Kev noj zaub mov muaj protein ntauKev noj haus tuaj yeem ua rau muaj zog intraglomerular siab thiab glomerular hyperfiltration, uas nyob rau hauv lub sij hawm ntev tuaj yeem ua rau denovo lossis aggravating preexisting.mob raum mob(CKD). Yog li ntawd, anoj cov protein tsawg(LPD,

{{0}}.6 mus rau 0.8 g / kg / hnub) raug pom zoo rau kev tswj hwm ntawm CKD. Muaj pov thawj tias kev txwv tsis pub noj zaub mov kom txo tau qhov kev loj hlob ntawm CKD thiab retard qhov pib ntawm kev lim ntshav lossis pab txhawb kev lim ntshav ntxiv. LPD kuj tseem muaj txiaj ntsig zoo los tswj cov kab mob metabolic derangements hauv CKD xws li metabolic acidosis thiab hyperphosphatemia. Tsis ntev los no, lub cev loj hlob ntawm cov pov thawj tau tshwm sim los ntawm cov txiaj ntsig ntawm kev noj zaub mov muaj protein tsawg (PLADO), uas yog tsim los ntawm> 50 feem pua ​​​​ntawm cov nroj tsuag. PLADO suav hais tias yog pab tau rau kev txo lub nra ntawm uremic thiab cov teeb meem metabolic hauv CKD piv rau cov tsiaj protein ntau noj. Nws kuj tseem tuaj yeem ua rau muaj kev hloov pauv zoo hauv lub plab microbiome, uas tuaj yeem hloov kho cov tshuaj uremic toxin tiam nrog rau txo qis kev pheej hmoo ntawm cov hlab plawv. Kev txo qis ntawm cem quav hauv PLADO tuaj yeem txo qhov kev pheej hmoo ntawm hyperkalemia. Kev noj zaub mov kom sib npaug thiab tus kheej rau kev ua raws li LPD siv ntau qhov chaw cog qoob loo raws li cov neeg mob cov kev nyiam yuav tsum tau piav qhia txog kev saib xyuas zoo hauv CKD. Kev soj ntsuam kev noj zaub mov raws sijhawm raws li kev saib xyuas ntawm cov kws qhia noj zaub mov yuav tsum tau lees paub kom tsis txhob muaj cov protein-zog nkim.

Ntsiab lus: Lub raum insufficiency, mob ntev; Noj zaub mov, txwv tsis pub muaj protein; Glomerular hyperfiltration;Nroj tsuag-tseem ceeb noj cov protein tsawg; Protein-zog nkim zog

Yog xav paub ntxiv thov hu rau:joanna.jia@wecistanche.com

Cistanche tubulosa tiv thaiv kab mob raum, nyem qhov no kom tau txais cov qauv

Taw qhia

Muaj kev txhawj xeeb loj zuj zus thoob ntiaj teb txog qhov muaj peev xwm nce ntxiv hauv kev nthuav dav ntawmmob raum mob(CKD), tshwj xeeb tshaj yog nyob rau hauv Asia thiab suav nrog Kaus Lim Kauslim, uas muaj qhov tshwm sim ntau tshaj plaws ntawm cov kab mob raum kawg raws li United States Renal Data System (USRDS) cov ntaub ntawv [1]. Kev noj zaub mov kom zoo nrog rau cov kev pabcuam tshuaj uas tsim nyog yog qhov tseem ceeb ntawm kev tswj xyuas cov neeg mob CKD kom ruaj khovlub raum ua haujlwmthiab tiv thaiv lwm yam teeb meem hauv nruab nrog cev [2]. Txawm li cas los xij, tseem muaj kev tsis sib haum xeeb txog qee cov tswv yim kev noj haus, xws li tswj tus nqi thiab kev noj cov protein kom zoo hauv cov neeg mob CKD. Tsis tas li ntawd, cov lus pom zoo rau kev noj zaub mov tsis muaj protein ntau (LPD) yuav txawv ntawm cov theem ntawm CKD vim qhov sib txawv ntawm qhov kev pheej hmoo-rau-cov txiaj ntsig sib piv. Qhov kev tshuaj xyuas no yog tsom mus rau nephron-tiv thaiv lub luag haujlwm ntawm LPD hauv cov neeg mob CKD thiab nthuav qhia cov ntsiab lus ntawm cov txheej txheem kev kho mob tam sim no thiab kev txhawb nqa pov thawj rau kev tswj kev noj zaub mov hais txog tus nqi ntawm cov protein ntau hauv cov neeg mob CKD.

Tam sim noSTATUSOFCOV LUSPROTEINNYIAJTHIABKev txhawj xeebHAIS KIDNEYKev Noj Qab Haus Huv

