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首页> 美国卫生研究院文献>Nutrients >Very Low-Protein Diet (VLPD) Reduces Metabolic Acidosis in Subjects with Chronic Kidney Disease: The Nutritional Light Signal of the Renal Acid Load
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Very Low-Protein Diet (VLPD) Reduces Metabolic Acidosis in Subjects with Chronic Kidney Disease: The Nutritional Light Signal of the Renal Acid Load

机译：超低蛋白饮食（VLPD）可减少患有慢性肾脏病的受试者的代谢性酸中毒：肾酸负荷的营养光信号

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Background: Metabolic acidosis is a common complication of chronic kidney disease; current guidelines recommend treatment with alkali if bicarbonate levels are lower than 22 mMol/L. In fact, recent studies have shown that an early administration of alkali reduces progression of CKD. The aim of the study is to evaluate the effect of fruit and vegetables to reduce the acid load in CKD. Methods: We conducted a case-control study in 146 patients who received sodium bicarbonate. Of these, 54 patients assumed very low-protein diet (VLPD) and 92 were controls (ratio 1:2). We calculated every three months the potential renal acid load (PRAL) and the net endogenous acid production (NEAP), inversely correlated with serum bicarbonate levels and representing the non-volatile acid load derived from nutrition. Un-paired T-test and Chi-square test were used to assess differences between study groups at baseline and study completion. Two-tailed probability values ≤0.05 were considered statistically significant. Results: At baseline, there were no statistical differences between the two groups regarding systolic blood pressure (SBP), diastolic blood pressure (DBP), protein and phosphate intake, urinary sodium, potassium, phosphate and urea nitrogen, NEAP, and PRAL. VLPD patients showed at 6 and 12 months a significant reduction of SBP (p < 0.0001), DBP (p < 0.001), plasma urea (p < 0.0001) protein intake (p < 0.0001), calcemia (p < 0.0001), phosphatemia (p < 0.0001), phosphate intake (p < 0.0001), urinary sodium (p < 0.0001), urinary potassium (p < 0.002), and urinary phosphate (p < 0.0001). NEAP and PRAL were significantly reduced in VLPD during follow-up. Conclusion: VLPD reduces intake of acids; nutritional therapy of CKD, that has always taken into consideration a lower protein, salt, and phosphate intake, should be adopted to correct metabolic acidosis, an important target in the treatment of CKD patients. We provide useful indications regarding acid load of food and drinks—the “acid load dietary traffic light”.
机译：背景：代谢性酸中毒是慢性肾脏疾病的常见并发症。当前的指南建议如果碳酸氢盐含量低于22 mMol / L，则使用碱进行处理。实际上，最近的研究表明，早期给予碱可降低CKD的进展。该研究的目的是评估水果和蔬菜对降低CKD中酸负荷的作用。方法：我们对146例接受碳酸氢钠治疗的患者进行了病例对照研究。在这些患者中，有54例患者接受了极低蛋白饮食（VLPD），而92例为对照（比率1：2）。我们每三个月计算一次潜在的肾脏酸负荷（PRAL）和净内源性酸产生（NEAP），与血清碳酸氢盐水平成反比，代表从营养中获取的非挥发性酸负荷。使用未配对的T检验和卡方检验评估基线和研究完成时研究组之间的差异。 ≤0.05的两尾概率值被认为具有统计学意义。结果：基线时，两组之间在收缩压（SBP），舒张压（DBP），蛋白质和磷酸盐摄入量，尿钠，钾，磷酸盐和尿素氮，NEAP和PRAL方面无统计学差异。 VLPD患者在6和12个月时显示出SBP（p <0.0001），DBP（p <0.001），血浆尿素（p <0.0001），蛋白质摄入（p <0.0001），血钙（p <0.0001），血磷症（ p <0.0001），磷酸盐摄入量（p <0.0001），尿钠（p <0.0001），尿钾（p <0.002）和尿磷（p <0.0001）。在随访期间，VLPD的NEAP和PRAL明显降低。结论：VLPD减少了酸的摄入。始终考虑降低蛋白质，盐和磷酸盐摄入量的CKD营养疗法应用于纠正代谢性酸中毒，这是CKD患者治疗的重要目标。我们提供有关食物和饮料酸负荷的有用指示-“酸负荷饮食交通信号灯”。

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