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Том 21 №3 2019 год - Нефрология и диализ

Диета с ограничением белка: история, лечение преддиализных больных, влияние на режим заместительной почечной терапии. Обзор литературы


Ермоленко В.М.

DOI: 10.28996/2618-9801-2019-3-281-291

Аннотация: Диета с ограничением суточного потребления белка, изначально предложенная для улучшения качества жизни больных с нарушением функции почек, в настоящее время стала элементом нефропротективной терапии, позволяющей не только уменьшить интоксикацию, обусловленную как белковыми метаболитами (водород, гуанидины, фенол, индоксил сульфат, микроглобулин, конечные продукты гликирования и т.д.), так и другими уремическими токсинами, в норме выводимыми с мочой, но и замедлить прогрессирование уремии и отдалить начало заместительной почечной терапии. Использование малобелковой диеты в период ввода в диализную программу позволяет избегать рекомендуемого рядом авторов интенсивного диализа, что сохраняет на более длительный срок остаточную функцию почек, профилактируя в известной мере развитие осложнений, обусловленных уремическими токсинами и гипергидратацией. У больных старше 75 лет малобелковая диета с добавлением эссенциальных аминокислот и кетоаналогов делает возможным проведение разового или двукратного в неделю диализа, а у мотивированных пациентов - продолжить консервативную терапию, несмотря на крайне низкие значения скорости клубочковой фильтрации. Качество жизни пациентов на малобелковой диете с аминокислотными добавками не хуже, чем на диализе, а частота госпитализаций из-за различных осложнений, в частности, обусловленных проблемами сосудистого доступа, существенной меньше. Длительное, в течение нескольких лет пребывание на малобелковой диете с обязательным применением эссенциальных аминокислот и кетоаналогов не влияет отрицательно на азотистый баланс, не ухудшает нутритивный статус и антропометрические показатели пациентов, не вызывает снижения в крови уровня общего белка и альбумина и крайне редко осложняется белково-энергетической недостаточностью, не влияя на конечные исходы лечения. Основной причиной перевода больных на заместительную почечную терапию являются гипергидратация или гиперкалиемия. Малобелковая диета позволяет разнообразить не только режимы гемодиализа, но и постоянного амбулаторного перитонеального диализа. Различные аспекты применения малобелковой диеты представлены в предлагаемом обзоре.

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Ключевые слова: малобелковая диета, хроническая почечная недостаточность, гемодиализ, перитонеальный диализ, low-protein diet, chronic renal disease, hemodialysis, peritoneal dialysis

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