低蛋白饮食在非透析慢性肾脏病中的应用研究
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摘要
低蛋白饮食(LPD)被认为是慢性肾脏病(CKD)综合治疗中的重要环节。目前,对于LPD是否有益于保护CKD患者的残肾功能,各研究结论不一;同时临床对于LPD对患者营养状况的影响也存在顾虑。本文综述了近年来有关蛋白质摄入对肾脏功能的影响,以及LPD对CKD患者作用的研究,并梳理了LPD实施中的要点,有助于提高CKD患者饮食管理的质量、减缓病情进展、延后或避免透析治疗,为营养师和临床医生对CKD患者制定和实施有效的饮食治疗计划提供参考。
Low protein diet(LPD) is an important element in the comprehensive treatment of chronic kidney disease(CKD).At present,whether the LPD is beneficial in protecting residual kidney function in patients with CKD is debated.In addition,concerns have been raised regarding the effect of LPD on patient nutritional status.This article reviews recent studies on the effects of protein intake on kidney function and the role of LPD in CKD treatment,and summarizes key points in implementing LPD,to improve the quality of dietary management,slow the progression of the disease,and delay dialysis treatment onset in patients with CKD.Our study also provides a reference for dietitians and clinicians to formulate and implement effective diet treatment plans for patients with CKD.
Low protein diet(LPD) is an important element in the comprehensive treatment of chronic kidney disease(CKD).At present,whether the LPD is beneficial in protecting residual kidney function in patients with CKD is debated.In addition,concerns have been raised regarding the effect of LPD on patient nutritional status.This article reviews recent studies on the effects of protein intake on kidney function and the role of LPD in CKD treatment,and summarizes key points in implementing LPD,to improve the quality of dietary management,slow the progression of the disease,and delay dialysis treatment onset in patients with CKD.Our study also provides a reference for dietitians and clinicians to formulate and implement effective diet treatment plans for patients with CKD.
引文
[1] ZHANG L, WANG F, WANG L, et al. Prevalence of chronic kidney disease in China:a cross-sectional survey[J]. Lancet,2012, 379(9818):815-822. DOI:10.1016/S0140-6736(12)60033-6.
[2] KALANTAR-ZADEH K, MOORE L W, TORTORICI A R, et al.North American experience with Low protein diet for Non-dialysisdependent chronic kidney disease[J]. BMC Nephrol, 2016, 17(1):90. DOI:10.1186/s 12882-016-0304-9.
[3] FOUQUE D, APARICIO M.Eleven reasons to control the protein intake of patients with chronic kidney disease[J]. Nat Clin Pract Nephrol, 2007, 3(7):383-392. DOI:10.1038/ncpneph0524.
[4]BELLIZZI V.Low-protein diet or nutritional therapy in chronic kidney disease?[J]. Blood Purif,2013,36(1):41-46. DOI:10.1159/000350585.
[5] KNIGHT E L, STAMPFER M J, HANKINSON S E, et al. The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency[J]. Ann Intern Med, 2003, 138(6):460-467.
[6]HALBESMA N, BAKKER S J, JANSEN D F, et al. High protein intake associates with cardiovascular events but not with loss of renal function[J].J Am Soc Nephrol,2009,20(8):1797-1804.DOI:10.1681/ASN.2008060649.
[7] JURASCHEK S P, APPEL L J, ANDERSON C A, et al. Effect of a high-protein diet on kidney function in healthy adults:results from the Omni Heart trial[J]. Am J Kidney Dis, 2013, 61(4):547-554. DOI:10.1053/j.ajkd.2012.10.017.
[8] BERRYMAN C E, AGARWAL S, LIEBERMAN H R, et al.Diets higher in animal and plant protein are associated with lower adiposity and do not impair kidney function in US adults[J].Am J Clin Nutr, 2016,104(3):743-749. DOI:10.3945/ajcn. 116.133819.
[9] M(?)LLER G, RIKARDT ANDERSEN J, RITZ C, et al. Higher protein intake is not associated with decreased kidney function in prediabetic older adults following a one-year intervention-a preview sub-study[J]. Nutrients, 2018, 10(1):54. DOI:10.3390/nu10010054.
[10] SALLSTROM J, CARLSTROM M, OLERUD J, et al. Highprotein-induced glomerular hyperfiltration is independent of the tubuloglomerular feedback mechanism and nitric oxide synthases[J]. Am J Physiol Regul Integr Comp Physiol,2010,299(5):R1263-1268. DOI:10.1152/ajpregu.00649.2009.
