慢性肾脏病和低蛋白饮食.ppt

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1、慢性腎臟病與低蛋白飲食ChronicKidneyDiseaseandLowProteinDiet腎臟科陳冠興FactorsAssociatedwithLossofKidneyFunctioninCKDSlowtheprogressionofkidneydiseaseHavebeenproventobeeffectiveStrictglucosecontrolindiabetesStrictbloodpressurecontrolACEIorARBHavebeenstudiedbutinconclusiveDietaryproteinrestrictionLipid-

2、loweringtherapyPartialcorrectionofanemiaFrequentcausesofacutedeclineinGFRVolumedepletion;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?TheEffectsofDietaryProteinRestrictionandBlood-PressureControlontheProgressionofChronicRenalDise

3、aseSauloKlahr,AndrewS.Levey,GeraldJ.Beck,ArleneW.Caggiula,LawrenceHunsicker,JohnW.Kusek,GaryStriker,forTheModificationofDietinRenalDiseaseStudyGroup*Volume330:877-884March31,1994Number13MDRDstudy研究設計StudyAGFR25-55mL/min(meanSCr1.9±0.5)Usualprotein1.3g/kg/d;lowproteindiet0.58g/kg/dN=585

4、StudyBGFR13-24mL/min(meanScr3.4±0.9)Lowproteindiet;verylowproteindietN=255論文發表NEnglJMed330:877-884,1994JAmSocNephrol7:2616-2626,1996AJKD27(5):652-663,1996JAmSocNephrol10:2426-2439,1999>.75g/Kg/d<.62.62-.68.68-.75Meta-AnalysisofLowProteinDietinProgressionofCKDCochranesystematicreviewand

5、meta-analysisFouqueD,etal,CochraneDatabaseSystRev2006;19:CD001892.如何確定病人是否有執行低蛋白飲食?Duplicatemeal&ashanalysisDietaryrecall24hrurinecollectionforurea-NDuplicatemeal&ashanalysisGoodforresearchstudyBarrierNeedaccuratecollectionofduplicatemealsbypatientsorresearchassistantNeedlabmethodstop

6、rocessspecimens:blender,freezing,burning,aciddigestionN2–analyzerCostlyNoclinicalapplicationforindividualpatientsDietaryrecallAdvantage:Bestpracticeampletimeforpersonel–patientinteractionPatientshavemorefreedomtoexpresstheirphysicalandemotionalconstraintBarrierNeedqualifieddietitianNee

7、dpatient’sunderstanding&cooperationInadequateinformativeaboutnutritionalvalueoflocalfoodsCalculationisuneasySubjecttobiologicalvariationMaynotbepracticalfornation-wideimplementationMonitoringofdietaryproteinfromurineureaNDPI=6.25[totalu.urea-N+0.031KgBW]+urineproteinBenefitof24hurine