老年透析患者饮食蛋白摄入和营养状态的研究

目的探讨不同透析方式对老年透析患者营养状态的影响。方法对2008年1月至12月在北京大学第三医院肾内科接受透析的老年患者进行横断面调查,营养状态的评估包括饮食记录、生物化学指标、主观综合性营养评估(subjective global assess-ment,SGA)及体测量4个方面。结果共141例老年(年龄≥65岁)透析患者,其中78例腹膜透析患者,63例血液透析患者。老年腹膜透析患者平均标化饮食蛋白质摄入(norma-lized dietary protein intake,NDPI)为(0.87±0.27)g/(kg.d),营养不良发生率为30.8%,老年血液透析患者平均NDPI为(0.94±0.23)g/(kg.d),营养不良发生率为33.3%,2组间饮食蛋白摄入和营养不良发生率差异无统计学意义(P>0.05),但腹膜透析患者血胆固醇、低密度脂蛋白以及皮下脂肪明显高于血液透析患者(P<0.05)。结论尽管老年透析患者饮食蛋白摄入低于美国肾脏病预后质量指南推荐值,但他们大多数都能维持好的营养状况。此外,对于老年腹膜透析患者的脂质代谢异常应予更多的关注。

Nutritional status and dietary protein intake in elderly patients on dialysis

Objective The aim of this study was to compare nutritional status in elderly patients undergoing different modalities of dialysis.Methods A cross-sectional study was performed in elderly patients on dialysis treated in Peking University Third Hospital between Jan.and Dec.,2008.Nutritional status including dietary record,blood biochemistry,subjective global assessment（SGA）,and body weight were assessed for each patient.Results A total of 141 patients aged ≥65 years were included in this study.Patients were treated with hemodialysis（HD,n=63） or peritoneal dialysis（PD,n =78）.In patients treated with HD and PD,the prevalence of malnutrition assessed by SGA was 33.3% and 30.8%（P0.05）,respectively,and the dietary protein intake normalized by ideal body weight was（0.94±0.23）g/（kg·day） and（0.87±0.27） g/（kg·day）（P0.05）,respectively,without significant differences between the 2 groups.However,PD patients had significantly higher values of serum cholesterol,serum low density lipoprotein and subcutaneous fat compared to HD patients（P 0.05）.Conclusions Our findings revealed that most elderly dialysis patients maintained good nutritional status despite their dietary protein intake lower than that recommended by K/DOQI.However,abnormal lipid metabolism should be concerned in elderly PD patients.