<< Вернуться к списку статей журнала

Том 2 №1,2 2000 год - Нефрология и диализ

Нутриционный статус больных на перитонеальном диализе

Земченков А.Ю. Райхельсон К.Л. Эйдельштейн В.А.

Аннотация: Больные, страдающие хронической почечной недостаточностью (ХПН), уже с ее ранних стадий начинают спонтанно ограничивать потребление белков. Это, в частности, было продемонстрировано в проспективном исследовании Ikizler и соавт. [31], основанном на наблюдении 90 пациентов. Авторы отметили, что при клубочковой фильтрации 50 мл/мин и более потребление белков составляет 1,0 г/кг веса/сут, но оно уменьшается до 0,54 г/кг веса/сут, если клубочковая филь-трация снижается до 10 мл/мин и ниже, причем этот эффект не провоцируется диетическими ограничениями. Подобные же результаты были представлены McCusker и соавт. [46]. В группе из 680 больных, наблюдавшихся в рамках совместного Канадско-Американского исследования, именуемого CAN-USA, показано, что при снижении клиренса креатинина с уровня, превышающего 50 мл/мин, до уровня ниже 25 мл/мин скорость катаболизма белка (СКБ), определенная по кинетике мочевины, уменьшается с 1,1 до 0,9 г/кг/сут.

Для цитирования: Земченков А.Ю., Райхельсон К.Л., Эйдельштейн В.А. Нутриционный статус больных на перитонеальном диализе. Нефрология и диализ. 2000. 2(1,2):85-94. doi:

Весь текст

Ключевые слова: ХПН, лечение ПАПД, особенности питания, нутриционный статус, белково-энергетическая недостаточность, прогностическая значимость

Список литературы:

