References

nid

Нефрология и диализ

Nephrology and Dialysis

1680-44222618-9801

Российское диализное общество

nid-1331

Research Article

ОБЗОРЫ И ЛЕКЦИИ

REVIEWS AND LECTURES

Нутритивный статус у больных с хронической почечной недостаточностью (Обзор литературы)

Nutritional status in patients with chronic renal failure Review

Шутов

Е. В.

Shutov

E. V.

noemail@neicon.ru

Адрес для переписки: 125101, г. Москва, 2-й Боткинский пр-д, д. 5, ГКБ им. Боткина, отделение диализаRussian Federation

2008

19062025

103-4199207

2025

Шутов Е.В.

Shutov E.V.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://journal.nephro.ru/jour/article/view/1331

Количество больных с терминальной стадией хронической почечной недостаточности (ТХПН) в мире прогрессивно увеличивается. Так, за последние 5 лет, число больных, находящихся на заместительной почечной терапии (ЗПТ), увеличилось более чем на 25%, и на данный момент насчитывает более 2 миллионов человек. При этом наибольшее количество больных, получающих ЗПТ, отмечено в Японии: 2230 пациентов на 1 млн жителей, и в США: 1650 больных на 1 млн. жителей. В то же время, наибольший рост числа пациентов, находящихся на ЗПТ зафиксирован в развивающихся странах (в том числе в России) - свыше 50% за 5 лет. Одной из важнейших проблем у этой категории больных является недостаточность питания, которая в значительной степени определяет их заболеваемость и летальность [45]. Необходимо отметить, что нарушения нутриционного статуса встречаются у 20-50% больных в додиализной стадии ХПН [13, 80] и еще чаще у больных на диализе: 10-70% [84].

хроническая почечная недостаточностьнутритивный статусбелково-энергетическая недостаточностьиндекс массы тела

References1

Дудко М.Ю., Шутов Е.В., Капитанов Е.Н. Устройство для измерения электрического импеданса в частях тела. Патент на изобретение № 2242165 от 17.07.2003.

Дудко М.Ю., Шутов Е.В., Капитанов Е.Н., Ермоленко В.М. Определение «количественной нормы» объемов жидкостных секторов организма с помощью сегментарной импедансометрии» Эфферентная терапия 2004; 10; 4: 25-30.

Капитанов Е.Н., Чернышева, Шутов Е.В. Практическая реализация оценки объема клеточной жидкости методом ПБИА. Диагностика и лечение нарушений регуляции сердечно-сосудистой системы», 9-я научно-практическая конференция. М., 2007: 132-140.

Шутов Е.В. Постоянный амбулаторный перитонеальный диализ в лечении терминальной уремии. Дисс. докт. мед. наук. М., 2000: 237.

Abbott K.C., Glanton C.W., Trespalacios F.C. et al. Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney Int 2004; 65: 597-605.

Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 1996; 7: 198-207.

Aparicio M., Chanvenu P., Combe C. Low protein diets and outcome of renal patients. J Nephrol 2001; 14: 433-439.

Aparicio M., Chauveau P., de Precigout V., Bouchet J.-L., Lasseur C., Combe C. Nutrition and outcome on renal replacement therapy of patients with chronic renal failure treated by a supplemented very low protein diet. J Am Soc Nephrol 2000; 11: 719-727.

Ballmer P.E., Mc Nurlan M.A., Hulter H.N. et al. Chronic metabolic acidosis decreases albumin synthesis and induces negative nitrogen balance in humans. J Clin Invest 1995; 95: 39-45.

Beddhu S., Samore M.H., Roberts M.S., Stoddard G.J., Ramkumar N., Pappas L.M., Cheung A.K. Impact of timing of initiation of dialysis on mortality. J Am Soc Nephrol 2003; 14: 2305-2312.

Blum W.F., Ranke M.B., Kietzmann K., Tonshoff B., Mehls O. Growth hormone resistance and inhibition of somatomedin activity by excess of insulin-like growth factor binding protein in uraemia. Pediatr Nephrol 1991; 5: 539-544.

Bonneux L., Reusser M. Overweight and mortality risk: no connection between overweight in middle and older age groups and increased mortality. Ned Tijdschr Geneeskd 2007; 15: 2764-2769.

Gansevoort R.T., De Zeeuw D., De Jong P.E. Additive antiproteinuric effect of ACE inhibition and a low-protein diet in human renal disease. Nephrol Dial Transpl 1995; 10: 497-504.

Caravaca F., Arrobas M., Pizarro J. et al. Uremic symptoms, nutritional status and renal function in pre-dialysis end-stage renal failure patients. Nephrol Dial Tranaspalant 2001; 16: 776-782.

