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对于阶段1-3慢性肾脏病的饮食危险因素的管理

时间:2016-04-28 09:39来源:www.liuxuelw.com 作者:留学论文网 点击:
身体健康的人理所当然地认为食品其烹饪,而不是它的生化值。
在某些情况下,然而,饮食也可批判性健康。慢性肾脏疾病的早期阶段的一般管理计划,大多数临床实践指南(日用消费品)建议,主要是基于发表的随机对照trials.1
表1.慢性肾脏病的分期
阶段描述GFR(mL / min的/1.73平方米)
1肾脏损害正常或升高≥90GFR
2轻度肾脏损害GFR下降60-89
3微跌GFR30-59
4严重降低的GFR15-29
5肾衰竭<15(或透析)
GFR:肾小球滤过率Healthy people rightly consider food for its culinary rather than its biochemical value. In some conditions, however, diet can also be critically to health. The general management plan for early stages of chronic kidney disease, recommended by most clinical practice guidelines (CPGs), is largely based on published randomized control trails.1
Table1. Staging of Chronic Kidney Disease
Stage Description GFR(mL/min/1.73m2)
1 Kidney damage with normal or increased GFR ≥90
2 Kidney damage with mild decreased GFR 60-89
3 Moderately Decreased GFR 30-59
4 Severely decreased GFR 15-29
5 Kidney failure <15 (or dialysis)
GFR: glomerular filtration rate
 
膳食风险因素适当管理可能导致消退或稳定了几十年的慢性肾脏疾病,特别是早期阶段(Stage1-3)由几个病例 - 对照建议studies.2To推迟发作和减少透析的频率,控制所述进气量蛋白,磷酸盐,脂肪酸acids3,维生素K4是必要的。
临床和实验观察表明,蛋白质和磷的早期饮食限制是延迟在大多数慢性肾脏疾病patients21进展和肾损伤的一种有效手段。动物研究的建议,限制饮食中蛋白质可能会减缓或absord在肾小球滤过率稳步下降,这些引起了很大的兴趣来自于人类最近的研究管理潜在的进行性肾功能disease.5,6大量证据表明,日粮中蛋白质的这一限制能延缓由于至少19 century.7的后半部分通过减少升高的肾小球毛细血管压和超滤8 .Dietary蛋白治疗慢性肾脏疾病的进展已被推荐为慢性肾疾病的治疗Suitable management of dietary risk factors may lead to regression or stabilization for many decades of chronic kidney disease especially early stages (Stage1-3) suggested by several case-control studies.2To postpone onset and reduce the frequency of dialysis, control the intake amount of protein, phosphate, fatty acids3, vitamin K4 are necessary.
 
Clinical and experimental observations have suggested that early dietary restriction of protein and phosphorus was an effective means of delaying the progression and renal injury in most chronic renal disease patients21. Suggestions from animal studies that restricting dietary protein might slow or absord a steady fall in the glomerular filtration rate aroused much interest in those managing potentially progressive renal disease.5,6Substantial evidence from recent studies in human suggests that restriction of dietary protein can retard the progression of chronic renal disease by reducing elevated glomerular capillary pressure and hyperfiltration8 .Dietary protein therapy has been recommended for the treatment of chronic renal disease since at least the last half of the 19th century.7
The Modification of Diet in Renal Disease (MDRD) Study was the largest randomized clinical trial to test the hypothesis that protein restriction slows the progression of chronic renal disease.8In Study A (moderate renal disease, GFR 25 to 55 ml/min/1.73m2, mean [SD] serum creatinine 1.9 [0.5] mg/dl ) patients (n=585) were prescribed a usual (n=294) or low protein diet (n=291), containing either 1.3 or 0.58g/Kg/day protein respectively.The primary outcome measure was the rate of decline in GFR in low protein diet group and normal protein diet groupof moderate CKD patients. Researchers hypothesized that the beneficial effects of low protein diet would result in a slowing in the mean GFR decline by at least 30%.9 Upon completion of the study, over a 3-yr interval, the average rate of GFR decline in low protein diet group is 3.8ml/min per year.8After 3 years, the decline in GFR was only 1.2ml/min (10%) less (p=0.3) in the low protein group compared with the usual protein diet group. Thus, the intention-to-treat analysis did not demonstrate a beneficial effect of low protein diet. This mean GFR declines is slower than expected. However, the low protein diet has opposite short-term and long-term effects on the GFR decline rate. Patients assigned to the low protein diet group have a 1.6ml/min faster mean decline in GFR during the frist 4 months (P = 0.004), but a 1.1ml/min per year (28%) slower mean GFR decline thereafter (P = 0.009), compared to patients of usual protein diet group.8 The magnitude of the short-term effect is sufficient to negate the long-term beneficial effect.  (责任编辑:anne)
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