[11] CIRILLO M, LOMBARDI C, CHIRICONE D, et al. Protein intake and kidney function in the middle-age population:contrast between cross-sectional and longitudinal data[J].Nephrol Dial Transplant, 2014, 29(9):1733-1740. DOI:10.1093/ndt/gfu056.
[12] RUILOPE L M, CASAL M C, PRAGA M, et al. Additive antiproteinuric effect of converting enzyme inhibition and a low protein intake[J]. J Am Soc Nephrol,1992,3(6):1307-1311.
[13] RICCIO E, DI NUZZI A, PISANI A.Nutritional treatment in chronic kidney disease:the concept of nephroprotection[J].Clin Exp Nephrol, 2015, 19(2):161-167. DOI:10.1007/s10157-014-1041-7.
[14] DI IORIO B R,CUCCINIELLO E,MARTINO R,et al. Acute and persistent antiproteinuric effect of a low-protein diet in chronic kidney disease[J]. G Ital Nefrol, 2009, 26(5):608-615.
[15]KLAHR S, LEVEY A S, BECK G J, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease.Modification of Diet in Renal Disease Study Group[J]. N Engl J Med, 1994, 330(31):877-884.DOI:10.1056/NEJM199403313301301.
[16] LEVEY A S, GREENE T,BECK G J, et al. Dietary protein restriction and the progression of chronic renal disease:what have all of the results of the MDRD study shown?[J]. J Am Soc Nephrol, 1999, 10(11):2426-2439.
[17] LEVEY A S, ADLER S, CAGGIULA A W, et al. Effects of dietary protein restriction on the progression of advanced renal disease in the modification of diet in renal disease study[J]. Am J Kidney Dis, 1996, 27(5):652-663.
[18] METZGER M, YUAN W L, HAYMANN J P, et al. Association of a low-protein diet with slower progression of CKD[J].Kidney Int Rep, 2017, 3(1):105-114. DOI:10.1016/j.ekir.2017.08.010.
[19] FOUQUE D, LAVILLE M.Low protein diets for chronic kidney disease in non diabetic adults[J]. Cochrane Database Syst Rev,2009, 8(3):CD001892. DOI:10.1002/14651858.CD001892.pub3.
[20] WEINER I D, MITCH W E, SANDS J M.Urea and ammonia metabolism and the control of renal nitrogen excretion[J].Clin J Am Soc Nephrol, 2015, 10(8):1444-1458. DOI:10.2215/CJN.10311013.
[21] CIANCIARUSO B, POTA A, PISANI A, et al. Metabolic effects of two low protein diets in chronic kidney disease stage 4-5—a randomized controlled trial[J]. Nephrol Dial Transplant,2008, 23(2):636-644. DOI:10.1093/ndt/gfm576.
[22] ST-JULES D E, WOOLF K, POMPEII M L, et al. Reexamining the phosphorus-protein dilemma:Does Phosphorus restriction compromise protein status?[J]. J Ren Nutr, 2016,26(3):136-140. DOI:10.1053/j.jrn.2015.12.004.
[23] CUPISTI A, KALANTAR-ZADEH K.Management of natural and added dietary phosphorus burden in kidney disease[J].Semin Nephrol, 2013, 33(2):180-190. DOI:10.1016/j.semnephrol.2012.12.018.
[24] DI IORIO B R, CUCCINIELLO E, MARTINO R, et al. Acute and persistent antiproteinuric effect of a low-protein diet in chronic kidney disease[J]. G Ital Nefrol, 2009, 26(5):608-615.
[25] CHAUVEAU P, APARICIO M.Benefits in nutritional interventions in patients with CKD stage 3-4[J]. J Ren Nutr, 2011, 21(1):20-22. DOI:10.1053/j.jrn.2010.11.005.
[26] CARRERO J J, CHMIELEWSKI M, AXELSSON J, et al.Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients[J]. Clin Nutr, 2008, 27(4):557-564. DOI:10.1016/j.clnu.2008.04.007.
[27] KALANTAR-ZADEH K, IKIZLER T A, BLOCK G, et al.Malnutrition-inflammation complex syndrome in dialysis patients:causes and consequences[J]. Am J Kidney Dis, 2003, 42(5):864-881.
[28] QURESHI A R, ALVESTRAND A, DANIELSSON A, et al.Factors predicting malnutrition in hemodialysis patients:a crosssectional study[J]. Kidney Int,1998,53(3):773-782.DIO:10.1046/j. 1523-1755.1998.00812.x.
