Nutritional management strategies in chronic kidney disease_West China Medical Journal

Authors：

CHEN Yi ¹ , LIU Yuan ² ,  SHI Yunying ³

1. Department of Nephrology, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

SHI Yunying, Email: yyshi@163.com

Keywords：

Chronic kidney disease; Nutrition management; Integration of doctors-nurses-therapists

DOI：

10.7507/1002-0179.202106091

Video：

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Chronic kidney disease (CKD) is a public health issue of global concern, and nutritional management of CKD can improve the nutritional status of patients and slow down the progression of the disease. However, nutrition management is a complex scientific issue, and there are few clinical practices of nutrition management in CKD, so there is an urgent need for a theoretical framework of nutrition management to guide the construction of a scientific and standardized program. This review will systematically describe the relationship between nutrition and kidney disease, sort out the current status of nutrition management in CKD in China, introduce the experience of CKD medical and nursing nutrition integration in West China Hospital of Sichuan University, and provide thoughts for further improvement of standardized scientific formulation of nutrition management strategy.

Citation： CHEN Yi, LIU Yuan, SHI Yunying. Nutritional management strategies in chronic kidney disease. West China Medical Journal, 2021, 36(7): 959-963. doi: 10.7507/1002-0179.202106091 Copy

1.	歐陽凌霞, 周攀, 陸海娜. 慢性腎臟病流行病學研究現狀. 國際移植與血液凈化雜志, 2012, 10(3): 1-3.
2.	Ene‐Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN‐KDDC): a cross‐sectional study. Lancet Glob Health, 2016, 4(5): e307-e319.
3.	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross‐sectional survey. Lancet, 2012, 379(9818): 815-822.
4.	史偉. 慢性腎臟病患者的營養管理. 中國中西醫結合學會腎臟疾病專業委員會 2018 年學術年會專題講座匯編. 重慶: 中國中西醫結合學會腎臟疾病專業委員會, 2018.
5.	Hensley MK. Historical perspective of nutrition in kidney disease//Byham-Gray LD, Chertow GM, Burrowes JD. Nutrition in Kidney Diseasepp. Totowa: Humana Press, 2008: 17-33.
6.	方仕, 麥海妍, 盧味, 等. 住院患者營養風險篩查及營養支持狀況. 中國公共衛生, 2010, 26(5): 574-575.
7.	Miao J, Liang R, Tian X, et al. Contributors to nutritional status in continuous ambulatory peritoneal dialysis as practised in Henan Province, China. Asia Pac J Clin Nutr, 2018, 27(2): 318-321.
8.	董捷, 范敏華, 齊惠敏, 等. 腹膜透析患者營養不良和蛋白質能量攝入不足的臨床影響因素分析. 中華醫學雜志, 2002, 82(1): 61-65.
9.	Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med, 2006, 144(1): 21-28.
10.	Tovar-Palacio C, Tovar AR, Torres N, et al. Proinflammatory gene expression and renal lipogenesis are modulated by dietary protein content in obese Zucker fa/fa rats. Am J Physiol Renal Physiol, 2011, 300(1): F263-F271.
11.	李春國, 周飛. 營養管理與慢性腎臟病的關系研究進展. 中國實用醫藥, 2020, 15(12): 184-187.
12.	Fouque D, Aparicio M. Eleven reasons to control the protein intake of patients with chronic kidney disease. Nat Clin Prace Nephrol, 2007, 3(7): 383-392.
13.	Schwingshackl L, Hoffmann G. Comparison of high vs. normal/low protein diets on renal function in subjects without chronic kidney disease: a systematic review and meta-analysis. PLoS One, 2014, 9(5): e97656.
14.	Ash S, Campbell KL, Bogard J, et al. Nutrition prescription to achieve positive outcomes in chronic kidney disease: a systematic review. Nutrients, 2014, 6(1): 416-451.
15.	Hahn D, Hodson EM, Fouque D. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev, 2018, 10(10): CD001892.
16.	中華人民共和國國家衛生和計劃生育委員會. WS/T557-2017 慢性腎臟病患者膳食指導, 2017.