Qhov tseem ceeb ntawm cov protein kom tsawg yog thawj zaug suav los them nyiaj rau txhua hnub uas yuav tsum tau nitrogen los ntawm cov protein degradation thiab nitrogen excretion. Qhov kwv yees qhov xav tau nruab nrab (EAR) rau kev noj cov protein hauv cov neeg laus tau pom tias yog {{0}}.46 txog 0.66 g / kg / hnub (grams ntawm cov protein ib kilogram ntawm lub cev qhov hnyav hauv ib hnub), uas sib haum rau tus nqi ntawm cov khoom noj protein yuav tsum tau kom tsis txhob muaj qhov tsis zoo nitrogen tshuav [3], thaum anoj proteinnoj tsawg npaum li {{0}}.46 g/kg/hnub yuav txaus kom tsis txhob muaj qhov tsis zoo nitrogen tshuav yog tias muab tag nrho cov amino acids tseem ceeb [4]. Cov kev pom zoo txhua hnub rau kev noj cov protein tau kwv yees li 0.8 g / kg / hnub kom ua tau raws li qhov yuav tsum tau muaj ntawm 97 feem pua ​​​​rau 98 feem pua ​​​​ntawm cov pejxeem (ob tus qauv sib txawv saum EAR) [5], uas tau dhau los ua qhov siab tshaj rau LPDs. Txawm hais tias feem ntau cov lus qhia txog kev noj haus rau cov neeg mob CKD pom zoo rau LPD, zoo li muaj qhov sib txawv tseem ceeb ntawm kev noj cov protein. Raws li kev tshawb fawb raws li National Health and Nutrition Examination Survey (NHANES) ntawm 2001 thiab 2008, ib tug neeg Asmeskas nruab nrab tau noj 1.3 mus rau 1.5 g / kg ntawm cov protein ib hnub, thiab cov protein ntau tshaj 1 g / kg / hnub txawm nyob rau hauv cov laus. > 75 xyoo lossis nrog rau lub raum tsis txaus, xws li CKD theem 4. Cov qauv kev noj haus hauv South Kauslim kuj tau hloov mus rau kev noj cov protein ntau dua. Ib tsab ntawv ceeb toom raws li Kore- Kev Tshawb Fawb Kev Noj Qab Haus Huv Hauv Tebchaws thiab Khoom Noj Khoom Noj (KNHANES) tau qhia txog kev noj cov protein ntau ntawm 250 feem pua ​​​​mus rau 300 feem pua ​​​​ntawm qhov xav tau nruab nrab ntawm cov neeg nyob nruab nrab ntawm 10 thiab 64 xyoo, uas yog piv rau NHANES cov ntaub ntawv [ 6]. Cov lus txhais rau qhov ntau ntawm cov protein kom tsawg yog cov ntsiab lus hauv Table 1 [7,8].

Kev nce hauv kev noj cov protein ntau tau ua rau muaj kev txhawj xeeb txoglub raum noj qab haus huv. Muaj ntau txoj kev tshawb fawb txog qhov cuam tshuam ntawm kev noj cov protein ntau ntawm covraum. Qhov teeb meem no tau kawm thawj zaug hauv kev sim tsiaj, uas pom tau tias cov zaub mov muaj protein ntau tau ua rau muaj kev nce qib hauv glomerular filtration rate (GFR) [9], nrog kev kwv yees qhov siab tshaj plaws GFR nce ze li 80 feem pua. Cov txiaj ntsig zoo sib xws tau pom hauv tib neeg kev tshawb fawb qhia tias kev noj zaub mov muaj protein ntau (cov protein muaj 25 feem pua ​​​​ntawm calories) nce kwv yees GFR (eGFR) los ntawm 3.8 mL / min / 1.73 m2 piv rau cov khoom noj muaj protein tsawg (cov protein muaj 15 feem pua ​​​​ntawm calories) tom qab 6 lub lis piam ntawm kev kho mob [10]. Glomerular hyperfiltration thaum kawg txhawb nqa mesangial cell signaling kom nce qib ntawm kev hloov pauv kev loj hlob-b (TGF-b), uas tom qab ntawd ua rau muaj kev loj hlob ntawm lub raum fibrosis [11]. Ntev-sawv glomerular hyperfiltration tshwm sim los ntawm kev noj cov protein ntau yuav ua rauraum puasthiab poob ntawmlub raum ua haujlwm, tshwj xeeb tshaj yog cov uas muaj CKD ua ntej. Hauv 11-xyoo kev soj ntsuam Kev Saib Xyuas Kev Noj Qab Haus Huv Kev Tshawb Fawb, txhua 10-g nce hauv cov protein kom tsawg tau cuam tshuam nrog kev ua phem ntawm eGFR ntawm −1.69 mL/min/1.73 m2 (95 feem pua ​​CI, −2.93 rau −0.45) ntawm cov poj niam uas muaj lub raum tsis txaus (txhais tau tias yog eGFR ntawm 55 txog 80 mL/min/1.73 m2) [12].

Kev noj zaub mov muaj protein ntau tuaj yeem ua rau apoptosis ntawm podocytes. Cov khoom noj muaj protein ntau, xws li cov nqaij siav thaum kub kub, muaj cov qib siab glycation kawg cov khoom (AGEs) [13], uas cuam tshuam cov protein degradation ua rau hauv qab daus membrane thickening thiab mesangial expansion hauv glomerulus ntawmmob ntshav qab zib raum[14]. Amino acid thiab kev kho mob ntshav qab zib siab tuaj yeem ua rau podocyte thiab mesangial cell voj voog ntes thiab apoptosisin vitr uao kev sim. Ntxiv mus, cov podocyte suav tau txo qis hauv cov nas mob ntshav qab zib tau noj cov zaub mov muaj protein ntau [15]. Qhov no pathogenic cov lus teb ntawm AGEs tuaj yeem kho nrog cov proinflammatory receptor rau AGE (RAGE) nthuav tawm ntawm cov hlwb glomerular [14]. RAGE activated signals culminating cellular o thiab tuag, thiab inhibition ntawm RAGE attenuated apoptosis thiab inflammatory cytokine ntau lawm tshwm sim los ntawm amino acid thiab kev kho mob ntshav qab zib hauv podocyte thiab mesangial hlwb [15]. Qhov tsis zoo ntawm podocytes rau AGEs yog accentuated hauv glomerular hypertrophy vim hais tias ib leeg podocyte yuav tsum npog thaj tsam loj dua [16]. Ua tau mechanisms ntawm kev noj zaub mov muaj protein ntau nyob raumob raumtau sau tseg hauv daim duab 1.