[29] DOMANSKI M, CIECHANOWSKI K.Sarcopenia:a major challenge in elderly patients with end-stage renal disease[J]. J Aging Res, 2012:754739. DOI:10.1155/2012/754739.
[30] KOPPLE J D, LEVEY A S, GREENE T, et al. Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study[J]. Kidney Int,1997,52(3):778-791.
[31] MITCH W E, REMUZZI G.Diets for patients with chronic kidney disease, should we reconsider?[J]. BMC Nephrol, 2016, 17(1):80. DOI:10.1186/s12882-016-0283-x.
[32] KOVESDY C P, KOPPLE J D,KALANTAR-ZADEH K.Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease:reconciling low protein intake with nutritional therapy[J]. Am J Clin Nutr,2013,97(6):1163-1177.DOI:10.3945/ajcn.112.036418.
[33] BERNHARD J, BEAUFRERE B, LAVILLE M, et al. Adaptive response to a low-protein diet in predialysis chronic renal failure patients[J]. J Am Soc of Nephrol, 2001, 12(6):1249-1254.
[34] MILOVANOVA S Y, MILOVANOV Y S, TARANOVA M V,et al. Effects of keto/amino acids and a low-protein diet on the nutritional status of patients with stages 3B-4 chronic kidney disease[J]. Ter Arkh, 2017, 89(6):30-33. DOI:10.17116/terarkh201789630-33.
[35]张蜜蜜,赵艳,朱英莉.个体化低蛋白饮食干预对慢性肾脏病患者肾功能的影响[J].中国医学科学院学报,2015, 37(4):384-391.DOI:10.3881/j.issn.1000-503X.2015.04.003.ZHANG M M, ZHAO Y, ZHU Y L.Effect of individualized lowprotein diet intervention on renal function of patients with chronic kidney disease[J]. Acta Academiae Medicinae Sinicae,2015, 37(4):384-391. DOI:10.3881/j.issn. 1000-503X.2015.04.003.
[36]邵春海,朱云,刘景芳,等.低蛋白饮食对3/4期慢性肾脏病患者肾功能及营养状况的影响[J].中华临床营养杂志,2009, 17(6):339-342. DOI:10.3760/cma.j.issn.1674-635X.2009.06.006.SHAO C H, ZHU Y, LIU J F, et al. Influences of low-protein diet on renal function and nutritional status in patients with stage3/4 chronic kidney diseases[J]. Chinese Journal of Clinical Nutrition, 2009, 17(6):339-342. DOI:10.3760/cma.j.issn. 1674-635X.2009.06.006.
[37] KALANTAR-ZADEH K, FOUQUE D.Nutritional management of chronic kidney disease[J]. N Engl J Med, 2017, 377(18):1765-1776. DOI:10.1056/NEJMra 1700312.
[38] GARNEATA L,STANCU A,DRAGOMIR D, et al.Ketoanalogue-supplemented vegetarian very low-protein diet and CKD progression[J]. J Am Soc Nephrol, 2016, 27(7):2164-2176. DOI:10.1681/ASN.2015040369.
[39]Kidney Disease:Improving Global Outcomes(KDIGO)CKD Work Group.KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease[J]. Kidney Int Suppl, 2013, 3(1):1-150. DOI:10.1038/kisup.2012.73.
[40] SHAH B V, PATEL Z M.Role of low protein diet in management of different stages of chronic kidney disease-practical aspects[J].BMC Nephrol, 2016, 17(1):156.DOI:10.1186/s12882-016-0360-1.
[41] GARNEATA L, STANCU A, DRAGOMIR D, et al.Ketoanalogue-supplemented vegetarian very low-protein diet and CKD progression[J].J Am Soc Nephrol,2016,27(7):2164-2176. DOI:10.1681/ASN.2015040369.
[42] WU H L,SUNG J M,KAO M D,et al. Nonprotein calorie supplement improves adherence to low-protein diet and exerts beneficial responses on renal function in chronic kidney disease[J].J Ren Nutr, 2013, 23(4):271-276. DOI:10.1053/j.jm.2012.09.003.
[43] KOPPLE J D.National Kidney Foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure[J]. Am J Kidney Dis, 2001, 37(1 Suppl 2):S66-70.
[44] MARONI B J, STEINMAN T I, MITCH W E.A method for estimating nitrogen intake of patients with chronic renal failure[J]. Kidney Int,1985,27(1):58-65.