17.	Johnson DW, Atai E, Chan M, et al. KHA-CARI guideline: early chronic kidney disease: detection, prevention and management. Nephrology (Carlton), 2013, 18(5): 340-350.
18.	Bellizzi V, Di Iorio BR, De Nicola L, et al. Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kidney Int, 2007, 71(3): 245-251.
19.	Kuhlmann MK, Schmidt F, K?hler H. High protein/energy vs. standard protein/energy nutritional regimen in the treatment of malnourished hemodialysis patients. Miner Electrolyte Metab, 1999, 25(4/5/6): 306-310.
20.	Kopple JD, Levey AS, Greene T, et al. Effect of dietary protein restriction on nutritional status in the modification of diet in renal disease study. Kidney Int, 1997, 52(3): 778-791.
21.	Herselman MG, Albertse EC, Lombard CJ, et al. Supplemented low-protein diets--are they superior in chronic renal failure?. S Afr Med J, 1995, 85(5): 361-365.
22.	Garneata L, Stancu A, Dragomir D, et al. Ketoanalogue-supplemented vegetarian very low-protein diet and CKD progression. J Am Soc Nephrol, 2016, 27(7): 2164-2176.
23.	中國醫師協會腎臟內科醫師分會, 中國中西醫結合學會腎臟疾病專業委員會營養治療指南專家協作組. 中國慢性腎臟病營養治療臨床實踐指南(2021 版). 中華醫學雜志, 2021, 101(8): 539-559.
24.	Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis, 2001, 37(1 Suppl 2): S66-S70.
25.	Ikizler TA, Cano NJ, Franch H, et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int, 2013, 84(6): 1096-1107.
26.	de Boer IH, Rue TC, Kestenbaum B. Serum phosphorus concentrations in the third National Health and Nutrition Examination Survey (NHANES Ⅲ). Am J Kidney Dis, 2009, 53(3): 399-407.
27.	Sullivan C, Sayre SS, Leon JB, et al. Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA, 2009, 301(6): 629-635.
28.	Borghi L, Meschi T, Amato F, et al. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5‐year randomized prospective study. J Urol, 1996, 155(3): 839-843.
29.	O’Donnell M, Mente A, Yusuf S. Sodi-umintake and cardiovascular health. Circ Res, 2015, 116(6): 1046-1057.
30.	Palmer BF, Clegg DJ. Achieving the benefits of a high-potassium, paleolithic diet, without the toxicity. Mayo Clin Proc, 2016, 91(4): 496-508.
31.	Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: a report from an ADA consensus conference. Am J Kidney Dis, 2014, 64(4): 510-533.
32.	KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis, 2007, 49(2 Suppl 2): S12-S154.
33.	Kalantar-Zadeh K, Fouque D. Nutritional management of chronic kidney disease. N Engl J Med, 2017, 377(18): 1765-1776.
34.	He J, Mills KT, Appel LJ, et al. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol, 2016, 27(4): 1202-1212.
35.	Selamet U, Tighiouart H, Sarnak MJ, et al. Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: the modification of diet in renal disease study. Kidney Int, 2016, 89(1): 176-184.
36.	Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl, 2013, 3(1): 1-150.
37.	國家腎臟疾病臨床醫學研究中心. 中國慢性腎臟病礦物質和骨異常診治指南概要. 腎臟病與透析腎移植雜志, 2019, 28(1): 52-57.
38.	陳艷鴻, 曲黔, 陳麗珠, 等. 飲食指導模式對提高慢性腎臟病患者低蛋白飲食治療依從性研究. 現代診斷與治療, 2013, 24(4): 723-726.
39.	魯新紅, 路潛. 臨床營養護理. 護士進修雜志, 2007, 22(21): 1925-1926.
40.	唐雯, 魯新紅, 汪濤. 慢性腎臟病飲食營養管理. 中國實用內科雜志, 2010, 30(6): 516-517.
41.	魯新紅, 陸潛, 汪濤. 慢性腎衰竭病人的飲食現狀調查. 護理研究, 2008, 22(28): 2560-2562.
42.	賈文娟. 慢性腎臟病 3-4 期住院患者的營養狀況調查及相關因素分析. 杭州: 浙江大學, 2011.
43.	Qureshi AR, Alvestrand A, Divino-Filho JC, et al. Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. J Am Soc Nephrol, 2002, 13(Suppl 1): S28-S36.
44.	de Mutsert R, Grootendorst DC, Axelsson J, et al. Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transplant, 2008, 23(9): 2957-2964.