1. Барановский А.Ю., Назаренко Л.И., Райхельсон К.Л. Применение соевых продуктов в клинической диетологии. Пособие для врачей. М., 1999; 38.
2. Кучер А.Г. Проблемы лечебного питания у больных с хронической почечной недостаточностью. Нефрология, 1997; 1; 1: 39-46.
3. Barrett B.J, Parfrey P.S., Morgan J. et al. Prediction of early death in end-stage renal disease patients starting dialysis. Am. J. Kidney Dis. 1997; 29 (2): 214-222.
4. Bergstrom J., Wang T., Lindholm B. Factors contributing to catabolism in end-stage renal disease patients. Miner. Electrolyte. Metab. 1998; 24 (1): 92-101.
5. Bhatla B., Moore H., Emerson P. et al. Lean body mass estimation by creatinine kinetics, bioimpedance, and dual energy x-ray absorptiometry in patients on continuous ambulatory peritoneal dialysis. 1995; ASAIO J. 41 (3): M442-M446.
6. Bilbrey G.L., Cohen T.L. Identification and treatment of protein-caloric malnutrition in chronic hemodialysis patients. Dial. Transplant 1989; 18 (4): 669-677.
7. Blake P.G., Flowerdew G., Blake R.M., Oreopoulos D.G. Serum albumin in patients on continuous ambulatory peritoneal dialysis: Predictors and correlations with outcomes. J. Am. Soc. Nephrol. 1993; 3: 1501-1507.
8. Blondin J., Ryan C. Nutritional Status: A Continuous Quality Improvement Approach. Am. J. Kidney Dis. 1999; 33 (1): 198-202.
9. Borah M.F., Schoenfeld P.Y., Gotch F.A. et al. Nitrogen balance during intermittent dialysis therapy of uremia. Kidney Int. 1978; 14 (5): 491-500.
10. Churchill D.N., Taylor D.W., Keshaviah P.R. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomes. J. Am. Soc. Nephrol. 1996; 7: 198-207.
11. Churchill D.N., Thorpe K.E., Nolph K.D. et al. Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J. Am. Soc. Nephrol. 1998; 9 (7): 1285-1292.
12. Cianciaruso B., Brunori G., Kopple J.D., Traverso G. Cross-sectional comparison of malnutrition in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am. J. Kidney Dis. 1995; 26 (3): 475-486.
13. Cueto-Manzano A.M., Espinosa A., Hernandez A., Correa-Rotter R. Peritoneal transport kinetics correlate with serum albumin but not the overall nutritional status in CAPD patients. Am. J. Kidney Dis. 1997; 30 (2): 229-236.
14. Detsky A.S., McLaughlin J.R., Baker J.P. What is Subjective Global Assessment of nutritional status? J. PEN. 1987; 11 (1): 8-13.
15. Druml W. Malnutrition is bad, but how can one detect malnutrition? Nephrol. Dial. Transplant. 1997; 12 (11): 2225-2227.
16. Durnin J.V., G.A., Womersley J. Body fat assessed from total body density and it estimation from scinfold thickness: measurements on 481men and women aged 18 to 72 years. Br. J. Nutr. 1974; 32 (1): 77-97.
17. Enia G., Sicuso C., Alati G., Zoccali C. Subjective Global Assessment of nutrition in dialysis patients. Nephrol. Dial. Transplant. 1993; 12: 1094-1098.
18. Fahal H., Bell G.M., Bone J.M., Edwards R.H. Physiological abnormalities of skeletal muscle in dialysis patient. Nephrol. Dial. Transplant. 1997; 12 (1): 119-127.
19. Flanigan M. J., Rocco M.V., Frankenfield D. et al. 1997 Peritoneal Dialysis-Core Indicators Study: Dialysis Adequacy and Nutritional Indicators Report. Am. J. Kidney Dis. 1999; 33 (6): E3 1-12.
20. Gokal R., Harty J. Are there limits for CAPD? Adequacy and nutritional considerations. Perit. Dial. Int. 1996; 16: 437-441.
21. Goldstein D.J. Assessment of nutritional status in Renal Disease. In: Handbook of nutrition and the kidney. Eds. W.E.Mitch, S.Klarh. Philadelphia. New-York. Lepincott Raven. 1998; 45-86.
22. Guarneri G., Toido G., Situlin R. et al. The assesment of nutritional status in chronically uremic patient. in low protein diet in renal patients. Ed. by Gretz N., Giovannetti S., Strauch M. Contr. Nephrol. 1989; 72: 73-103.
23. Harty J., Boulton H., Faragher B. The influence of small so-lute clearance on dietary protein intake in continuous ambulatory peritoneal dialysis patients: a methodologic analysis based on cross-sectional and prospective studies. Am. J. Kidney Dis. 1996; 28 (4): 553-60.
24. Harty J., Boulton H., Venning M., Gokal R. The impact of increasing dialysis volume on adequacy targets: A prospective study. J. Am. Soc. Nephrol. 1997; 8 (8): 1304-1310.
25. Harty J., Faragher B., Venning M., Gokal R. Urea kinetic modeling exaggerates the relationship between nutrition and dialysis in CAPD patients. (The hazards of cross-sectional analysis). Perit. Dial. Int., 1995, 15 (2): 105-109.
26. Harty J.C., Boulton H., Curwell J. et al. The normalized protein catabolic rate is a flawed marker of nutrition in CAPD patients. Kidney Int. 1994; 45 (1): 103-109.
27. Наrvey К.B., Blumenkrantz M.J., Levine S.E., Blackburn G.L. Nutritional assessment and treatment of chronical renal failure. Am. J. Clin. Nutr. 1980; 33 (7): 1586-1597.
28. Held P.J., Port F.K, Turenne M.N. et al. Continuous ambulatory peritoneal dialysis and hemodialysis: Comparison of patient mortality with adjustment for comorbid conditions. J. Am. Soc. Nephrol. 2:328, 1991.
29. Heymsfield S.B., McMoney C., Stevens V., Smith J. Muscle mass: reliable of energy malnutrition severity and outcome. Am. J. Clin. Nutr. 1982; 35 (5): 1192-1199.