[45]李丽丽,徐天华,徐爽,等. Maroni公式评估膳食蛋白质摄入在慢性肾脏病患者的应用[J].临床肾脏病杂志,2017, 17(9):549-552. DOI:10.3969/j.issn.1671-2390.2017.09.008.LI L L,XU T H, XU S, et al. Validation of Maroni formula for estimating diet protein intake of patients with chronic kidney disease[J]. Journal of Clinical Nephrology,2017,17(9):549-552. DOI:10.3969/j.issn. 1671-2390.2017.09.008.
[46] D'ALESSANDRO C, ROSSI A, INNOCENTI M, et al. Dietary protein restriction for renal patients:don't forget protein-free foods[J]. J Ren Nutr, 2013, 23(5):367-371. DOI:10.1053/j.jrn.2012.12.006.
[47] ARMSTRONG J E, LAING D G, WILKES E J, et al. Smell and taste function in children with chronic kidney disease[J]. Pediatr Nephrol, 2010, 25(8):1497-1504. DOI:10.1007/s00467-010-1529-7.
[48] KONSTANTINOVA D, NENOVA-NOGALCHEVA A,PANCHEVA R, et al. Taste disorders in patients with end-stage chronic kidney disease[J]. G Ital Nefrol,2017,34(3):54-60.
[2] KALANTAR-ZADEH K, MOORE L W, TORTORICI A R, et al.North American experience with Low protein diet for Non-dialysisdependent chronic kidney disease[J]. BMC Nephrol, 2016, 17(1):90. DOI:10.1186/s 12882-016-0304-9.
[3] FOUQUE D, APARICIO M.Eleven reasons to control the protein intake of patients with chronic kidney disease[J]. Nat Clin Pract Nephrol, 2007, 3(7):383-392. DOI:10.1038/ncpneph0524.
[4]BELLIZZI V.Low-protein diet or nutritional therapy in chronic kidney disease?[J]. Blood Purif,2013,36(1):41-46. DOI:10.1159/000350585.
[5] KNIGHT E L, STAMPFER M J, HANKINSON S E, et al. The impact of protein intake on renal function decline in women with normal renal function or mild renal insufficiency[J]. Ann Intern Med, 2003, 138(6):460-467.
[6]HALBESMA N, BAKKER S J, JANSEN D F, et al. High protein intake associates with cardiovascular events but not with loss of renal function[J].J Am Soc Nephrol,2009,20(8):1797-1804.DOI:10.1681/ASN.2008060649.
[7] JURASCHEK S P, APPEL L J, ANDERSON C A, et al. Effect of a high-protein diet on kidney function in healthy adults:results from the Omni Heart trial[J]. Am J Kidney Dis, 2013, 61(4):547-554. DOI:10.1053/j.ajkd.2012.10.017.
[8] BERRYMAN C E, AGARWAL S, LIEBERMAN H R, et al.Diets higher in animal and plant protein are associated with lower adiposity and do not impair kidney function in US adults[J].Am J Clin Nutr, 2016,104(3):743-749. DOI:10.3945/ajcn. 116.133819.
[9] M(?)LLER G, RIKARDT ANDERSEN J, RITZ C, et al. Higher protein intake is not associated with decreased kidney function in prediabetic older adults following a one-year intervention-a preview sub-study[J]. Nutrients, 2018, 10(1):54. DOI:10.3390/nu10010054.
[10] SALLSTROM J, CARLSTROM M, OLERUD J, et al. Highprotein-induced glomerular hyperfiltration is independent of the tubuloglomerular feedback mechanism and nitric oxide synthases[J]. Am J Physiol Regul Integr Comp Physiol,2010,299(5):R1263-1268. DOI:10.1152/ajpregu.00649.2009.
[11] CIRILLO M, LOMBARDI C, CHIRICONE D, et al. Protein intake and kidney function in the middle-age population:contrast between cross-sectional and longitudinal data[J].Nephrol Dial Transplant, 2014, 29(9):1733-1740. DOI:10.1093/ndt/gfu056.
[12] RUILOPE L M, CASAL M C, PRAGA M, et al. Additive antiproteinuric effect of converting enzyme inhibition and a low protein intake[J]. J Am Soc Nephrol,1992,3(6):1307-1311.
[13] RICCIO E, DI NUZZI A, PISANI A.Nutritional treatment in chronic kidney disease:the concept of nephroprotection[J].Clin Exp Nephrol, 2015, 19(2):161-167. DOI:10.1007/s10157-014-1041-7.
