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时间:2021-04-18
《最新慢性肾脏病和低蛋白饮食教学讲义ppt.ppt》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、慢性肾脏病和低蛋白饮食FactorsAssociatedwithLossofKidneyFunctioninCKDSlowtheprogressionofkidneydiseaseHavebeenproventobeeffectiveStrictglucosecontrolindiabetesStrictbloodpressurecontrolACEIorARBHavebeenstudiedbutinconclusiveDietaryproteinrestrictionLipid-loweringtherapyPartialcorrect
2、ionofanemiaFrequentcausesofacutedeclineinGFRVolumedepletion;contrast;NSAID;antimicrobialagents;ACEI/ARB;cyclosporine;obstructionuropathy…什麼時候開始認為低蛋白飲食可能會延緩腎臟病的惡化?Meta-AnalysisofLowProteinDietinProgressionofCKDCochranesystematicreviewandmeta-analysisFouqueD,etal,CochraneD
3、atabaseSystRev2006;19:CD001892.如何確定病人是否有執行低蛋白飲食?Duplicatemeal&ashanalysisDietaryrecall24hrurinecollectionforurea-NDuplicatemeal&ashanalysisGoodforresearchstudyBarrierNeedaccuratecollectionofduplicatemealsbypatientsorresearchassistantNeedlabmethodstoprocessspecimens:blende
4、r,freezing,burning,aciddigestionN2–analyzerCostlyNoclinicalapplicationforindividualpatientsDietaryrecallAdvantage:Bestpracticeampletimeforpersonel–patientinteractionPatientshavemorefreedomtoexpresstheirphysicalandemotionalconstraintBarrierNeedqualifieddietitianNeedpatient
5、’sunderstanding&cooperationInadequateinformativeaboutnutritionalvalueoflocalfoodsCalculationisuneasySubjecttobiologicalvariationMaynotbepracticalfornation-wideimplementationMonitoringofdietaryproteinfromurineureaNDPI=6.25[totalu.urea-N+0.031KgBW]+urineproteinBenefitof24hu
6、rinecollectionforDPImonitoring1.Cheap2.Slightlyinconvenientbutacceptablebymostpatients3.Accurateandreliablefeedback(topatient)4.Bodylanguageismoreconvincingpersuasive5.achievemorecompliancetotheguidelinePropermonitoring1.U.protein:surrogatemarkerforglomerularpermselecturi
7、ty2.Bodyweight:calorieintake(dry)3.24hUrineureaN+BW:nPNA(nDPI)4.24hU.Na:saltintake低蛋白飲食會造成病人營養不良嗎?低蛋白飲食對糖尿病腎病變有幫忙嗎?DietaryproteinrestrictionsignificantlyreducestheriskofdeclineinGFRorcreatinineclearanceinpatientswithdiabeticnephropathy.Lowproteindiet:effectonprogressiono
8、fCRFindiabeticCKDpatients:meta-analysisPEDRINIetal.(1996):Effectofdietaryproteinrestrictiononthe
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