慢性肾脏病3～5期患者蛋白质、磷摄入量的现况调查

目的 了解慢性肾脏病（chronic kidney disease，CKD）3～5期患者实际蛋白质、磷的摄入情况，为CKD患者的营养管理提供方向。方法 本研究纳入2015年10月—2016年6月在华西医院及成都医学院第一附属医院CKD管理中心随访的CKD 3～5期非透析患者68例，根据肾小球滤过率估算值（estimated glomerular filtration rate，eGFR）分为CKD3、4、5期。采用t检验、方差分析、χ2检验或Fisher确切概率法对其一般情况、3日内摄入食物种类及其数量、生化指标、营养状况进行分析和比较。结果 纳入人群组间比较，随着CKD由3期向5期进展，磷(F = 13.850,P＜0.001)、蛋白质(F = 21.044,P＜0.001)、营养素的摄入均呈现下降趋势，营养不良发生率(P = 0.003)和低蛋白饮食依从性(P＜0.001)呈上升趋势，但不同CKD分期每日平均实际蛋白质摄入量(t = 11.595,P＜0.001；t = 9.735,P＜0.001；t = 3.321,P＜0.001)均超过推荐量。结论 CKD3～5期患者磷的摄入量基本在推荐摄入范围以内,但是营养不良发生率较高，低蛋白饮食实施情况也较差，需加强营养管理，进一步制订不同阶段CKD患者的膳食磷推荐量，提高患者低蛋白饮食的依从性，改善患者营养状况。

Survey of protein and phosphorus intake in patients with chronic kidney disease stages 3 to 5

Objective To understand the actual protein and phosphorus intake of patients with chronic kidney disease(CKD)at stages 3-5, and provide reference for nutritional management of CKD patients. Methods Sixty-eight non-dialysis CKD patients followed up by the CKD management centers of West China Hospital and the First Affiliated Hospital of Chengdu Medical College from October 2015 to June 2016 were enrolled in this study. The patients were grouped into CKD stages 3,4, and 5 according to the estimated glomerular filtration rate(eGFR). Their general information, food types, intake quantity,biochemical indicators, and nutritional status within 3 days were analyzed and compared using t-test, ANOVA, chi-square test, or Fisher’s exact probability method. Results As CKD progressed from stage 3 to stage 5, the intake of phosphorus(F=13.850, P<0.001), protein(F=21.044, P<0.001), and nutrients showed a decreasing trend, while the incidence of malnutrition(P=0.003) and low protein diet compliance(P<0.001) went up. The mean actual daily protein intake at different CKD stages(t =11.595, P <0.001; t =9.735, P <0.001; t =3.321, P <0.001) all exceeded the recommended amount. Conclusion The phosphorus intake of patients with CKD stages 3 to 5 was basically within the recommended intake range, but the incidence of malnutrition was high and low-protein diet compliance was poor. It is necessary to strengthen nutritional management, set the recommended amount of dietary phosphorus intake for CKD patient