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.	欧阳凌霞, 周攀, 陆海娜. 慢性肾脏病流行病学研究现状. 国际移植与血液净化杂志, 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.	史伟. 慢性肾脏病患者的营养管理. 中国中西医结合学会肾脏疾病专业委员会 2018 年学术年会专题讲座汇编. 重庆: 中国中西医结合学会肾脏疾病专业委员会, 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, 麦海妍, 卢味, 等. 住院患者营养风险筛查及营养支持状况. 中国公共卫生, 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, 范敏华, 齐惠敏, 等. 腹膜透析患者营养不良和蛋白质能量摄入不足的临床影响因素分析. 中华医学杂志, 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.	李春国, 周飞. 营养管理与慢性肾脏病的关系研究进展. 中国实用医药, 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.	中华人民共和国国家卫生和计划生育委员会. WS/T557-2017 慢性肾脏病患者膳食指导, 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, Köhler 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.	中国医师协会肾脏内科医师分会, 中国中西医结合学会肾脏疾病专业委员会营养治疗指南专家协作组. 中国慢性肾脏病营养治疗临床实践指南(2021 版). 中华医学杂志, 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.	国家肾脏疾病临床医学研究中心. 中国慢性肾脏病矿物质和骨异常诊治指南概要. 肾脏病与透析肾移植杂志, 2019, 28(1): 52-57.
38.	陈艳鸿, 曲黔, 陈丽珠, 等. 饮食指导模式对提高慢性肾脏病患者低蛋白饮食治疗依从性研究. 现代诊断与治疗, 2013, 24(4): 723-726.
39.	鲁新红, 路潜. 临床营养护理. 护士进修杂志, 2007, 22(21): 1925-1926.
40.	唐雯, 鲁新红, 汪涛. 慢性肾脏病饮食营养管理. 中国实用内科杂志, 2010, 30(6): 516-517.
41.	鲁新红, 陆潜, 汪涛. 慢性肾衰竭病人的饮食现状调查. 护理研究, 2008, 22(28): 2560-2562.
42.	贾文娟. 慢性肾脏病 3-4 期住院患者的营养状况调查及相关因素分析. 杭州: 浙江大学, 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. 欧阳凌霞, 周攀, 陆海娜. 慢性肾脏病流行病学研究现状. 国际移植与血液净化杂志, 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. 史伟. 慢性肾脏病患者的营养管理. 中国中西医结合学会肾脏疾病专业委员会 2018 年学术年会专题讲座汇编. 重庆: 中国中西医结合学会肾脏疾病专业委员会, 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, 麦海妍, 卢味, 等. 住院患者营养风险筛查及营养支持状况. 中国公共卫生, 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, 范敏华, 齐惠敏, 等. 腹膜透析患者营养不良和蛋白质能量摄入不足的临床影响因素分析. 中华医学杂志, 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. 李春国, 周飞. 营养管理与慢性肾脏病的关系研究进展. 中国实用医药, 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. 中华人民共和国国家卫生和计划生育委员会. WS/T557-2017 慢性肾脏病患者膳食指导, 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, Köhler 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. 中国医师协会肾脏内科医师分会, 中国中西医结合学会肾脏疾病专业委员会营养治疗指南专家协作组. 中国慢性肾脏病营养治疗临床实践指南(2021 版). 中华医学杂志, 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. 国家肾脏疾病临床医学研究中心. 中国慢性肾脏病矿物质和骨异常诊治指南概要. 肾脏病与透析肾移植杂志, 2019, 28(1): 52-57.
38. 陈艳鸿, 曲黔, 陈丽珠, 等. 饮食指导模式对提高慢性肾脏病患者低蛋白饮食治疗依从性研究. 现代诊断与治疗, 2013, 24(4): 723-726.
39. 鲁新红, 路潜. 临床营养护理. 护士进修杂志, 2007, 22(21): 1925-1926.
40. 唐雯, 鲁新红, 汪涛. 慢性肾脏病饮食营养管理. 中国实用内科杂志, 2010, 30(6): 516-517.
41. 鲁新红, 陆潜, 汪涛. 慢性肾衰竭病人的饮食现状调查. 护理研究, 2008, 22(28): 2560-2562.
42. 贾文娟. 慢性肾脏病 3-4 期住院患者的营养状况调查及相关因素分析. 杭州: 浙江大学, 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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