饮食蛋白的限制对高龄患者营养状况和慢性肾脏病进展的影响

目的 观察饮食蛋白的限制对老年慢性肾脏病（CKD）患者营养状况及肾功能进展的影响.方法 对168例高龄（75 ～94岁）男性CKD 3期患者的低蛋白饮食（LPD）治疗情况进行回顾性分析.采用Maroni公式估算患者平均每日蛋白质入量（eDPI）以评估患者对LPD的依从性,并依据eDPI水平及是否服用复方α-酮酸制剂（KA）治疗将患者分为单纯限制蛋白组、限制蛋白＋KA组、未限制蛋白组及未限制蛋白＋KA组,比较分析18个月病程中四组患者的营养状况和肾功能的进展.结果 单纯限制蛋白组患者的血清白蛋白水平和前白蛋白水平降低（P＜0.05）；未限制蛋白组患者的血磷水平明显升高（P＜0.05）,服用KA制剂两组患者的血钙水平明显升高（P＜0.05）；较未限制蛋白组及单纯限制蛋白组,限制蛋白＋KA组患者的eGFR下降幅度最小（P＜0.05）.结论 高龄CKD患者单纯给予限制蛋白治疗,可能会导致营养不良；KA可以改善CKD患者的营养状况和血钙水平；限制蛋白并辅以KA治疗可以有效延缓老年CKD进展.

Effects of dietary protein restriction on the nutritional status and renal function in the very elderly with chronic kidney disease

Objective To investigate the effects of dietary protein restriction supplemented with or without α-ketoacids（KA） on nutritional status and renal function in the very elderly with chronic kidney disease （CKD）.Methods The clinical data of 168 elderly patients with CKD stage 3 were analyzed in this retrospective cohort study.The compliance to LPD was evaluated using estimated daily protein intake （eDPI）.According to the level of eDPI and supplementation with or without KA,the patients were divided into four groups including protein-restriction alone,protein-restriction ＋ KA,non protein-restriction and non protein-restriction ＋ KA.The nutritional status and the changes of eGFR were recorded and followed up for 18 months.Results The levels of serum albumin,serum prealbumin and serum calcium in protein-restriction ＋ KA group and non protein-restriction ＋ KA group were higher than that in protein-restriction alone group and non protein-restriction group （P 〈 0.05）.Protein-restriction ＋ KA group had a slower decline in eGFR than other groups during the 18 months of follow-up.Conclusions Dietary protein restriction therapy alone may lead to malnutrition in the very elderly with CKD.Dietary protein restriction supplemented with α-ketoacids can improve the nutritional condition and slow the progression of CKD in the very elderly.