慢性肾脏病和低蛋白饮食.pptVIP

慢性腎臟病與低蛋白飲食Chronic Kidney Disease and Low Protein Diet 腎臟科 陳冠興 Factors Associated with Loss of Kidney Function in CKD Slow the progression of kidney disease Have been proven to be effective Strict glucose control in diabetes Strict blood pressure control ACEI or ARB Have been studied but inconclusive Dietary protein restriction Lipid-lowering therapy Partial correction of anemia Frequent causes of acute decline in GFR Volume depletion; contrast; NSAID; antimicrobial agents; ACEI/ARB; cyclosporine; obstruction uropathy… 什麼時候開始認為低蛋白飲食可能會延緩腎臟病的惡化 ? MDRD study 研究設計 Study A GFR 25-55 mL/min (mean SCr 1.9±0.5) Usual protein 1.3 g/kg/d; low protein diet 0.58 g/kg/d N=585 Study B GFR 13-24 mL/min (mean Scr 3.4±0.9) Low protein diet; very low protein diet N=255 論文發表 N Engl J Med 330: 877-884, 1994 J Am Soc Nephrol 7: 2616-2626, 1996 AJKD 27(5): 652-663, 1996 J Am Soc Nephrol 10: 2426-2439, 1999 Meta-Analysis of Low Protein Diet in Progression of CKD Cochrane systematic review and meta-analysis 如何確定病人是否有執行低蛋白飲食 ? Duplicate meal ash analysis 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 ? 何謂 Supplemented Very Low Protein Diet (SVLPD) ? Mechanisms of Protective Effects of LPD+KS in CKD * The Effects of Dietary Protein Restriction and Blood-Pressure Control on the Progression of Chronic Renal Disease Saulo Klahr, Andrew S. Levey, Gerald J. Beck, Arlene W. Caggiula, Lawrence Hunsicker, John W. Kusek, Gary Striker, for The Modification of Diet in Renal Disease Study Group* Number 13 ?? March 31, 1994 ?? Volume 330:877-884 .75 g/Kg/d .62 .62 - .68 .68 - .75 Fouque D, et al, Cochrane Database Syst Rev 2006; 19: CD001892. Duplicate meal ash analysis Dietary recall 24 hr urine collection for urea- N Good for research study Barrier Need accurate collection of duplicate meals by pat