Maroni和Boaz公式评估慢性肾脏病患者蛋白质及磷摄入量
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摘要
目的:探索Boaz公式是否可以真实反应中国慢性肾脏病(CKD) 3～5D期患者磷摄入量; Maroni公式是否能准确预测CKD 3～5期患者蛋白质摄入量。方法:于2016年3月～2017年6月于中国医科大学附属第一医院肾内科,运用CKD-EPI公式估算患者肾小球滤过率(e GFR)判断其肾功能,选取确诊CKD 3～5D期的住院患者110例。肾内科医师筛选符合入选及排除标准患者介绍给营养师进行营养宣教、膳食调查,比较患者蛋白质及磷实际摄入量与推荐及评估摄入量关系。结果:CKD 3～5期患者蛋白质实际摄入量符合推荐摄入量,但其均高于Maroni公式评估摄入量,且有统计学差异(P<0. 05); CKD 3～4期及CKD 5D期患者磷实际摄入量在标准范围内,CKD 5期低于推荐量,各期均与Boaz公式评估摄入量无统计学差异(P> 0. 05);结论:大部分CKD患者都能按指南推荐量合理控制饮食; Maroni公式可能不适用于评估我国CKD患者蛋白质摄入量,而Boaz公式适合评估磷摄入量。
Objective: To explore whether Boaz formula can truly reflect phosphorus intake in CKD patients in China,and whether Maroni formula can accurately predict protein intake in patients with CKD 3 ～ 5 patients.Methodology: In department of renal medicine,the first affiliated Hospital of China Medical University,from March 2016 to June 2017,the CKD-EPI formula was used to calculate the renal function of patients with GFR,and 110 inpatients with CKD3 ～ 5D stage were selected. Renal physicians selected according to the criteria of inclusion and exclusion of patients were introduced to nutritionists for nutrition education,dietary survey( 3 days and 24 hours diet weighing method),to compare the actual intake of protein and phosphorus in patients and the recommended and estimated intake relationship. Results:The actual intake of protein in patients with CKD 3 ～ 5 was in accordance with the recommended intake,but there was a significant difference between the actual intake of protein and the estimated intake of maroni( P<0. 05). The actual intake of phosphorus in CKD 3 ～ 4 and CKD 5D patients was lower than the recommended amount in the standard range,and there was no significant difference between each period and the estimated intake of Boaz( P> 0. 05). Conclusion: Most CKD patients can reasonably control their diet according to the recommended amount of guidelines; Maroni formula may not be suitable for evaluating protein intake of CKD patients in China,but Boaz formula is suitable for estimating phosphorus intake.
Objective: To explore whether Boaz formula can truly reflect phosphorus intake in CKD patients in China,and whether Maroni formula can accurately predict protein intake in patients with CKD 3 ～ 5 patients.Methodology: In department of renal medicine,the first affiliated Hospital of China Medical University,from March 2016 to June 2017,the CKD-EPI formula was used to calculate the renal function of patients with GFR,and 110 inpatients with CKD3 ～ 5D stage were selected. Renal physicians selected according to the criteria of inclusion and exclusion of patients were introduced to nutritionists for nutrition education,dietary survey( 3 days and 24 hours diet weighing method),to compare the actual intake of protein and phosphorus in patients and the recommended and estimated intake relationship. Results:The actual intake of protein in patients with CKD 3 ～ 5 was in accordance with the recommended intake,but there was a significant difference between the actual intake of protein and the estimated intake of maroni( P<0. 05). The actual intake of phosphorus in CKD 3 ～ 4 and CKD 5D patients was lower than the recommended amount in the standard range,and there was no significant difference between each period and the estimated intake of Boaz( P> 0. 05). Conclusion: Most CKD patients can reasonably control their diet according to the recommended amount of guidelines; Maroni formula may not be suitable for evaluating protein intake of CKD patients in China,but Boaz formula is suitable for estimating phosphorus intake.
引文
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2 周蓉,蒋更如.慢性肾脏病患者营养状态分析.中国基层医药,2010,17(2):179-181.
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7 Maraj M,Ku s'nierz-Cabala B,Dumnicka P,et al. Malnutrition,Inflammation, Atherosclerosis Syndrome(MIA)and Diet Recommendations among End-Stage Renal Disease Patients Treated with Maintenance Hemodialysis.Nutrients,2018,10(1),pii:E69.