Cov txiaj ntsig ntawm cov khoom noj muaj protein tsawg

Ib qho LPD muaj ntau yam zoo hauv kev tswj hwm cov neeg mob CKD los ntawm kev txo cov khoom pov tseg nitrogen thiab txo lub raum ua haujlwm los ntawm kev txo qis hauv lub raum, uas muaj kev tiv thaiv lub raum, tshwj xeeb tshaj yog rau cov neeg uas muaj qhov txo qis hauv kev ua haujlwm nephrons. LPD kuj tseem ua rau muaj txiaj ntsig zoo hauv metabolic uas tuaj yeem khaws cialub raum ua haujlwmthiab pab tswj cov tsos mob uremic.

Cov txiaj ntsig ntawm cov khoom noj muaj protein tsawg ntawm PROTEINURIA

Glomerular hyperfiltration tshwm sim los ntawm kev noj zaub mov muaj protein ntau yog txuam nrog glomerular structural puas thiab nce siab ntawm cov glomeruli ntxiv, uas yuav ua rau muaj kev pheej hmoo ntawm cov proteinuria. Txawm hais tias qhov tseeb pathophysiology tsis tau piav qhia, kev noj cov protein ntau tau koom nrog hauv lub raum cov kua dej tso tawm ua haujlwm thiab tubular amino acid overload, ua rau vasodilation ntawm afferent glomerular arterioles. Cov kab mob paracrine thiab cov neeg nruab nrab cuam tshuam nrog glomerular hemodynamics, xws li insulin-zoo li kev loj hlob yam 1, prostanoids, nitric oxide, thiab renin-angiotensin-aldosterone system (RAAS), tau raug qhia kom koom nrog hauv cov lus teb no [17]. Ntxiv mus, nce proinflammatory cytokine noob qhia los ntawm kev noj zaub mov muaj protein ntau tuaj yeem cuam tshuam nrog cov qauv kev puas tsuaj thiab hyperfiltration los ntawm cov seem glomeruli [18]. Qhov txiaj ntsig ntawm kev noj zaub mov muaj protein ntau tau pom hauv kev kho mob kom muaj feem cuam tshuam nrog kev pheej hmoo ntawm albuminuria, piv rau cov qauv protein kom tsawg hauv ntau cov kev tshawb fawb soj ntsuam, txawm tias tom qab suav txog kev cuam tshuam ntawm cov teeb meem kev noj qab haus huv, comorbidities, anthropometric yam, kev coj noj coj ua ( Piv txwv li, kev siv lub cev, kev siv lub zog, kev haus luam yeeb), thiab keeb kwm tshuaj, txawm hais tias lwm cov kev tshawb fawb tau muab cov ntaub ntawv tsis sib xws uas qhia tias tsis muaj kev koom tes lossis koom nrog hauv cov neeg mob ntshav siab thiab ntshav qab zib. Hauv kev tshawb fawb nrog kev tsim qauv crossover ntawm cov neeg mob nephrotic syndrome piv cov qauv piv rau LPD lub sijhawm, kev txwv tsis pub muaj protein ntau tau pom tias ua rau kom nce txog li 2 0 feem pua ​​​​ntawm cov proteinuria hauv txhua tus neeg mob, uas txhawb nqa lub luag haujlwm zoo ntawm LPD ntawm proteinuria txawm tias tom qab txiav txim siab tias nws tau ua nyob rau hauv ib pawg me me nrog lub sijhawm cuam tshuam luv luv (2 lub lis piam) [19]. LPD kuj tseem cuam tshuam nrog kev tswj ntshav siab zoo dua, uas cuam tshuam nrog rau lub raum tau tshwm sim [20]. Hauv kev tshawb fawb ntawm cov neeg mob CKD IV thiab V, ib qho LPD heev ntxiv nrog keto analogs (SVLPD) ua rau txo qis ntshav siab li ntawm 10 feem pua ​​(143 ± 19/83 ± 10 txog 128 ± 16/78 ± 7 mmHg. ; p <0.001) [21]="" ib.="" cov="" teebmeem="" ntawm="" lpd="" ntawm="" lub="" raum="" physiology="" tau="" pom="" ntau="" qhov="" zoo="" sib="" xws="" rau="" cov="" raas="" inhibition,="" thiab="" kev="" sim="" kev="" tshawb="" fawb="" pom="" tau="" tias="" nws="" muaj="" cov="" nyhuv="" anti-proteinuric="" ntxiv="" nrog="" raas="" inhibition="" [17].="" hauv="" kev="" tshuaj="" xyuas="" tsis="" ntev="" los="" no="" los="" ntawm="" koppe="" thiab="" fouque="" [17],="" cov="" kws="" sau="" ntawv="" tau="" piav="" qhia="" txog="" lub="" peev="" xwm="" ntawm="" kev="" ua="" haujlwm="" thiab="" kev="" ua="" tau="" zoo="" ntawm="" lpd="" thiab="" raas="" inhibitors="" hauv="" ckd,="" nrog="" rau="" qhov="" tshwj="" xeeb="" ntawm="" cov="" qib="" phosphate,="" uremic="" toxin="" ntau="" lawm,="" acid="" load,="" thiab="" ntsev="" kom="" tsawg.="" yog="" li="" ntawd,="" kev="" kho="" mob="" ua="" ke="" nrog="" lpd="" thiab="" raas="" thaiv="" yuav="" raug="" lees="" paub="" kom="" ua="" tiav="" cov="" qib="" qis="" hauv="" cov="" zis="" thiab="" ntxiv="" kom="" txo="" tau="" qhov="" kev="" pheej="" hmoo="" ntawm="" ckd.="" tsis="" ntev="" los="" no,="" sodium-glucose="" cotransporter="" -2="" (sglt2)="" inhibitors="" kuj="" tau="" pom="" tias="" muaj="" kev="" tiv="" thaiv="" reno-tiv="" thaiv="" suav="" nrog="" txo="" qis="" albuminuria="" thiab="" txo="" qis="" ntawm="" lub="" raum="" ua="" haujlwm="" poob.="" nws="" tau="" pom="" zoo="" tias="" qhov="" kev="" tiv="" thaiv="" reno-tiv="" thaiv="" ntawm="" sglt2="" yog="" kho="" tau="" los="" ntawm="" glomerular="" hyperfiltration="" los="" ntawm="" kev="" txhim="" kho="" cov="" lus="" qhia="" ntawm="" tubule-glomerular,="" uas="" qhia="" cov="" txheej="" txheem="" tiv="" thaiv="" hauv="" lpd="" thiab="" raas="" blockade="" [22,23].="" cov="" kev="" tshawb="" fawb="" yav="" tom="" ntej="" yog="" xav="" tau="" los="" tshuaj="" xyuas="" seb="" puas="" muaj="" cov="" txiaj="" ntsig="" zoo="" sib="" xws="" yuav="" tshwm="" sim="" yog="" tias="" sglt2="" inhibitors="" tau="" muab="" nrog="" lpd="" thiab="" cov="" zaub="" mov="" tseem="" ceeb="">