1. 歐陽凌霞, 周攀, 陸海娜. 慢性腎臟病流行病學研究現狀. 國際移植與血液凈化雜志, 2012, 10(3): 1-3.
2. Ene‐Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN‐KDDC): a cross‐sectional study. Lancet Glob Health, 2016, 4(5): e307-e319.
3. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross‐sectional survey. Lancet, 2012, 379(9818): 815-822.
4. 史偉. 慢性腎臟病患者的營養管理. 中國中西醫結合學會腎臟疾病專業委員會 2018 年學術年會專題講座匯編. 重慶: 中國中西醫結合學會腎臟疾病專業委員會, 2018.
5. Hensley MK. Historical perspective of nutrition in kidney disease//Byham-Gray LD, Chertow GM, Burrowes JD. Nutrition in Kidney Diseasepp. Totowa: Humana Press, 2008: 17-33.
6. 方仕, 麥海妍, 盧味, 等. 住院患者營養風險篩查及營養支持狀況. 中國公共衛生, 2010, 26(5): 574-575.
7. Miao J, Liang R, Tian X, et al. Contributors to nutritional status in continuous ambulatory peritoneal dialysis as practised in Henan Province, China. Asia Pac J Clin Nutr, 2018, 27(2): 318-321.
8. 董捷, 范敏華, 齊惠敏, 等. 腹膜透析患者營養不良和蛋白質能量攝入不足的臨床影響因素分析. 中華醫學雜志, 2002, 82(1): 61-65.
9. Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med, 2006, 144(1): 21-28.
10. Tovar-Palacio C, Tovar AR, Torres N, et al. Proinflammatory gene expression and renal lipogenesis are modulated by dietary protein content in obese Zucker fa/fa rats. Am J Physiol Renal Physiol, 2011, 300(1): F263-F271.
11. 李春國, 周飛. 營養管理與慢性腎臟病的關系研究進展. 中國實用醫藥, 2020, 15(12): 184-187.
12. Fouque D, Aparicio M. Eleven reasons to control the protein intake of patients with chronic kidney disease. Nat Clin Prace Nephrol, 2007, 3(7): 383-392.
13. Schwingshackl L, Hoffmann G. Comparison of high vs. normal/low protein diets on renal function in subjects without chronic kidney disease: a systematic review and meta-analysis. PLoS One, 2014, 9(5): e97656.
14. Ash S, Campbell KL, Bogard J, et al. Nutrition prescription to achieve positive outcomes in chronic kidney disease: a systematic review. Nutrients, 2014, 6(1): 416-451.
15. Hahn D, Hodson EM, Fouque D. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev, 2018, 10(10): CD001892.
16. 中華人民共和國國家衛生和計劃生育委員會. WS/T557-2017 慢性腎臟病患者膳食指導, 2017.
17. Johnson DW, Atai E, Chan M, et al. KHA-CARI guideline: early chronic kidney disease: detection, prevention and management. Nephrology (Carlton), 2013, 18(5): 340-350.
18. Bellizzi V, Di Iorio BR, De Nicola L, et al. Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kidney Int, 2007, 71(3): 245-251.
19. Kuhlmann MK, Schmidt F, K?hler H. High protein/energy vs. standard protein/energy nutritional regimen in the treatment of malnourished hemodialysis patients. Miner Electrolyte Metab, 1999, 25(4/5/6): 306-310.
20. Kopple JD, Levey AS, Greene T, et al. Effect of dietary protein restriction on nutritional status in the modification of diet in renal disease study. Kidney Int, 1997, 52(3): 778-791.
21. Herselman MG, Albertse EC, Lombard CJ, et al. Supplemented low-protein diets--are they superior in chronic renal failure?. S Afr Med J, 1995, 85(5): 361-365.