Cecchin F., Ittoop O., Sinha M.K., Caro J.F. Insulin resistance in uremia: Insulin receptor kinase activity in liver and muscle from chronic uremic rats. Am J Physiol 1988; 254: 394-401.

Chauveau P., Barthe N., Rigalleau V., Ozenne S., Castaing F., Delclaux C., de Precigout V., Combe C., Aparicio M. Outcome of nutritional status and body composition of uremic patients on a very low protein diet. Am J Kid Dis 1999; 34: 500-507.

Cheng L., Tang W., Wang T. Strong association between volume status and nutritional status in peritoneal dialysis patients. Am J Kidney Dis 2005; 45: 891-902.

Coresh J., Walser M., Hill S. Survival on dialysis among chronic renal failure patients treated with a supplemented low-protein diet before dialysis. J Am Soc Nephrol 1995; 6: 1379-1385.

Degoulet P., Legrain M., Reach I. et al. Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. Nephron 1982; 31: 103-110.

Detsky A.S., McLaughlin J.R., Baker J.P., Johnston N., Whittaker S., Mendelson R.A., Jeejeebhoy K.N. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr 1987; 11: 8-13.

Durnin J.V., Womersley J. Body fat assessed from total body density and its estimation from skinfold thickness: Measurements on 481 men and women aged from 16 to 72 years. Br J Nutr 1974; 32: 77-97.

EBPG guideline on nutrition. Nephrol Dial Transplant 2007; 22 (Suppl. 2): 45-87.

Enia G., Sicuso C., Alati G., Zoccali C. Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant 1993; 8: 1094-1098.

Feldman A.M., Combes A., Wagner D. et al. The role of tumor necrosis factor in the pathophysiology of heart failure. J Am Coll Cardiol 2000; 35: 537-544.

Fleischmann E., Teal N., Dudley J., May W., Bower J.D., Salahudeen A.K. Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int 1999; 55: 1560-1567.

Foley R.N., Parfrey P.S., Sarnak M.J. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 1998; 9: 16-23.

Fontan M.P., Rodrigues-Carmona A., Cordido F. et al. Hyperleptinemia in uremic patients undergoing conservative management, peritoneal dialysis and hemodialysis: A comparative analysis. Am J Kidney Dis 1999; 34: 824-831.

Fouque D., Vennegoor M., Piet Ter Wee et al. EBPG Guideline on Nutrition Nephrology Dialysis Transplantation 2007; 22 (2): 45-87.

Goldstein D.J. Assessment of nutritional status in renal disease. In. Mitch W.E., Klahr S., eds. Handbook of nutrition and the kidney, 3rd ed. Philadelphia 1998: 46-86.

Grabowski D.C., Ellis J.E. High body mass index does not predict mortality in older people: analysis of the Longitudinal Study of Aging. J Am Geriatr Soc 2001; 49: 968-979.

Gutierrez A., Begstrom J., Alvestrand A. Hemodialysis-associated protein catabolism with and without glucose in the dialysis fluid. Kidney Int 1994; 46: 814-822.

Herbelin A., Urena P., Nguyen A.T. et al. Elevated circulating levels of interleukin -6 in patients with chronic renal failure. Kidney Int 1991; 39: 954-960.

Horwich T., Hamilton M., Fonarow D. B-type natriuretic peptide levels in obese patients with advanced heart failure. J Am Coll Cardiol 2006; 3: 47 (1): 85-90.

Horwich T.B., Fonarow G.C., Hamilton M.A., MacLellan W.R., Woo M.A., Tillisch J.H. The relationship between obesity and mortality in patients with heart failure. J Am Coll Cardiol 2001; 38: 789-795.

Hotamisligil G.S., Peraldi P., Budavari A., Ellis R., White M.F., Spiegelman B.M. IRS-1-mediated inhibition of insulin receptor tyrosine kinase activity in TNF-a- and obesity-induced insulin resistance. Science 1996; 271: 665-668 [Abstract].

Hylander B., Barkeling B., Rossner S. Eating behavior in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am Kidney Dis 1992; 20: 592-597.

Ikizler T., Flakoll P., Parker R. et al. Amino acid and albumin losses during hemodialysis. Kiney Int 1994; 46: 830-837.

James L., Bailey, Bin Zheng et al. Chronic Kidney Disease Causes Defects in Signaling through the Insulin Receptor Substrate/Phosphatidylinositol 3-Kinase/Akt Pathway: Implications for Muscle Atrophy. J Am Soc Nephrol 2006; 17: 1388-1394.

Jones C., Akbani H., Croft D. et al. The relationship between serum albumin and hydration status in hemodialysis patients. J Ren Nutr 2002; 12: 209-212.