Cov txiaj ntsig ntawm cov khoom noj muaj protein tsawg ntawm kev rov qab los ntawm CKD kev loj hlob thiab kev ncua ntawm DIALYSIS

Raws li lub raum yog lub luag hauj lwm rau lub excretion ntawm feem ntau cov protein degradation cov khoom, yuav muaj ib tug tsub zuj zuj ntawm cov byproducts, xws li p-cresyl sulfate, indoxyl sulfate, thiab trimethylamine oxide, nyob rau hauv cov neeg mob CKD [25], uas yuav ua rau muaj kev vam meej ntxiv. kev puas tsuaj ntawmlub raum ua haujlwm[26]. Txawm li cas los xij, Kev Hloov Kho Kev Noj Qab Haus Huv Hauv Lub Raum Kab Mob (MDRD) txoj kev tshawb fawb, kev sim loj tshaj plaws hauv cov neeg mob CKD rau hnub tim, ua tsis tiav qhov ua tau zoo ntawm LPD hauv kev thim rov qab CKD kev nce qib [27], Hloov chaw, nws tau qhia tias LPD tuaj yeem muaj kev cuam tshuam tsis zoo hauv kev tswj hwm ntawm CKD. Txawm li cas los xij, kev soj ntsuam thib ob ntawm MDRD txoj kev tshawb fawb nrog lub sijhawm soj ntsuam ntev dua tau pom tias txhua 0.2 g / kg / hnub txo qis hauv cov protein kom tsawg tau cuam tshuam nrog kev poob qis ntawm GFR los ntawm 1.15 mL / min / 1.73 m2 toj xyoo. , thiab nrog halved txaus ntshai ntawmraum tsis ua haujlwmlos yog tuag [28]. Tsis tas li ntawd, cov kev ntsuas meta-kev soj ntsuam thiab kev tshuaj xyuas cov txheej txheem kuj tau tshaj tawm cov txiaj ntsig zoo sib xws. Kev tshuaj xyuas kev tshuaj xyuas cov ntaub ntawv ntawm cov neeg mob uas tsis yog mob ntshav qab zib CKD pom tau tias txwv tsis pub noj cov protein ntau txo cov neeg mob pib kho mob ntshav qab zib li 32 feem pua ​​[26]. Ib qho kev soj ntsuam meta-tshaj tsis ntev los no suav nrog xya qhov kev sim ntsuas randomized (RCTs) tau tshaj tawm txog kev tiv thaiv tseem ceeb ntawm LPD thiab SVLPD ntawm qhov txo qis hauv eGFR, piv rau cov zaub mov muaj protein ntau [29]. Kev txo qis uremic milieu nrog SVLPD kuj tseem muaj txiaj ntsig zoo rau kev tswj cov zis ntim thiab lub raum tsis zoo, uas ua rau muaj kev ua haujlwm ntawm kev ua kom ntshav lim ntshav txhua lub lim tiam. Tom qab 24 lub hlis ntawm qhov kev zov me nyuam, 40 feem pua ​​​​ntawm cov neeg mob tseem nyob rau kev kho mob lim ntshav txhua lub lim tiam, tsis muaj kev noj zaub mov tsis zoo, mob ntshav siab, lossis metabolic derangement [30].