22. Garneata L, Stancu A, Dragomir D, et al. Ketoanalogue-supplemented vegetarian very low-protein diet and CKD progression. J Am Soc Nephrol, 2016, 27(7): 2164-2176.
23. 中國醫師協會腎臟內科醫師分會, 中國中西醫結合學會腎臟疾病專業委員會營養治療指南專家協作組. 中國慢性腎臟病營養治療臨床實踐指南(2021 版). 中華醫學雜志, 2021, 101(8): 539-559.
24. Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis, 2001, 37(1 Suppl 2): S66-S70.
25. Ikizler TA, Cano NJ, Franch H, et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int, 2013, 84(6): 1096-1107.
26. de Boer IH, Rue TC, Kestenbaum B. Serum phosphorus concentrations in the third National Health and Nutrition Examination Survey (NHANES Ⅲ). Am J Kidney Dis, 2009, 53(3): 399-407.
27. Sullivan C, Sayre SS, Leon JB, et al. Effect of food additives on hyperphosphatemia among patients with end-stage renal disease: a randomized controlled trial. JAMA, 2009, 301(6): 629-635.
28. Borghi L, Meschi T, Amato F, et al. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5‐year randomized prospective study. J Urol, 1996, 155(3): 839-843.
29. O’Donnell M, Mente A, Yusuf S. Sodi-umintake and cardiovascular health. Circ Res, 2015, 116(6): 1046-1057.
30. Palmer BF, Clegg DJ. Achieving the benefits of a high-potassium, paleolithic diet, without the toxicity. Mayo Clin Proc, 2016, 91(4): 496-508.
31. Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: a report from an ADA consensus conference. Am J Kidney Dis, 2014, 64(4): 510-533.
32. KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis, 2007, 49(2 Suppl 2): S12-S154.
33. Kalantar-Zadeh K, Fouque D. Nutritional management of chronic kidney disease. N Engl J Med, 2017, 377(18): 1765-1776.
34. He J, Mills KT, Appel LJ, et al. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol, 2016, 27(4): 1202-1212.
35. Selamet U, Tighiouart H, Sarnak MJ, et al. Relationship of dietary phosphate intake with risk of end-stage renal disease and mortality in chronic kidney disease stages 3-5: the modification of diet in renal disease study. Kidney Int, 2016, 89(1): 176-184.
36. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl, 2013, 3(1): 1-150.
37. 國家腎臟疾病臨床醫學研究中心. 中國慢性腎臟病礦物質和骨異常診治指南概要. 腎臟病與透析腎移植雜志, 2019, 28(1): 52-57.
38. 陳艷鴻, 曲黔, 陳麗珠, 等. 飲食指導模式對提高慢性腎臟病患者低蛋白飲食治療依從性研究. 現代診斷與治療, 2013, 24(4): 723-726.
39. 魯新紅, 路潛. 臨床營養護理. 護士進修雜志, 2007, 22(21): 1925-1926.
40. 唐雯, 魯新紅, 汪濤. 慢性腎臟病飲食營養管理. 中國實用內科雜志, 2010, 30(6): 516-517.
41. 魯新紅, 陸潛, 汪濤. 慢性腎衰竭病人的飲食現狀調查. 護理研究, 2008, 22(28): 2560-2562.
42. 賈文娟. 慢性腎臟病 3-4 期住院患者的營養狀況調查及相關因素分析. 杭州: 浙江大學, 2011.
43. Qureshi AR, Alvestrand A, Divino-Filho JC, et al. Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. J Am Soc Nephrol, 2002, 13(Suppl 1): S28-S36.
44. de Mutsert R, Grootendorst DC, Axelsson J, et al. Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transplant, 2008, 23(9): 2957-2964.

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