/Nutrition for the treatment of chronic kidney disease

Nutrition for the treatment of chronic kidney disease

author:admin       pubdate:2017-08-07 14:57

First, metabolic disorder in chronic kidney disease

1. protein metabolism disorder of protein metabolism in chronic renal disease was the most prominent, usually there are two results: the protein accumulation of metabolites (i.e. azotemia): the system can cause symptoms. The malnutrition: including serum albumin, pre albumin, immunoglobulin, complement and tissue protein in water decreased, essential amino acid the level of plasma and tissue decreased, some non essential amino acid levels increased, affecting the prognosis and quality of life; obvious malnutrition can cause the quality of life of patients with CRF decreased, anemia, decreased immunity, infection increased, increased multiple system dysfunction and mortality.

2. water, electrolyte and acid-base balance in patients with chronic kidney disease, sodium, potassium, chloride, calcium, phosphorus, magnesium and other electrolyte metabolic disorders and metabolic acidosis are very common. These metabolic abnormalities, clinical manifestations can make C RF patients with multiple system dysfunction, severe cases can be life-threatening (such as serious water sodium retention, hyperkalemia, etc.), but also on other nutrients (such as protein) adversely affect metabolism.

3. the abnormal glucose metabolism is mainly manifested by impaired glucose tolerance and occasional hypoglycemia. Metabolic acidosis, high PTH and uremic toxins (such as methyl guanidine) can affect the regulation of insulin on blood sugar

4. abnormal lipid metabolism in hyperlipidemia is common in patients with chronic kidney disease. Mild to moderate hypertriglyceridemia and / or mild hypercholesterolemia. Lipoprotein abnormalities in plasma lipoprotein a, elevated levels of VLDL and HDL levels were significantly lower, while the level of low density lipoprotein most of the normal.

Two, the significance of nutritional therapy in chronic kidney disease

1. studies have shown that a low protein diet does not affect survival rates and complications, and that a good nutritional level can be maintained with the addition of essential amino acids or their keto acids and enough energy

2. to alleviate symptoms of uremic application of essential amino acid (EAA)) + alpha ketoacid therapy, essential amino acid supplement to the patient required, the urea nitrogen recycling, which can promote the synthesis of protein, decrease the concentration of nitrogen metabolites in the blood, the corresponding symptoms due to nitrogen metabolism products caused by some the nutritional therapy can be alleviated. The correction of metabolic acidosis inhibits the decomposition of protein / protein synthesis or improvement, in order to reduce the accumulation of some uremic toxins by reducing endocrine disorders (hyperparathyroidism, insulin resistance and so on). The corresponding complications such as renal osteodystrophy, pruritus, gastrointestinal hemorrhage, hypertension clinical manifestations such as loss.

3. delaying the progression of chronic kidney disease, protein diet can significantly affect the renal hemodynamics, and then change the glomerular filtration. Low protein diet can reduce the high filtration and reduce the degree of impairment of renal units

Specific implementation of nutritional therapy

1. limit protein intake: the compensatory stage of renal insufficiency (GFR50-80ml/min): the normal diet, 1g.kg-1.d-1 (70g); the renal insufficiency decompensation (GFR 20 50ml/min) and renal failure stage (GFR 10 - 20ml / min): low protein and low phosphorus diet, protein (about 0.5-0.6g.kg-1.d-1 35~45g, P 5~10mg.kg-1.d-1), plus alpha keto acid or amino acid preparations (0.1~0.15g.kg-1.d-1); uremia period (GFR<10ml/min): very low protein and low phosphorus diet, protein 0.3~0.4g.kg-1.d-1 (20~30g), P 5~8g.kg-1.d-1, plus alpha keto acid or amino acid preparations (0.1~0.2 g.kg-1.d-1); the patients with diabetic nephropathy protein intake may be appropriate to relax, usually in patients with diabetic nephropathy than failure 0.05~0.1 g.kg-1.d-1, and in GFR<15ml/min begins when a very low protein and low phosphorus diet.

2. protein, amino acid / alpha keto acid nutrition therapy should be paid attention to in the proportion of animal protein and plant protein ratio to ensure the proper proportion of animal protein in 50%-60%; the application has a-ketoacid or essential amino acid preparations of patients, can not limit the proportion. Because of high vegetable protein containing essential amino acid composition, expansion renal tubular function is not prominent, can reduce the effect of glomerular hyperfiltration, beneficial to delay the progression of renal disease. The application of the appropriate EAA and alpha KA ratio can be more conducive to the improvement of protein metabolism. The advantages of alpha -KA is that there is no nitrogen amount, slightly more will not cause nitrogen metabolites increased, alpha -KA and NH2 generates the necessary amino acids contribute to urea nitrogen utilization, calcium salt containing alpha -KA preparation, to correct calcium and phosphorus metabolism and secondary hyperparathyroidism.

3. mineral, trace elements, vitamins, L-, carnitine and other nutrients intake

The intake of sodium varies from person to person, but in patients with high blood pressure, edema and serious impairment of renal function, the restriction of sodium intake should be strict, generally 500 to 1500mg / d.

The intake of potassium and phosphorus in patients with serious impairment of renal function must be limited, and potassium intake is generally 400 to 800mg / D., and the total phosphorus intake is 500 to 700mg / d.

The iron, zinc) on dialysis patients, should pay attention to regular serum iron, zinc concentration, timely oral preparation. Part of dialysis patients often require intravenous iron, can be completely corrected according to iron deficiency, serum iron, transferrin saturation and ferritin levels to adjust the dose.

Vitamin D, such as B6 (10 ~ 100mg / D), B12 (500 g/L), folic acid (5 ~ 15mg / D), can significantly improve hyperhomocysteinemia and reduce the risk factors of cardiovascular disease

The L- L- was the main effect of carnitine carnitine improve lipid metabolism, muscle metabolism, myocardial metabolism, anemia and so on. The correct low meat so that the alkalinization, clinical symptoms, such as fatigue, anorexia, anemia and other relief. Each stage C RF patients should pay attention to eating meat (the main source of food in L- carnitine) on food intake. The difference, or by eating hard to correct carnitine deficiency for patients with multiple choice intravenous supplement of L- carnitine, the total amount is 3G / week (1.5g 5.0g / week).

The exogenous hormones or growth factors of erythropoietin, active vitamin D3, can improve the nutritional therapy effect. The application of exogenous growth hormone and insulin-like growth factor. The experienced specialists under the guidance of short-term supplementation, to improve appetite, improve nutritional status and help.

 

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