Cov nyhuv renoprotective ntawm LPD tuaj yeem ntxiv rau hauv kev faib ua feem ntawm cov protein txwv. Ib qho RCT tsis ntev los no tau qhia tias SVLPD ({0}}.3 g/kg/hnub) txo qislub raum ua haujlwmpoob qis thiab txo tus naj npawb ntawm cov neeg mob uas xav tau kev kho lub raum hloov hauv kev sib piv nrog cov pa LPD ({0}}.6 g / kg / hnub) [31]. Ntxiv nrog rau keto analogs, uas tuaj yeem hloov pauv thiab siv los ua cov amino acids tseem ceeb, pab tswj cov protein-zog cov xwm txheej yam tsis muaj kev nce qib ntawm nitrogen cov khoom pov tseg nrog txo phosphorus thiab acid load hauv VLPD nrog rau cov protein degradation thiab txhim kho protein synthesis [32 ]. SVLPD tau pom tias txo cov theem ntawm cov co toxins loj, xws li indoxyl sulfate, hauv cov neeg mob predialysis CKD [33]. Hauv lwm RCT ntawm cov neeg mob uas muaj GFR 5 txog 7 mL / min, SVLPD txawm ncua qhov pib ntawm kev kho mob lim dej kom zoo los ntawm lub sijhawm nruab nrab ntawm 10.7 lub hlis yam tsis muaj qhov tshwm sim tsis zoo, uas muab cov txiaj ntsig kev lag luam kwv yees li ntawm € 21,180 rau ib tus neeg mob hauv thawj xyoo [34 ].

Cov txiaj ntsig zoo ntawm cov khoom noj muaj protein tsawg ntawm cov khoom noj muaj txiaj ntsig zoo

Hais txog metabolic acidosis

Metabolic acidosis, qhov tshwm sim ntawm metabolic tshwm sim ntawm CKD siab heev, yuav tsum tau tswj kom rov qab CKD kev loj hlob thiab tiv thaiv lwm yam teeb meem, xws li insulin tsis kam thiab kab mob plawv [35]. Raws li cov kua qaub tsim tawm thaum cov txheej txheem ntawm cov protein degradation, nrog rau cov sulfur-muaj cov amino acids, kev noj cov protein ntau dua thiab kev noj zaub mov kom cov kua qaub nce siab yog cuam tshuam nrog kev txo qis hauv cov ntshav.lub raum ua haujlwm[36], thiab nws tus kheej cuam tshuam nrog kev pheej hmoo ntawm qhov kawgmob raumhauv cov neeg mob CKD [37]. Yog li, LPD, tshwj xeeb tshaj yog tias nws yog feem ntau los ntawm cov nroj tsuag (saib hauv qab), ntseeg tau tias muaj txiaj ntsig zoo rau metabolic acidosis hauv cov neeg mob CKD. Qhov tseeb, LPD tau tshaj tawm rau ameliorate metabolic acidosis hauv cov neeg mob CKD siab heev. Hauv RCT tshawb xyuas qhov cuam tshuam ntawm kev noj zaub mov ntawm cov ntshav qab zib bicarbonate rau 1 xyoos, txhais tau tias cov ntshav qab zib bicarbonate tseem <19 mmol="" l="" tom="" qab="" 1="" xyoos="" ntawm="" lpd,="" thaum="" nws="" nce="" mus="" rau="" qib="" qub="" hauv="" pawg="" svlpd="" [31].="" hauv="" lwm="" txoj="" kev="" tshawb="" fawb,="" tus="" nqi="" ntawm="" qhov="" ncauj="" bicarbonate="" hloov="" kho="" kom="" muaj="" qib="" zoo="" sib="" xws="" ntawm="" cov="" ntshav="" hauv="" cov="" pa="" roj="" carbon="" dioxide="" (lossis="" cov="" ntshav="" sib="" piv="" tag="" nrho="" cov="" pa="" roj="" carbon="" dioxide="" [38])="" qis="" dua="" hauv="" pawg="" svlpd="" piv="" rau="" cov="" neeg="" koom="" nrog="" noj="" cov="" protein="" ntau="" [39].="" kho="" cov="" metabolic="" acidosis="" los="" ntawm="" kev="" hloov="" pauv="" kev="" noj="" haus="" lossis="" los="" ntawm="" kev="" hloov="" sodium="" bicarbonate="" yog="" qhov="" pab="" tau="" kom="" txo="" qis="" kev="" poob="">lub raum ua haujlwmHauv cov neeg mob uas muaj theem 4 CKD [40].

Hais txog hyperphosphatemia

Raws li cov khoom noj muaj protein ntau yog qhov tseem ceeb ntawm kev noj phosphorus (1 g ntawm cov protein muaj li 13 mg ntawm phosphorus) [41], thiab muaj kev sib raug zoo ntawm kev noj zaub mov muaj protein ntau thiab phosphorous, LPD tuaj yeem pab tau rau kev tswj hwm hyperphosphatemia hauv Cov neeg mob CKD, uas yog qhov paub zoo txog kev pheej hmoo rau cov kab mob plawv thiab cov pob txha muaj zog txawv txav [42]. Hauv RCT hauv cov neeg mob nrog CKD IV thiab V, kev txwv tsis pub noj cov protein tau pom tias ua rau muaj kev poob qis hauv cov ntshav phosphate thiab cov khoom calcium-phosphorus [43]. Kev ua tau zoo ntawm LPD rau kev txo qis hauv cov ntshav phosphorus kuj ua rau txo qis hauv cov ntshav ntawm cov tshuaj parathyroid hormone thiab fibroblast kev loj hlob 23 [44,45], thiab kev tswj kom zoo dua cov cim ntawm cov pob txha pob txha los ntawm kev txwv kev noj zaub mov muaj feem cuam tshuam nrog kev ua kom qeeb. ntawm vascular calcification thiab txhim kho cov hlab plawv [46].

