慢性肾脏病门诊管理方案.pptVIP

CurrentUsesofDietaryTherapyforPatientswithFar-AdvancedCKD

NorioHanafusa,*?BereketTessemaLodebo,??andJoelD.Kopple?§|ClinJAmSocNephrol2017.doi:10.2215/CJNAbstractForseveraldecades,inquiryconcerningdietarytherapyfornondialyzedpatientswithCKDhasfocusedmainlyonitscapabilitytoretardprogressionofCKD.However,severalstudiespublishedinrecentyearsindicatethat,independentofwhetherdietcandelayprogressionofCKD,welldesignedlow-proteindietsmayprovideanumberofbenefitsforpeoplewithadvancedCKDwhoareclosetorequiringoractuallyinneedofRRT.Dietarytherapymaybothmaintaingoodnutritionalstatusandsafelydelaytheneedforchronicdialysisinsuchpatients,offeringthepossibilityofimprovingqualityoflifeandreducinghealthcarecosts.Withthegrowinginterestinincrementaldialysis,dietarytherapymayenablelowerdosesofdialysistobesafelyandeffectivelyused,evenasGFRcontinuestodecrease.SuchcombinationsofdietaryandincrementaldialysistherapymightslowtherateoflossofresidualGFR,possiblyreducemortalityinpatientswithadvancedCKD,improvequalityoflife,andalso,reducehealthcarecosts.Theamountofevidencethatsupportsthesepossibilitiesislimited,andmorewelldesigned,randomizedclinicaltrialsareclearlyindicated.***除了优质分离乳清蛋白和高能量外，圣悦健优蛋白能量粉根据透析患者营养要求的特殊性，设计了低钾低磷低钠配方，有利于透析患者控制血钾血磷和血压，强化维生素C、B6、叶酸、铁含量，有利于促进肠道铁的吸收，促进红细胞生成，改善肾性贫血。除此之外，添加了L-肉碱，L-肉碱可以降低炎症水平，促进脂质代谢，有利于提高心脏功能。钠含量58mg/100g，有利于血压的控制磷含量32mg/100g，有利于磷摄入量控制钾含量仅为155mg/100g，防止高血钾症L-肉碱：600mg/100g降低炎症水平、促进脂质代谢，从而提高透析患者心脏功能维生素B6：2.2mg/100g维生素C：100mg/g叶酸：4.4ug/100gVB6有效促进红细胞生成VC可以促进肠道铁的吸收叶酸可以提高同型半胱氨酸清除*慢性肾脏病管理方案

2018.4目录项目背景1项目意义2项目方案3项目实施4目录项目背景1项目意义2项目实施3项目实施4我国CKD流行病学调查结果1、ZhangL,etal.Lancet.20123;379(9818):815-8222、全国血液净化病例信息系统登记数据报告CNRDSCKD分期发病率预计人数1-5期10.80%1.2亿3期1.60%192万4期0.10%12万5期0.03%3.6万透析系统