8 Wang J,Zhang XY,Guan YF.[Hyperphosphatemia in Chronic Kidney Disease(CKD)].Sheng Li Ke Xue Jin Zhan,2015,46(4):241-244.
9 TrifiròG,Fatuzzo PM,Ientile V,et al. Expert opinion of nephrologists about the effectiveness of low-protein diet in different stages of chronic kidney disease(CKD).Int J Food Sci Nutr,2014,65(8):1027-1032.
11 袁伟杰,杨满.如何提高慢性肾脏病患者对低蛋白饮食的依从性.肾脏病与透析肾移植杂志,2017,26(4):347-348.
12 Maroni BJ,Steinman TI,Mitch WE. A method for estimating nitrogen intake of patients with chronic renal failure.Kidney Int,1985,27(1):58-65.
13 李素蘋,许菲菲.Maroni公式评估慢性肾脏病患者饮食蛋白质摄入在国人中的应用.浙江临床医学,2008,10(10):1310-1312.
14 Masud T,Manatunga A,Cotsonis G,et al. The precision of estimating protein intake of patients with chronic renal failure.Kidney Int,2002,62(5):1750-1756.
15 Boaz M,Smetana S. Regression equation predicts dietary phosphorus intake from estimate of dietary protein intake.J Am Diet Assoc,1996,96(12):1268-1270.
16 彭艾.血液透析技术治疗高磷血症的体会.肾脏病与透析肾移植杂志,2015,24(3):259-260.
2 周蓉,蒋更如.慢性肾脏病患者营养状态分析.中国基层医药,2010,17(2):179-181.
3 Pan X,Xiang H,Ding C,et al.Cost of two different therapies for endstage renal disease in northwest China. Journal of Medical Colleges of Pla,2012,27(2):80-86.
4 Peev V, Nayer A, Contreras G. Dyslipidemia, malnutrition,inflammation,cardiovascular disease and mortality in chronic kidney disease.Curr Opin Lipidol,2014,25(1):54-60.
5 Tsai MT,Hu FH,Lien TJ,et al. Interaction between geriatric nutritional risk index and decoy receptor 3 predicts mortality in chronic hemodialysis patients.Am J Nephrol,2014,40(3):191-199.
6 Bellizzi V,Cupisti A,Locatelli F,et al. Low-protein diets for chronic kidney disease patients:the Italian experience.BMC Nephrol,2016,17(1):77.
7 Maraj M,Ku s'nierz-Cabala B,Dumnicka P,et al. Malnutrition,Inflammation, Atherosclerosis Syndrome(MIA)and Diet Recommendations among End-Stage Renal Disease Patients Treated with Maintenance Hemodialysis.Nutrients,2018,10(1),pii:E69.
8 Wang J,Zhang XY,Guan YF.[Hyperphosphatemia in Chronic Kidney Disease(CKD)].Sheng Li Ke Xue Jin Zhan,2015,46(4):241-244.
9 TrifiròG,Fatuzzo PM,Ientile V,et al. Expert opinion of nephrologists about the effectiveness of low-protein diet in different stages of chronic kidney disease(CKD).Int J Food Sci Nutr,2014,65(8):1027-1032.
11 袁伟杰,杨满.如何提高慢性肾脏病患者对低蛋白饮食的依从性.肾脏病与透析肾移植杂志,2017,26(4):347-348.
12 Maroni BJ,Steinman TI,Mitch WE. A method for estimating nitrogen intake of patients with chronic renal failure.Kidney Int,1985,27(1):58-65.
13 李素蘋,许菲菲.Maroni公式评估慢性肾脏病患者饮食蛋白质摄入在国人中的应用.浙江临床医学,2008,10(10):1310-1312.
14 Masud T,Manatunga A,Cotsonis G,et al. The precision of estimating protein intake of patients with chronic renal failure.Kidney Int,2002,62(5):1750-1756.
15 Boaz M,Smetana S. Regression equation predicts dietary phosphorus intake from estimate of dietary protein intake.J Am Diet Assoc,1996,96(12):1268-1270.
16 彭艾.血液透析技术治疗高磷血症的体会.肾脏病与透析肾移植杂志,2015,24(3):259-260.