Hais txog nephrolithiasis

Cov zaub mov muaj protein ntau, tshwj xeeb tshaj yog cov tsiaj tsis muaj protein ntau (cov nqaij qaib, nqaij, ntses, qe), nrog rau cov khoom noj uas tsis tshua muaj alkali, suav tias yog txuam nrog cov pob zeb tsim hauv cov zis. Nws tau xav tias yuav ua rau cov calcium tsis zoo, cov zis pH tsawg, thiab tso zis tsawg ntawm citrate, potassium, thiab magnesium [47]. Tshwj xeeb tshaj yog, tsiaj protein kom tsawg nce purine metabolism ua rau hyperuricosuria, uas ua rau ob qho tib si uric acid thiab calcium nephrolithiasis [48,49]. Kev txwv tsis pub noj cov protein ua rau txo qis hauv cov zis calcium, uric acid, oxalate, thiab hydroxyproline qib. Ntawm qhov tod tes, urinary citrate tau tshaj tawm tias yuav nce ntxiv tom qab tau txais LPD nrog rau kev txo qis tso zis ntawm urea [50]. Nws yog qhov ua tau tias muaj kev hloov pauv ntawm tus kheej uas ua rau muaj qhov sib txawv ntawm qhov cuam tshuam ntawm kev noj haus ntawm cov pob zeb tsim. Kev noj cov tsiaj protein ntau tau pom tias muaj feem cuam tshuam nrog kev tso zis oxalate hauv cov neeg mob uas muaj idiopathic calcium nephrolithiasis, thaum tsis muaj qhov cuam tshuam zoo li no tau pom hauv cov neeg noj qab haus huv [51].

TSEEM CEEB NTAWM SOURCE OF PROTEIN INTAKE (COJ VS. Tsiaj Protein)

Ntxiv nrog rau qhov ntau npaum li cas ntawm cov protein kom tsawg, muaj peev xwm sib txawv los ntawm qhov chaw ntawmnoj proteintau txais kev txaus siab. Kev noj cov tsiaj protein, tshwj xeeb tshaj yog cov nqaij liab ua tiav, muaj feem cuam tshuam nrog kev tshwm sim thiab kev loj hlob ntawm CKD. Atherosclerosis Risk in Communities Study (ARIC), txoj kev tshawb fawb yav tom ntej raws li kev soj ntsuam ntawm Tebchaws Meskas cov pej xeem hauv zej zog tsis muaj ntshav qab zib thiab kab mob plawv hauv eGFR> 60 mL / min / 1.73 m2 nrog kev soj ntsuam nruab nrab ntawm 23 xyoo, pom tias muaj kev nce ntxiv. Kev pheej hmoo ntawm qhov tshwm sim ntawm CKD ntawm cov neeg uas tau noj ntau tshaj plaws quintile ntawm cov nqaij liab / ua tiav piv rau cov uas tau noj tsawg kawg [52]. Lub koom haum muaj txiaj ntsig zoo ntawm kev noj zaub mov zoo nrog CKD tshwm sim tau tshwm sim hauv cov zaub mov noj qab haus huv uas siv tag nrho cov nplej, txiv hmab txiv ntoo, zaub, txiv ntoo, thiab legumes ntau dua li cov zaub mov tsis zoo noj qab haus huv nrog cov nplej, qos yaj ywm, txiv hmab txiv ntoo. kua txiv, thiab dej qab zib-sweetened [53]. Cov txiaj ntsig zoo sib xws tau tshwm sim hauv kev tshawb fawb hauv Asia; Singapore Suav Kev Tshawb Fawb Txog Kev Noj Qab Haus Huv, uas tau qhia txog kev sib koom ua ke ntawm cov nqaij liab noj nrog ESRD txaus ntshai nyob rau hauv koob tshuaj [54]. Cov nyhuv renoprotective ntawm cov nroj tsuag-raws li cov protein noj tau cuam tshuam nrog kev tuag qis hauv cov neeg mob CKD [55].

Txawm hais tias cov ncauj lus kom ntxaws txog cov teebmeem sib txawv ntawm cov khoom noj muaj protein ntau, nws tau pom nyob rau hauv kev tshawb fawb soj ntsuam tias glomerular hyperfiltration ntau dua tau pom nyob rau hauv cov neeg uas muaj nqaij ntau thiab zaub protein tsawg [56]. Qhov txiaj ntsig no tau txais kev txhawb nqa los ntawm lwm qhov kev tshawb fawb ntev ntev, Kev Tshawb Fawb Kev Noj Qab Haus Huv nrog 11- xyoo rov qab mus rau 3,328 cov neeg, uas pom tau tias qhov siab tshaj plaws quartile ntawm tsiaj rog thiab ob lossis ntau dua cov nqaij liab hauv ib lub lis piam yog ncaj qha cuam tshuam nrog microalbuminuria [57]. Tsiaj protein noj zaub mov kuj tseem ntseeg tias ua rau muaj qhov tsis sib xws hauv cov plab hnyuv microbiome [58] ua rau kev tsim cov khoom siv ntau dua ntawm ammonia thiab sulfur-based cov ntaub ntawv nrog cov proinflammatory profile thiab yog li ua rau inflammatory cytokines thiab oxidative stress [ 59, 60] ib. Kev sim tshuaj ntev ntev ntawm cov neeg mob ntshav qab zib nephropathy tau pom tias hloov ib nrab ntawm cov tsiaj protein kom tsawg nrog cov kua protein noj rau 4 xyoo txo ​​qis ntawm cov proteinuria thiab urinary creatinine [61] nrog rau kev txhim kho cov cim ntawm cov kab mob metabolic, uas cuam tshuam rau kev pheej hmoo siab. ntawm CKD [62].

