目的 观察高龄男性慢性肾病(CKD)患者低蛋白饮食(LPD)的执行情况,探讨LPD依从性对其营养状况及肾功能进展等方面的影响。方法 对139例高龄男性CKD 3期患者的饮食蛋白管理情况进行回顾性观察,观察期为15个月。为评估患者对LPD的依从性,根据24 h尿尿素氮量(UUN)来估算每日蛋白摄入量(eDPI),并依据eDPI水平及是否补充复方α-酮酸片(KA)将观察对象分为LPD组、未限制蛋白组、LPD+KA组及未限制蛋白+KA组,随访结束后比较各组患者的营养状况、钙磷代谢及肾功能进展等方面的变化。结果 最终入组对象有126例,46.8%(59/126)患者有效实施LPD。随访结束后,LPD组的血清白蛋白水平较基线明显降低,差异有统计学意义(P＜0.05);服用KA制剂两组的血清前白蛋白及血钙水平明显高于未服用KA制剂的两组,差异有统计学意义(P＜0.05);LPD+KA组的估算肾小球滤过率(eGFR)下降幅度显著小于其他三组,差异有统计学意义(P＜0.05)。结论 高龄男性CKD患者对LPD的依从性不高,单纯LPD治疗可能会导致高龄男性患者营养不良的风险增加,补充KA可以维持甚至改善CKD患者的营养状况和血钙水平,有效延缓高龄男性CKD的进展。
Abstract
Objective To observe the implementation of low-protein diet (LPD) in elderly male patients with chronic kidney disease (CKD) and to explore the influence of LPD compliance on their nutritional status and the progression of renal function. Methods A retrospective observation which was 15 months was conducted on the dietary protein control in 139 elderly male patients with CKD stage 3. To evaluate the compliance of patients with LPD, the daily protein intake (eDPI) was estimated based on 24-hour urine urea nitrogen (UUN), and the subjects were categorized into four groups based on eDPI and supplementation with or without α-ketoacids (KA): LPD group, non-protein-restriction group, LPD + KA group, and non-protein-restriction+KA group. The changes in the nutritional status, calcium-phosphate metabolism, and renal function progression were compared at the end of follow-up. Results A total of 126 subjects were included in the final analysis, and 46.8% (59/126) of them effectively adhered to LPD. After the follow-up, the serum albumin level in the LPD group was significantly lower than the baseline (P＜0.05), whereas the serum prealbumin and serum calcium levels in the two KA-supplemented groups were significantly higher than those in the two non-KA groups (P＜0.05). Notably, the LPD+KA group showed a slower decline in estimated glomerular filtration rate than the other three groups (P<0.05). Conclusions The compliance of the elderly male CKD patients with LPD is not high. LPD treatment alone may increase the risk of malnutrition in the elderly male patients, whereas supplementation with KA can maintain or even improve the nutritional status and blood calcium levels of CKD patients, and effectively delay CKD progression in this population.
关键词
低蛋白饮食 /
酮酸 /
高龄老人 /
慢性肾病
Key words
low-protein diet /
ketoacid /
the elderly /
chronic kidney disease
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