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對于階段1-3慢性腎臟病的飲食危險因素的管理

時間:2016-04-28 09:39來源:livesitehelp.com 作者:留學論文網 點擊:
身體健康的人理所當然地認為食品其烹飪,而不是它的生化值。
在某些情況下,然而,飲食也可批判性健康。慢性腎臟疾病的早期階段的一般管理計劃,大多數臨床實踐指南(日用消費品)建議,主要是基于發表的隨機對照trials.1
表1.慢性腎臟病的分期
階段描述GFR(mL / min的/1.73平方米)
1腎臟損害正常或升高≥90GFR
2輕度腎臟損害GFR下降60-89
3微跌GFR30-59
4嚴重降低的GFR15-29
5腎衰竭<15(或透析)
GFR:腎小球濾過率Healthy people rightly consider food for its culinary rather than its biochemical value. In some conditions, however, diet can also be critically to health. The general management plan for early stages of chronic kidney disease, recommended by most clinical practice guidelines (CPGs), is largely based on published randomized control trails.1
Table1. Staging of Chronic Kidney Disease
Stage Description GFR(mL/min/1.73m2)
1 Kidney damage with normal or increased GFR ≥90
2 Kidney damage with mild decreased GFR 60-89
3 Moderately Decreased GFR 30-59
4 Severely decreased GFR 15-29
5 Kidney failure <15 (or dialysis)
GFR: glomerular filtration rate
 
膳食風險因素適當管理可能導致消退或穩定了幾十年的慢性腎臟疾病,特別是早期階段(Stage1-3)由幾個病例 - 對照建議studies.2To推遲發作和減少透析的頻率,控制所述進氣量蛋白,磷酸鹽,脂肪酸acids3,維生素K4是必要的。
臨床和實驗觀察表明,蛋白質和磷的早期飲食限制是延遲在大多數慢性腎臟疾病patients21進展和腎損傷的一種有效手段。動物研究的建議,限制飲食中蛋白質可能會減緩或absord在腎小球濾過率穩步下降,這些引起了很大的興趣來自于人類最近的研究管理潛在的進行性腎功能disease.5,6大量證據表明,日糧中蛋白質的這一限制能延緩由于至少19 century.7的后半部分通過減少升高的腎小球毛細血管壓和超濾8 .Dietary蛋白治療慢性腎臟疾病的進展已被推薦為慢性腎疾病的治療Suitable management of dietary risk factors may lead to regression or stabilization for many decades of chronic kidney disease especially early stages (Stage1-3) suggested by several case-control studies.2To postpone onset and reduce the frequency of dialysis, control the intake amount of protein, phosphate, fatty acids3, vitamin K4 are necessary.
 
Clinical and experimental observations have suggested that early dietary restriction of protein and phosphorus was an effective means of delaying the progression and renal injury in most chronic renal disease patients21. Suggestions from animal studies that restricting dietary protein might slow or absord a steady fall in the glomerular filtration rate aroused much interest in those managing potentially progressive renal disease.5,6Substantial evidence from recent studies in human suggests that restriction of dietary protein can retard the progression of chronic renal disease by reducing elevated glomerular capillary pressure and hyperfiltration8 .Dietary protein therapy has been recommended for the treatment of chronic renal disease since at least the last half of the 19th century.7
The Modification of Diet in Renal Disease (MDRD) Study was the largest randomized clinical trial to test the hypothesis that protein restriction slows the progression of chronic renal disease.8In Study A (moderate renal disease, GFR 25 to 55 ml/min/1.73m2, mean [SD] serum creatinine 1.9 [0.5] mg/dl ) patients (n=585) were prescribed a usual (n=294) or low protein diet (n=291), containing either 1.3 or 0.58g/Kg/day protein respectively.The primary outcome measure was the rate of decline in GFR in low protein diet group and normal protein diet groupof moderate CKD patients. Researchers hypothesized that the beneficial effects of low protein diet would result in a slowing in the mean GFR decline by at least 30%.9 Upon completion of the study, over a 3-yr interval, the average rate of GFR decline in low protein diet group is 3.8ml/min per year.8After 3 years, the decline in GFR was only 1.2ml/min (10%) less (p=0.3) in the low protein group compared with the usual protein diet group. Thus, the intention-to-treat analysis did not demonstrate a beneficial effect of low protein diet. This mean GFR declines is slower than expected. However, the low protein diet has opposite short-term and long-term effects on the GFR decline rate. Patients assigned to the low protein diet group have a 1.6ml/min faster mean decline in GFR during the frist 4 months (P = 0.004), but a 1.1ml/min per year (28%) slower mean GFR decline thereafter (P = 0.009), compared to patients of usual protein diet group.8 The magnitude of the short-term effect is sufficient to negate the long-term beneficial effect.  (責任編輯:anne)
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