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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CKD3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。
Objective To observe the effects of dietary protein restriction on nutritional status and renal function in elderly patients with chronic kidney disease (CKD). Methods A retrospective analysis of the treatment of low protein diet (LPD) in 168 CKD patients aged 75-94 years was performed. Maroni’s formula was used to estimate patients’ mean daily protein intake (eDPI) to assess patient compliance with LPD and to divide the patients into single-limiting proteome groups based on eDPI levels and whether to take compound alpha-keto acid preparations (KA) Protein + KA group, unrestricted protein group and unrestricted protein + KA group. The nutritional status and renal function of the four groups of patients during 18 months were compared. Results Serum albumin and prealbumin levels were decreased in patients with protein restriction alone (P <0.05). Levels of serum phosphorus were significantly increased in patients without protein restriction (P <0.05) (P <0.05). The decrease of eGFR in the patients with limited protein + KA group was the smallest (P <0.05). Conclusions Treatment of limited protein in elderly patients with CKD may lead to malnutrition. KA can improve nutritional status and serum calcium level in patients with CKD. Limiting protein and KA treatment can effectively delay the progression of CKD in the elderly.