Kalantar-Zadeh K., Block G., Humphreys M.H. et al. A low, rather than a high, total plasma homocysteine is an indicator of poor outcome in hemodialysis patients. J Am Soc Nephrol 2004; 15: 442-453.

Kalantar-Zadeh K., Block G., Humphreys M.H. et al. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003; 63:793-808.

Kalantar-Zadeh K., Abbot K., Salahudeen K. et al. Survival advantages of obesity in dialysis patients. Am J Clin Nutr 2005; 81 (3): 543-554.

Kano N., Fiaccadori E., Tesinsky P. et al. ESPEN Guidelines on Enteral Nutrition Adult Renal Failure. Clinical Nutrition 2006; 25: 295-310.

Klahr S., Levey A.S., Beck G.L. et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal failure. N Engl J Med 1994; 330: 878-884.

Kopple J.D. Nutritional status as a predictor of morbidity and mortality in maintenance dialysis patients. Asaio J 1997; 43 (3): 246-250.

Kopple J., Greene T., Chumlea W. et al. Relationship between nutritional status and the glomerular filtration rate: Results from the MDRD study. Kidney Int 2000; 57: 1688-1703.

Kopple J.D., Levey A.S., Green T. et al. Effect of dietary protein restriction of nutritional status in the Modification of Diet in Renal Disease (MDRD) Study. Kidney Int 1997; 52: 778-791.

Kovesdy C., Anderson J. Reverse epidemiology in patients with chronic kidney disease who are not yet on dialysis. Semin Dial 2007; 20 (6): 566-569.

Leavey S.F., Strawderman R.L., Jones C.A., Port F.K., Held P.J. Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis 1998; 31: 997-1006.

Levey A.S., Adler S., Caggiula A.W., England B.K., Greene T., Hunsicker L.G., Kusek J.W., Rogers N.L., Teschan P.E. MDRD Study Group: Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study. Am J Kidney Dis 1996; 27: 652-663.

Maroni B.J., Staffeld C., Young V.R., Manatunga A., Tom K. Mechanisms permitting nephrotic patients to achieve nitrogen equilibrium with a protein-restricted diet. J Clin Invest 1997; 99: 2479-2487.

Memoli B., Postiglione L., Cianciaruso B. et al. Role of different dialysis membranes in the release of interleukin-6 soluble receptor in uremic patients. Kidney Int 2000; 58: 417-424.

Mitch W.E., Goldberg A.L. Mechanisms of muscle wasting. The role of the ubiquitin-proteasome pathway. N Engl J Med 1996; 335: 1897-1905.

Mitch W.E., Price S.R. Transcription factors and muscle cahexia: have we defined a therapeutic target? Lancet 2001; 357: 734-735.

Mitch W.E., Walser N. Nutritional therapy of the uremic patient. In the Kidney, ed. By Breuner B.M., Philadelphia, W.B. Sanders 2000; 2298-2340.

Mitch W.E. Requirements for protein, calories, and fat in the predialysis patients. In: Handbook of Nutrition and the Kidney, edited by Mitch W.E., Klahr S., Philadelphia, Lippincott, Williams and Wilkins 2002: 144-165.

Mohamed-Ali V., Goodrick S., Bulmer K. et al. Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo. Am J Physiol 1999; 277: 971-975.

Moxley M., Bell N., Wagle S. et al. Parathyroid hormone stimulation of glucose and urea production in isolated liver cells. Am J Physiol 1974; 227: 1058-1061.

Neyra R., Chen K., Sun M. et al. Increased resting energy expenditure in patients with end-stage renal disease. J Parenter Enteral Nutr 2003; 27: 36-42.

Niebauer J., Volk H., Kemp M. et al. Endotoxin and immune activation in chronic heart failure a prospective cohort study. Lancet 1999; 353: 1838-1842.

Nishizawa Y., Shoji T., Ishimura E. et al. Paradox of risk factors for cardiovascular mortality in uremia: is a higher cholesterol level better for atherosclerosis in uremia? Am J Kidney Dis 2001; 38: 4-7.

Odamaki M., Furuya R., Yoneyama T. et al. Association of the serum leptin concentration with weight loss in chronic hemodialysis patients. Am J Kidney Dis 1999; 33: 361-368.

Patel V.B., Topol E.J. The pathogenesis and spectrum of acute coronary syndromes: from plaque formation to thrombosis. Cleve Clin J Med 1999; 66: 561-571.

Pollock C., Ibels L., Zhu F. et al. Protein intake in renal disease. J Am Soc Nephrol 1997; 8: 777-783.

Powell D.R., Rosenfeld R.G., Hintz R.L. Effects of growth hormone therapy and malnutrition on the growth of rats with renal failure. Pediatr Nephrol 1988; 2: 425-430.

