慢性腎臟疾病營養治療與食物選擇技巧

Nutritional management and food choices for patients with chronic kidney disease

10.6691/NSJ.202209_46(3).0002

黃孟娟(Meng-Chuan Huang)；羅培倫(Pei-Lun Lao)；林子琳(Tze-Lin Lin)；黃泰傑(Tai-Che Huang)；蘇怡如(Yi-Ru Su)；邱怡文(Yi-Wein Chu)

慢性腎臟疾病 ； 低蛋白飲食 ； 營養治療 ； 磷 ； 鉀 ； chronic kidney disease ； low-protein diet ； medical nutrition therapy ； phosphorus ； potassium

台灣營養學會雜誌

46卷3期（2022 / 09 / 01）

90 - 100

英文

慢性腎臟疾病（chronic kidney disease, CKD）已成為全球公共衛生的負擔，而營養治療為減緩CKD進展的策略。本報告根據科學文獻說明CKD病人整體營養需求和食物選擇。證據顯示蛋白質限制對延緩CKD的疾病進展有益；而根據K/DOQI 2020年指引，CKD第3期到第5期蛋白質建議範圍為0.6-0.8g/kg/day，同時保持適量熱量攝入對維持氮平衡和避免營養不良也至關重要。脂肪和碳水化合物建議可依病人合併症（如糖尿病或血脂異常）進行調整。高磷血症和高鉀血症都與CKD死亡風險有顯著相關，而本文也根據台灣食品成分數據庫估算了包括加工食品在內的六大類食物的蛋白質、磷和磷／蛋白質比率，應用數據來討論低磷食物選擇及食物製備技巧，以限制磷的攝入量。文中亦針對低鉀（300mg/份）水果也進行鉀的估算，可提供低鉀飲食營養教育之客觀參考。此外，針對鈉和水溶性維生素需求也提供近期建議。本報告總結CKD營養治療原則及衛教實務內容，期待能有助於醫療人員獲得CKD營養衛教的臨床知識與衛教技能。

Chronic kidney disease (CKD) is a global public health burden, for which nutritional therapy as a strategy to slow CKD progression has been recommended. In this report, we describe the nutrient needs and food choices of patients with stages of CKD as suggested by evidence-based scientific literature. A consistent body of evidence suggests that it is beneficial to restrict protein intake to slow the progression of CKD. K/DOQI clinical practice guidelines for nutrition updated in year 2020 recommend protein intakes at levels equaling 0.6-0.8 g/kg/day for patients with CKD stages 3 to 5, depending on etiology while maintaining adequate energy intake to maintain nitrogen balance and avoid malnutrition. The provision of fat and carbohydrate should be adjusted based on underlying comorbidities, such as diabetes or dyslipidemia. Hyperphosphatemia and hyperkalemia in CKD have both been associated with an increased risk of mortality. In this report, we estimate protein, phosphorus, and phosphorus/protein ratios for food items belonging to various food groups including processed foods using a food composition database in Taiwan. We then use our estimates when discussing modifications of food choices and food preparation methods to limit the dietary intake of phosphorus. For the control of potassium levels, we identified fruits containing low-(<200mg/serving), medium- (200-300mg/serving) and high- (>300mg/serving) levels of potassium for dietary reference. Sodium and water-soluble vitamin requirements are also described. This report summarizes key dietary components emphasized in the care of patients with CKD and addresses practical considerations in nutrition education, hoping to provide health practitioners with the clinical knowledge and skills they need to provide nutritional guidance to their patients with CKD.

1. 鐘秋鳳(Ciou-Fong Chung);程禎嫻(Jhen-Sian Cheng)(2024)。照顧一位慢性腎病高齡獨居者出院安置之護理經驗。彰化護理。31(3)。152-164。