30. Ikizler T.A. Biochemical markers: clinical aspects. J. Ren. Nutr. 1997; 7 (2): 61-64.
31. Ikizler T.A., Greene T., Schluchter M.D. et al. Spontaneous dietary protein intake during progression of chronical renal failure. J. Am. Soc. Nephrol. 1995; 6 (5): 1386-1391.
32. Ikizler T.A., Hakim R.M. Nutrition in end-stage renal disease. Kidney Int. 1996; 50 (2): 343-357.
33. Jones M.R. Serum albumin and survival in CAPD patients: the implication of concentration trends over time. Nephrol. Dial. Transplant. 1997; 12 (3): 554-558.
34. Jones M.R., Gehr T.W., Burkart J.M., Hamburger R.J. Replacement of amino acid and protein losses with 1.1% amino acid peritoneal dialysis solution. Perit. Dial. Int. 1998; 18 (2): 210-216.
35. Kang D.H., Yoon K.I., Choi K.B. et al. Relationship of peritoneal membrane transport characteristics to the nutritional status in CAPD patients. Nephrol. Dial.Transplant. 1999; 14 (7): 1715-1722.
36. Kasiske B.L., Lakatua J.D., Ma J.Z., Louis T.A. A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am. J. Kidney Dis. 1998; 31 (6): 954-961.
37. Kaysen G.A., Stevenson F.T., Depner T.A. Determinants of albumin concentration in hemodialysis patients. Am. J. Kidney Dis. 1997; 29 (5): 658-668.
38. Keshaviah P.R., Nolph K.D., Moore H.L. et al. Lean body mass estimation by creatinine kinetics. J. Am. Soc. Nephrol. 1994; 4 (7): 1475-1485.
39. Keshaviah P.R., Nolph K.D. Protein catabolic rate calculations in CAPD patients. ASAIO Trans. 1991; 37: M400-M402.
40. Kopple J.D., Jones M.R., Keshaviah P.R. et al. A proposed glossary for dialysis kinetics. Am. J. Kidney Dis. 1995; 26 (6): 963-981.
41. Lindholm B., Bergstrom J. Nutritional Requirements of Peritoneal Dialysis Patients. The Textbook of Peritoneal Dialysis. Ed. by Gokal R., Nolf K.D. Dordrecht: Klewer Academic Publishers. 1994; 443-472.
42. Lindsay R.M., Spanner E., Heidenheim R.P. et al. Which comes first, Kt/V or PCR-chicken or egg? Kidney Int. Suppl 1992; 38: S32-S36.
43. Locatelli F., Del Vecchio L. How long can dialysis be postponed by low protein diet and ACE inhibitors? Nephrol. Dial. Transplant. 1999; 14 (6): 1360-1364.
44. Maiorca R., Brunori G., Zubani R. et al. Predictive value of dialysis adequacy and nutritional indices for mortality and morbidity in CAPD and HD patients. A longitudinal study. Nephrol. Dial. Transplant. 1995; 10 (12): 2295-2305.
45. Malhotra D., Tzamalouskas A.H., Murata G.H. et al. Serum albumin in continuous ambulatory peritoneal dialysis: its predictors and relation to urea clearance. Kidney Int. 1996; 50 (1): 243-249.
46. McCusker F.X., Teehan B.P., Thorpe K.E. et al. How much peritoneal dialysis is required for the maintenance of a good nutritional state? Canada-USA (CANUSA) Peritoneal Dialysis Study Group. Kidney Int. Suppl. 1996; 56: S56-61.
47. Mitch W.E., Maroni B.J. Factors causing malnutrition in patients with chronic uremia. Am. J. Kidney Dis. 1999; 33 (1): 176-179.
48. Mitch W.E., Walser M. A proposed mechanism for reduced creatinine excretion in severe chronic renal failure. Nephron. 1978; 21 (5): 248-254.
49. Modern Nutrition in Health and Disease. Ed. by Shils M.E., Olson J.A., Williams S.M. and Williams. 1994; 348 p.
50. Nelson E.E., Hong C.D., Pesce A.L. et al. Anthropometric norms for the dialysis population. Am. J. Kidney Dis. 1990; 16 (1): 32-37.
51. NKF-DOQI Clinical Practice Guidelines for Peritoneal Dialysis Adequacy. Am. J. Kidney Dis. 1997; 30 (suppl 2): S67-S136.
52. Spiegel D.M., Breyer J.A. Serum albumin: A predictor of long-term outcome in peritoneal dialysis patients. Am. J. Kidney Dis. 1994; 23 (2): 283-285.
53. Stein A., Walls J. The correlation between Kt/V and protein catabolic rate-a self-fulfilling prophecy. Nephrol. Dial. Transplant. 1994; 9 (7): 743-745.
54. Teplan V., Mengerova O. An individualized supplemented diet in hemodialysis patients with malnutrition. J. Ren. Nutr. 1997; 7 (2): 73-76.
55. Torun B., Chew F. Protein-energy malnutrition. In Modern Nutrition in Health and Disease. Ed. by Shils M.E., Olson J.A., Shike M., 8th ed. Williams and Williams. 1994; 950-976.
56. Tzamaloukas A.H., Balaskas E.V., Voudiklari S. et al. Serum albumin in continuous peritoneal dialysis: absence of universal predictors. Adv Perit Dial. 1997; 13: 146-149.
57. Watson P.E., Watson I.D., Batt R.D. Total body water volumes for adult males and females estimated from simple anthropometric measurements. Am. J. Clin. Nutr. 1980; 33 (1): 27-39.
58. Yeun J.Y., Kaysen G.A. Acute phase proteins and peritoneal dialysate albumin loss are the main determinants of serum albumin in peritoneal dialysis patients. Am. J. Kidney Dis. 1997; 30 (6): 923-927.

Другие статьи по теме

• Проблемы лечения перитонитов, осложняющих хронический перитонеальный диализ
• Белково-энергетическая недостаточность у больных с терминальной стадией хронической почечной недостаточности, корригируемой различными видами заместительной терапии
• Две стороны одной медали: роль недостаточного и избыточного веса в патогенезе хронической болезни почек
• Особенности нутриционного статуса у пациентов с сахарным диабетом 2 типа, находящихся на программном гемодиализе