, which is not surprising given their common dietary sources. Some patients (9%) reported protein intakes below that recommended, which is of concern. Table 2 compares biochemical parameters to current recommendations. Patients who adhered to all restrictions had serum potassium and phosphate levels within target range. However, serum potassium and phosphate levels were acceptable regardless of compliance, particularly so in those with stage 4 C.K.D. This raises the question as to whether dietary restrictions may be too strict for patients with less advanced disease. Although 83% of patients were not meeting calculated energy requirements, only 11% (n=4) of these had a BMI<20kg/m2 whereas 61% (n=23) had a BMI>25kg/ m2. Fibre (NSP) intake was insufficient in 65% (n=30) of patients and in 62% (n=8) of diabetics. Compliance with potassium and phosphate restrictions had a significant adverse affect on fibre intake (P=0.001 and 0.038 respectively) and also affected the adequacy of B vitamins, folate, iron, calcium and zinc. Conclusions: For the majority of patients, biochemical parameters were within acceptable limits. However, some patients reported dietary intakes of a number of nutrients that were below the recommended intakes, leaving them at risk for malnutrition. Intensive dietetic intervention is paramount to promote adherence to renal dietary restrictions but also to prevent nutrient deficiencies. Therefore, we advocate a more liberal and individualised approach to restriction when biochemical parameters are acceptable or patients are at nutritional risk.