[14] DI IORIO B R,CUCCINIELLO E,MARTINO R,et al. Acute and persistent antiproteinuric effect of a low-protein diet in chronic kidney disease[J]. G Ital Nefrol, 2009, 26(5):608-615.
[15]KLAHR S, LEVEY A S, BECK G J, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease.Modification of Diet in Renal Disease Study Group[J]. N Engl J Med, 1994, 330(31):877-884.DOI:10.1056/NEJM199403313301301.
[16] LEVEY A S, GREENE T,BECK G J, et al. Dietary protein restriction and the progression of chronic renal disease:what have all of the results of the MDRD study shown?[J]. J Am Soc Nephrol, 1999, 10(11):2426-2439.
[17] LEVEY A S, ADLER S, CAGGIULA A W, et al. Effects of dietary protein restriction on the progression of advanced renal disease in the modification of diet in renal disease study[J]. Am J Kidney Dis, 1996, 27(5):652-663.
[18] METZGER M, YUAN W L, HAYMANN J P, et al. Association of a low-protein diet with slower progression of CKD[J].Kidney Int Rep, 2017, 3(1):105-114. DOI:10.1016/j.ekir.2017.08.010.
[19] FOUQUE D, LAVILLE M.Low protein diets for chronic kidney disease in non diabetic adults[J]. Cochrane Database Syst Rev,2009, 8(3):CD001892. DOI:10.1002/14651858.CD001892.pub3.
[20] WEINER I D, MITCH W E, SANDS J M.Urea and ammonia metabolism and the control of renal nitrogen excretion[J].Clin J Am Soc Nephrol, 2015, 10(8):1444-1458. DOI:10.2215/CJN.10311013.
[21] CIANCIARUSO B, POTA A, PISANI A, et al. Metabolic effects of two low protein diets in chronic kidney disease stage 4-5—a randomized controlled trial[J]. Nephrol Dial Transplant,2008, 23(2):636-644. DOI:10.1093/ndt/gfm576.
[22] ST-JULES D E, WOOLF K, POMPEII M L, et al. Reexamining the phosphorus-protein dilemma:Does Phosphorus restriction compromise protein status?[J]. J Ren Nutr, 2016,26(3):136-140. DOI:10.1053/j.jrn.2015.12.004.
[23] CUPISTI A, KALANTAR-ZADEH K.Management of natural and added dietary phosphorus burden in kidney disease[J].Semin Nephrol, 2013, 33(2):180-190. DOI:10.1016/j.semnephrol.2012.12.018.
[24] DI IORIO B R, CUCCINIELLO E, MARTINO R, et al. Acute and persistent antiproteinuric effect of a low-protein diet in chronic kidney disease[J]. G Ital Nefrol, 2009, 26(5):608-615.
[25] CHAUVEAU P, APARICIO M.Benefits in nutritional interventions in patients with CKD stage 3-4[J]. J Ren Nutr, 2011, 21(1):20-22. DOI:10.1053/j.jrn.2010.11.005.
[26] CARRERO J J, CHMIELEWSKI M, AXELSSON J, et al.Muscle atrophy, inflammation and clinical outcome in incident and prevalent dialysis patients[J]. Clin Nutr, 2008, 27(4):557-564. DOI:10.1016/j.clnu.2008.04.007.
[27] KALANTAR-ZADEH K, IKIZLER T A, BLOCK G, et al.Malnutrition-inflammation complex syndrome in dialysis patients:causes and consequences[J]. Am J Kidney Dis, 2003, 42(5):864-881.
[28] QURESHI A R, ALVESTRAND A, DANIELSSON A, et al.Factors predicting malnutrition in hemodialysis patients:a crosssectional study[J]. Kidney Int,1998,53(3):773-782.DIO:10.1046/j. 1523-1755.1998.00812.x.
[29] DOMANSKI M, CIECHANOWSKI K.Sarcopenia:a major challenge in elderly patients with end-stage renal disease[J]. J Aging Res, 2012:754739. DOI:10.1155/2012/754739.
[30] KOPPLE J D, LEVEY A S, GREENE T, et al. Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study[J]. Kidney Int,1997,52(3):778-791.
[31] MITCH W E, REMUZZI G.Diets for patients with chronic kidney disease, should we reconsider?[J]. BMC Nephrol, 2016, 17(1):80. DOI:10.1186/s12882-016-0283-x.
[32] KOVESDY C P, KOPPLE J D,KALANTAR-ZADEH K.Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease:reconciling low protein intake with nutritional therapy[J]. Am J Clin Nutr,2013,97(6):1163-1177.DOI:10.3945/ajcn.112.036418.
