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首页> 美国卫生研究院文献>Nutrients >The Diet and Haemodialysis Dyad: Three Eras Four Open Questions and Four Paradoxes. A Narrative Review Towards a Personalized Patient-Centered Approach
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The Diet and Haemodialysis Dyad: Three Eras Four Open Questions and Four Paradoxes. A Narrative Review Towards a Personalized Patient-Centered Approach

机译：饮食和血液透析研究：三个时代四个悬而未决的问题和四个悖论。叙事回顾以个性化以患者为中心的方法

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The history of dialysis and diet can be viewed as a series of battles waged against potential threats to patients’ lives. In the early years of dialysis, potassium was identified as “the killer”, and the lists patients were given of forbidden foods included most plant-derived nourishment. As soon as dialysis became more efficient and survival increased, hyperphosphatemia, was identified as the enemy, generating an even longer list of banned aliments. Conversely, the “third era” finds us combating protein-energy wasting. This review discusses four questions and four paradoxes, regarding the diet-dialysis dyad: are the “magic numbers” of nutritional requirements (calories: 30–35 kcal/kg; proteins > 1.2 g/kg) still valid? Are the guidelines based on the metabolic needs of patients on “conventional” thrice-weekly bicarbonate dialysis applicable to different dialysis schedules, including daily dialysis or haemodiafiltration? The quantity of phosphate and potassium contained in processed and preserved foods may be significantly different from those in untreated foods: what are we eating? Is malnutrition one condition or a combination of conditions? The paradoxes: obesity is associated with higher survival in dialysis, losing weight is associated with mortality, but high BMI is a contraindication for kidney transplantation; it is difficult to limit phosphate intake when a patient is on a high-protein diet, such as the ones usually prescribed on dialysis; low serum albumin is associated with low dialysis efficiency and reduced survival, but on haemodiafiltration, high efficiency is coupled with albumin losses; banning plant derived food may limit consumption of “vascular healthy” food in a vulnerable population. Tailored approaches and agreed practices are needed so that we can identify attainable goals and pursue them in our fragile haemodialysis populations.
机译：透析和饮食的历史可以看作是针对患者生命潜在威胁的一系列斗争。在透析的早期，钾被确定为“杀手”，并且给患者名单上的禁忌食物包括大多数植物来源的营养。一旦透析变得更加有效并且存活率增加，高磷血症就被确定为敌人，从而产生了更长的禁用饮食清单。相反，“第三时代”使我们与蛋白质能量浪费作斗争。这篇评论讨论了关于饮食透析二元组的四个问题和四个悖论：营养需求（卡路里：30–35 kcal / kg；蛋白质> 1.2 g / kg）的“魔术数字”仍然有效吗？基于患者在“常规”每周三次的碳酸氢盐透析中的代谢需求的指南是否适用于不同的透析时间表，包括每日透析或血液透析滤过？加工和腌制食品中所含的磷酸盐和钾的数量可能与未经处理的食品中的含量明显不同：我们在吃什么？营养不良是一种状况还是多种状况的结合？悖论：肥胖与透析中较高的存活率相关，体重减轻与死亡率相关，但高BMI是肾移植的禁忌症；当患者采用高蛋白饮食（如通常在透析中规定的饮食）时，很难限制磷酸盐的摄入量；血清白蛋白低与透析效率低和存活率降低有关，但是在血液透析滤过中，高效率与白蛋白损失有关。禁止植物衍生食品可能会限制脆弱人群中“血管健康”食品的消费。需要量身定制的方法和商定的做法，以便我们可以确定可实现的目标，并在我们脆弱的血液透析人群中追求这些目标。

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