Rauchhaus M., Coats A.J., Anker S.D. The endotoxin-lipoprotein hypothesis. Lancet 2000; 356: 930-933.

Rauchhaus M., Koloczek V., Volk H. et al. Inflammatory cytokines and the possible immunological role for lipoproteins in chronic heart failure. Int J Cardiol 2000; 76: 125-133.

Reaich D., Channon S., Scrimgeour C. et al. Correction of acidosis in humans with CRF decreases protein degradation and amino acid oxidation. Am J Physiol 1993; 265: 230-235.

Remuzzi G., Bertani T. Pathophysiology of progressive nephropathies. N Engl J Med 1998; 339: 1448-1456.

Romero-Corral A., Montori V., Somers U. et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 2006; 368 (9536): 666-678.

Ross R. Atherosclerosis an inflammatory disease. N Engl J Med 1999; 340: 115-126.

Rui L., Aguirre V., Kim J.K. et al. Insulin/IGF-1 and TNF-a stimulate phosphorylation of IRS-1 at inhibitory Ser307 via distinct pathways. J Clin Invest 2001; 107: 181-189.

Salahudeen A.K., Fleischmann E.H., Bower J.D. et al. Underweight rather than overweight is associated with higher prevalence of hypertension: BP vs. BMI in hemodialysis population. Nephrol Dial Transplant 2004; 19: 427-432.

Salahudeen A.K. Obesity and survival on dialysis. Am J Kidney Dis 2003; 41: 925-932.

Schrier R.W., Abraham W.T. Hormones and hemodynamics in heart failure. N Engl J Med 1999; 341: 577-585.

Sherwin R.S., Bastl C., Finkelstein F. et al. Influence of uremia and hemodialysis on the turnover and metabolic effects of glucagons. J Clin Invest 1976; 57: 722-731.

Snyder J.J., Foley R.N., Gilbertson D.T. et al. Body size and outcomes on peritoneal dialysis in the United States. Kidney Int 2003; 64: 1838-1844.

Stenvinkel P., Heimburger O., Lindholm B. et al. Are there two types of malnutritient in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA-sindrome). Nephrol Dial Transpl 2000; 15: 953-960.

Stenvinkel P., Heimburger O., Lonnqvist F. Serum leptin concentrations correlate to plasma insulin concentrations independent of body fat content in chronic renal failure Nephrol Dial Transplant 1997; 12: 1321-1325.

Stenvinkel P., Heimburger O., Paultre F. et al. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 1999; 55: 1899-1911.

Stenvinkel P., Lindholm B., Lonqvist F. et al. Increases in serum leptin levels during peritoneal dialysis are associated with inflammation and decrease in lean body mass. J Am Soc Nephrol 2000; 11: 1303-1309.

Sugimoto T., Kikkawa R., Haneda M., Shigeta Y. Effect of dietary protein restriction on proteinuria in non-insulin-dependent diabetic patients with nephropathy. J Nutr Sci Vitaminol 1996; 37: 87-92.

Tielemans C., Husson C., Schurmans T. et al. Effects of ultrapure and non-sterile dialysate on the inflammatory response during in vitro hemodialysis. Kidney Int 1996; 49: 236-243.

Toigo G., Aparacio M., Attman P. et al. Espen consensus on nutritional treatment of patients with renal insufficiency. Clin Nutr 2000; 19: 197-207.

Traynor J.P., Simpson K., Geddes C.C., Deighan C.J., Fox J.G. Early initiation of dialysis fails to prolong survival in patients with end-stage renal failure. J Am Soc Nephrol 2002; 13: 2125-2132.

United States Renal Data System. U.S. Department of Public Health and Human Services, Public Health Service Bethesda, MD: National Institutes of Health. 1998.

Walser M., Hill S. Сan renal replacement be differed by a supplemented very-low protein diet? J Am Soc Nephrol 1999; 10: 110-116.

Walser M., Mitch W.E., Maroni B.J., Kopple J.D. Should protein be restricted in predialysis patients? Kidney Int 1999; 55: 771-777.

Wang X., Hu Z., Hu J. et al. Insulin Resistance Accelerates Muscle Protein Degradation: Activation of the Ubiquitin-Proteasome Pathway by Defects in Muscle Cell Signaling. Endocrinology 2006; 147; 9: 4160-4168.

Weber M.A., Neutel J.M., Smith D.H. Contrasting clinical properties and exercise responses in obese and lean hypertensive patients. J Am Coll Card 2001; 37: 169-174.

Zager P.G., Nikolic J., Brown R.H. et al. "U" curve association of blood pressure and mortality in hemodialysis patients. Medical Directors of Dialysis Clinic, Inc. Kidney Int 1998; 54: 561-569.

The authors declare that there are no conflicts of interest present.