[33] BERNHARD J, BEAUFRERE B, LAVILLE M, et al. Adaptive response to a low-protein diet in predialysis chronic renal failure patients[J]. J Am Soc of Nephrol, 2001, 12(6):1249-1254.
[34] MILOVANOVA S Y, MILOVANOV Y S, TARANOVA M V,et al. Effects of keto/amino acids and a low-protein diet on the nutritional status of patients with stages 3B-4 chronic kidney disease[J]. Ter Arkh, 2017, 89(6):30-33. DOI:10.17116/terarkh201789630-33.
[35]张蜜蜜,赵艳,朱英莉.个体化低蛋白饮食干预对慢性肾脏病患者肾功能的影响[J].中国医学科学院学报,2015, 37(4):384-391.DOI:10.3881/j.issn.1000-503X.2015.04.003.ZHANG M M, ZHAO Y, ZHU Y L.Effect of individualized lowprotein diet intervention on renal function of patients with chronic kidney disease[J]. Acta Academiae Medicinae Sinicae,2015, 37(4):384-391. DOI:10.3881/j.issn. 1000-503X.2015.04.003.
[36]邵春海,朱云,刘景芳,等.低蛋白饮食对3/4期慢性肾脏病患者肾功能及营养状况的影响[J].中华临床营养杂志,2009, 17(6):339-342. DOI:10.3760/cma.j.issn.1674-635X.2009.06.006.SHAO C H, ZHU Y, LIU J F, et al. Influences of low-protein diet on renal function and nutritional status in patients with stage3/4 chronic kidney diseases[J]. Chinese Journal of Clinical Nutrition, 2009, 17(6):339-342. DOI:10.3760/cma.j.issn. 1674-635X.2009.06.006.
[37] KALANTAR-ZADEH K, FOUQUE D.Nutritional management of chronic kidney disease[J]. N Engl J Med, 2017, 377(18):1765-1776. DOI:10.1056/NEJMra 1700312.
[38] GARNEATA L,STANCU A,DRAGOMIR D, et al.Ketoanalogue-supplemented vegetarian very low-protein diet and CKD progression[J]. J Am Soc Nephrol, 2016, 27(7):2164-2176. DOI:10.1681/ASN.2015040369.
[39]Kidney Disease:Improving Global Outcomes(KDIGO)CKD Work Group.KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease[J]. Kidney Int Suppl, 2013, 3(1):1-150. DOI:10.1038/kisup.2012.73.
[40] SHAH B V, PATEL Z M.Role of low protein diet in management of different stages of chronic kidney disease-practical aspects[J].BMC Nephrol, 2016, 17(1):156.DOI:10.1186/s12882-016-0360-1.
[41] GARNEATA L, STANCU A, DRAGOMIR D, et al.Ketoanalogue-supplemented vegetarian very low-protein diet and CKD progression[J].J Am Soc Nephrol,2016,27(7):2164-2176. DOI:10.1681/ASN.2015040369.
[42] WU H L,SUNG J M,KAO M D,et al. Nonprotein calorie supplement improves adherence to low-protein diet and exerts beneficial responses on renal function in chronic kidney disease[J].J Ren Nutr, 2013, 23(4):271-276. DOI:10.1053/j.jm.2012.09.003.
[43] KOPPLE J D.National Kidney Foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure[J]. Am J Kidney Dis, 2001, 37(1 Suppl 2):S66-70.
[44] MARONI B J, STEINMAN T I, MITCH W E.A method for estimating nitrogen intake of patients with chronic renal failure[J]. Kidney Int,1985,27(1):58-65.
[45]李丽丽,徐天华,徐爽,等. Maroni公式评估膳食蛋白质摄入在慢性肾脏病患者的应用[J].临床肾脏病杂志,2017, 17(9):549-552. DOI:10.3969/j.issn.1671-2390.2017.09.008.LI L L,XU T H, XU S, et al. Validation of Maroni formula for estimating diet protein intake of patients with chronic kidney disease[J]. Journal of Clinical Nephrology,2017,17(9):549-552. DOI:10.3969/j.issn. 1671-2390.2017.09.008.
[46] D'ALESSANDRO C, ROSSI A, INNOCENTI M, et al. Dietary protein restriction for renal patients:don't forget protein-free foods[J]. J Ren Nutr, 2013, 23(5):367-371. DOI:10.1053/j.jrn.2012.12.006.
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