Tsis tas li ntawd, ntau cov kev tshawb fawb tau pom tias cov nroj tsuag muaj protein ntau pab tau rau kev tswj cov metabolic acidosis. Plant-based protein muaj cov qib siab dua ntawm glutamate, ib qho anionic amino acid uas siv hydrogen ions hauv cov metabolism, ua rau kev saib xyuas ntawm nruab nrab pH. Cov zaub mov cog kuj tseem muaj cov ntsev anionic poov tshuaj ntau dua, uas tseem ua rau txo qis hauv cov qib hydrogen ions [63]. Txoj Kev Tshawb Fawb Txog Lub Raum Tsis Txaus Siab tau pom tias kev noj zaub mov ntau dua ntawm cov zaub mov muaj feem cuam tshuam nrog cov qib bicarbonate ntau dua [45]. Raws li qhov ncauj bioavailability ntawm phosphorus yog siab dua nyob rau hauv cov tsiaj protein, piv rau cov nroj tsuag raws li cov protein, uas nws phosphorus nyob rau hauv daim ntawv ntawm phytate yog tsawg bioavailable nyob rau hauv tib neeg lub plab, ntau tsiaj protein noj tej zaum yuav muaj teeb meem rau kev tswj hyperphosphatemia nyob rau hauv cov neeg mob CKD [64] .

Raws li cov txiaj ntsig tau los ntawm ntau cov kev tshawb fawb txog qhov txiaj ntsig zoo ntawm kev noj cov zaub mov muaj protein ntau, muaj kev txav mus los kom pom zoo rau kev noj zaub mov tsis muaj protein ntau (PLADO) hauv cov neeg mob CKD [7,60,65] . Nws txhais tau tias yog kev noj zaub mov ntawm kev noj zaub mov muaj protein ntau ntawm 0.6 mus rau 0.8 g / kg / hnub nrog tsawg kawg yog 50 feem pua ​​​​ntawm cov nroj tsuag, uas yuav tsum yog tag nrho, unrefined, thiab unprocessed zaub mov. Lwm cov yam ntxwv ntawm PLADO suav nrog kev noj cov sodium tsawg tsawg dua 3 mus rau 4 g / hnub thiab cov khoom noj muaj fiber ntau tsawg kawg yog 25 mus rau 30 g / hnub raws li kev ua kom muaj zog txaus (30 txog 35 Cal / kg / hnub) [60]. Txawm hais tias kev qhia txog PLADO kev tswj hwm hauv cov neeg mob CKD yuav tsum tau txais txiaj ntsig ntau yam txiaj ntsig raws li tau hais los saum no, kuj tseem muaj ntau qhov kev txhawj xeeb. Cov tsiaj proteins feem ntau yog cov protein ua tiav, uas muab tag nrho cov amino acids tseem ceeb nkag los ntawm cov khoom noj.

Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias cov nroj tsuag cov proteins feem ntau suav hais tias tsis muaj qee qhov tseem ceeb amino acids thiab yog li feem ntau categorized raws li muaj pes tsawg leeg muaj txiaj ntsig zoo li piv rau qhov hu ua "siab biologic value" (HBV) cov proteins uas feem ntau. ntawm tsiaj keeb kwm, nyob rau hauv uas ntau yam tseem ceeb amino acids yog bioavailable thiab absorbable ntawm tib neeg lub plab. Txawm li cas los xij, txawm hais tias ib txwm qis HBV qeb duas ntawm cov nroj tsuag-raws li cov protein, lawv tsis muaj qhov qis dua "protein digestibility-corrected amino-acid score" (PDCAAS), uas yog txoj kev nyiam rau kev ntsuas cov protein zoo, piv rau tsiaj cov proteins. . Tseeb tiag, kev tshawb fawb soj ntsuam siv cov khoom noj uas muaj ze li ntawm tag nrho cov nroj tsuag los yog tsuas yog cog cov zaub mov hauv cov neeg mob CKD tsis pom muaj kev noj haus tsis txaus [66-68]. Yog li ntawd, ua tib zoo saib xyuas txog qhov txaus rau qhov kom muaj nuj nqis thiab zoo los ntawm kev siv ntau yam khoom noj tuaj yeem ua rau siv cov khoom noj cog qoob loo hauv cov neeg mob CKD yam tsis muaj kev phom sij. Kev tshawb fawb hauv tebchaws United States tsis ntev los no tau qhia tias HBV protein ntau dua tau cuam tshuam nrog cov txiaj ntsig tsis zoo hauv cov neeg muaj CKD [69].

