电子辅助工具改善慢性肾病患者饮食依从性及酸负荷状况的研究

目的探讨电子辅助工具改善慢性肾病患者饮食依从性及酸负荷状况的效果。方法抽取本中心慢性肾病管理门诊慢性肾脏病(chronic kidney disease,CKD)3-4期合并代谢性酸中毒的116例患者,采用单双数字随机法,分为两组:(1)对照组,根据CKD分期给予患者常规护理及健康教育。(2)研究组,在常规治疗和护理基础上将电子辅助工具融入CKD患者营养指导。收集患者基线人口学资料、用药情况、肾功能、血生化、尿蛋白、饮食依从态度评分、饮食依从行为评分等指标,并在干预12个月后进行比较。结果共103例患者完成了随访,干预组54例,对照组49例。12个月后干预组饮食依从态度总分、饮食依从行为总分均高于对照组,差异有统计学意义(P<0.05);干预组每日蛋白摄入量(daily protein intake,DPI)、标准化蛋白氮呈现率(normalized protein equivalent of nitrogen appearance,nPNA)较基线下降(P<0.05),且显著低于对照组(P<0.05);干预组潜在肾酸负荷(potential renal acid load,PRAL)低于对照组(P<0.05),血总二氧化碳(total carbon dioxide,T-CO 2)显著高于对照组(P<0.05),干预组血肌酐、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)较基线无明显变化(P>0.05),血尿素氮较基线下降(P<0.05);对照组血肌酐、尿素较基线均有增高(P<0.05),eGFR较基线下降(P<0.05)。结论电子智能辅助工具融入CKD患者管理可以提高患者饮食依从性及改善患者代谢性酸中毒,延缓肾功能的减退。

Effects of electronic aids on dietary compliance and acid load in chronic kidney disease patients

Objective To explore the effects of electronic aids on dietary compliance and acid load in chronic kidney disease(CKD)patients.Methods A total of 116 patients with metabolic acidosis plus CKD3-4 at CKD management clinic were recruited and divided into two groups by single/double digit random method.Control group(n=49)received routine care and health tutorial according to CKD stages while research group(n=54)had additional electronic aids.Baseline demographics,medication usage,renal function,biochemistry,urinary protein,attitude/behavior score of dietary compliance and other indicators were collected and compared with those after 12-month intervention.Results A total of 103 patients completed follow-ups.No statistically significant inter-group difference in baseline clinical characteristics(P<0.05).The values of daily protein intake(DPI)and normalized protein equivalent of nitrogen appearance(nPNA)of research group were lower than baseline(P<0.05).After 12 months,the total score of attitude/behavior score of dietary compliance was higher in research group than control group.And the difference was statistically significant(P<0.05);potential renal acid load(PRAL)was lower(P<0.05)and blood total carbon dioxide(T-CO 2)significantly higher(P<0.05).Serum levels of creatinine and estimated glomerular filtration rate(eGFR)in research group had no significant change from baseline(P>0.05)and blood urea declined from baseline(P<0.05);serum levels of creatinine and urea increased in control group(P<0.05)and eGFR decreased from baseline(P<0.05).Conclusion The integration of electronic intelligent aids in the management of CKD patients can boost dietary compliance,improve metabolic acidosis and delay the decline of renal function.