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.
Key words
low-protein diet /
ketoacid /
the elderly /
chronic kidney disease
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References
[1] 蒋佳维.中国慢性肾脏病的发病率[J].中华危重病急救医学,2023,35(7):718.
[2] 中华医学会老年医学分会肾病学组,国家老年疾病临床医学研究中心.老年慢性肾脏病诊治的中国专家共识(2018)[J].中华老年医学杂志,2018,37(7):725-731.
[3] 徐 兰,赵雪兰,赵霞娟,等.健康老年人肾功能增龄性下降与早期动脉硬化的相关性研究[J].中国老年保健医学,2023,21(2):29-33.
[4] Li X, Luo J K. Perceptions and attitudes of kidney supportive care among elderly patients with advanced chronic kidney disease and dialysis health care professionals in China: a qualitative study[J]. BMC Neprol, 2023, 24(1): 316.
[5] Levey A S, Adler S, Cagglula A W, et al. Effects of dietary protein restriction on the progression of moderate renal disease in the modification of diet in renal disease study[J]. J Am Soc Nephrol, 1996,7 (12):2616-2626.
[6] Greene J H. The new CKD nutrition practice guidelines[J]. Nephrol News Issues, 2011, 25(4): 22.
[7] Maroni B J, Steinman T I, Mitch W E. A method for estimating nitrogen intake of patients with chronic renal failure[J]. Kidney Int, 1985, 27(1), 58-65.
[8] Levey A S, Stevens L A, Schmid C H, et al. A new equation to estimate glomerular filtration rate[J]. Ann Intern Med,2009,150(9):604-612.
[9] Oliveira C M, Kubrusly M, Mota R S, et al. Malnutrition in chronic kidney failure: what is the best diagnostic method to assess? [J].J Bras Nephro,2010,32(1):55-68.
[10] Maclaughlin H L, Friedman A N, Ikizler T A. Nutrition in kidney disease: core curriculum 2022[J].Am J Kidney Dis,2022,79(3): 437-449.
[11] Brown T J, Williams H, Mafrici B, et al. Dietary interventions with dietitian involvement in adults with chronic kidney disease: a systematic review[J]. J Hum Nutr Diet, 2021, 34(4): 747-757.
[12] 郭文娟,王利华.饮食管理对慢性肾脏病患者影响效果的系统评价[J].中华临床营养学杂志,2023,31(1):26-38.
[13] 张倩倩,单 岩,乔 娟,等.慢性肾脏病患者饮食依从性的研究现状及对我国的启示[J].中国实用护理杂志,2014,30(25):16-19.
[14] Ertuglu L, Ikizler T A. Nutrition management in geriatric patients with CKD[J]. Kidney 360, 2024,5(2):310-319.
[15] Kovesdy C P, Kopple J D, Kalantar Z K. Management of protein-energy wasting in non-dialysis dependent chronic kidney disease: reconciling low protein intake with nutritional therapy[J].Am J Clin Nutr,2013,18(2):172-174.
[16] Piccolli G B, Cederholm T, Avesani C M, et al. Nutritional status and the risk of malnutrition in older adults with chronic kidney disease-implications for low protein intake and nutritional care: a critical review endorsed by ERN-ERA and ESPEN[J]. Clin Nutr, 2023,42(4):443-457.
[17] Cacciapuoti N, Lonardo M S, Lauro M, et al. Effects of dietary intervention on nutritional status in elderly individuals with chronic kidney disease[J]. Nutrients, 2024, 16(5): 632.
[18] Massini G, Caldiroli L, Molinari P, et al. Nutritional strategies to prevent muscle loss and sarcopenia in chronic kidney disease: what do we currently know? [J]. Nutrients, 2023, 15(14):3107.
[19] Bellizzi V, Chiodini P, Cupisti A, et al. Very low-protein diet plus ketoacids in chronic kidney disease and risk of death during end-stage renal disease: a historical cohort controlled study[J]. Nephrol Dial Transplant,2015,30(1):71-77.
[20] Chen Z, Lin Y, Wang J, et al. Relationship between compound α- keto acids and micro -inflammation in patient with chronic kidney disease [J]. Curr Pharm Des, 2024, 30(8): 589-596.
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