Lwm qhov kev txhawj xeeb nrog kev noj zaub mov zoo yog kev pheej hmoo ntawm hyperkalemia. Txawm li cas los xij, kev noj zaub mov potassium ex-plained tsuas yog kwv yees li 2 feem pua ​​​​ntawm qhov sib txawv hauv peb lub hlis twg txhais tau tias ua ntej lim ntshav ntshav poov tshuaj [70]. Ntxiv mus, tsib qhov chaw ntawm cov poov tshuaj saum toj kawg nkaus yog nqaij nyuj, nqaij qaib, Mexican zaub mov, hamburgers, thiab legumes [71]. Qhov tseeb, kev noj zaub mov muaj fiber ntau tuaj yeem txhim kho lub plab zom mov thiab yuav tiv thaiv kev nqus ntawm cov poov tshuaj ntau dua los ntawm cov khoom noj. Alkali muab nrog cov nroj tsuag raws li kev noj haus kuj tseem tuaj yeem txo qhov kev pheej hmoo ntawm hyperkalemia [72,73]. Qhov tseeb ib txoj kev tshawb fawb tsis ntev los no tau qhia tias kev txo qis cov poov tshuaj yog cuam tshuam nrog kev tuag ntawm cov neeg mob uas muaj CKD tab tom lim ntshav [74]. Cov txiaj ntsig thiab cov teeb meem ntawm PLADO tau sau tseg nyob rau hauv Table 2. Kev soj ntsuam ze rau kev ua raws li kev noj cov calories, protein, ntsev, thiab fiber ntau, thiab kev siv cov khoom noj muaj protein ntau thiab hom zaub mov raws li qhov nyiam ntawm cov neeg mob yuav yog. pab qhia qhov txiaj ntsig zoo ntawm PLADO kev tswj hwm ntawmlub raum noj qab haus huv.

Kev pheej hmoo ntawm PROTEIN-ENERGY WASTING & MONITORING

Lub xeev hypercatabolic raug ntxias los ntawm uremia, anorexia vim yog txuam nrog anorectics, o ntawm cov kab mob hauv lub cev, thiab cov kab mob autoimmune raws li etiologies rau CKD tau pom tias muaj feem xyuam rau qhov muaj feem ntau ntawm cov protein-zog nkim (PEW) [75] hauv CKD. cov neeg mob, cuam tshuam nrog cov leeg nqaij qis thiab nce kev tuag [76]. Raws li kev noj zaub mov tsis txaus yog qhov tseem ceeb ntawm kev pheej hmoo rau PEW, kev txwv tsis pub noj cov protein ua rau muaj kev txhawj xeeb txog qhov muaj peev xwm ua rau PEW ua rau cov neeg mob CKD thiab txo qis lub cev qhov ntsuas tau pom tias muaj feem cuam tshuam nrog kev tuag ntau dua ntawm ESRD cov neeg mob kho nrog dialysis [77,78]. Kev soj ntsuam ntawm lub cev muaj pes tsawg leeg ntsuas hauv MDRD txoj kev tshawb fawb pom tau tias txo qis hauv lub cev qhov hnyav, caj npab cov leeg nqaij, thiab cov zis creatinine excretion nyob rau hauv cov pab pawg tsawg-thiab-tsawg protein ntau, piv rau kev tswj kev noj zaub mov. Txawm li cas los xij, caloric kom tsawg kuj tau txo qis hauv pawg txwv protein, thiab qhov nruab nrab ntawm feem ntau cov anthropometric thiab biochemical indices rau cov khoom noj khoom haus tseem nyob hauv qhov qub [79].

Lwm txoj kev tshawb fawb soj ntsuam qhov cuam tshuam ntawm SVLPD ntawm lub cev muaj pes tsawg leeg ntawm cov neeg mob CKD V tau pom tias me ntsis txo qis hauv lub cev nqaij daim tawv thaum thawj 3 lub hlis tom qab kev noj zaub mov. Txawm li cas los xij, nws maj mam nce ntxiv tom qab ntawd, thiab tseem nyob ruaj khov ntawm 12 thiab 24 lub hlis, qhia tias SVLPD ua ke nrog cov calories kom txaus yog noj zaub mov zoo rau lub sijhawm ntev [80]. Ib qho kev tshuaj ntsuam meta-kev soj ntsuam ntawm 14 cov kev tshawb fawb tau soj ntsuam qhov cuam tshuam ntawm LPD ntawm lub cev muaj pes tsawg leeg hauv cov neeg mob CKD, thiab nws tau pom tias tsis muaj kev hloov pauv loj hauv lub cev muaj pes tsawg leeg nyob rau lub sijhawm hauv CKD cov neeg mob LPD [81]. Txawm li cas los xij, asprotein ntauthiab cov kev xav tau ntawm lub zog yuav tsum tau sib txawv raws li kev kho mob thiab thoob plaws cov kab mob hnyav, nws yog ib qho tseem ceeb uas yuav tsum tau saib xyuas kev noj zaub mov kom tsis tu ncua thiab ntsuas kev noj zaub mov kom zoo hauv kev siv LPD [82,83]. Kev noj zaub mov noj tuaj yeem raug soj ntsuam nrog kev rov qab los ntawm kev noj zaub mov, kev xam phaj, thiab cov lus nug txog zaub mov, thiab tus nqi ntawm cov protein kom tsawg tuaj yeem txheeb xyuas nrog cov zis nitrogen (UNA). Txawm li cas los xij, kev noj cov protein ntau tuaj yeem kwv yees ntau dhau los ntawm UNA-raws li kev suav yog tias cov neeg mob nyob hauv lub xeev hypercatabolic, suav nrog kev noj zaub mov tsis txaus, mob mob, lub sijhawm ua haujlwm tom qab, thiab hlawv raug mob. Yog li, lwm yam cuab yeej rau kev ntsuam xyuas kev noj haus yuav tsum tau saws nyob rau hauv cov xwm txheej. [84]. Tsis tas li ntawd, kev kho mob dialysis stimulates protein catabolism [85]. Tag nrho lub cev nqaij daim tawv nqaij metabolism zoo li nce, uas tuaj yeem ua rau cov leeg nqaij tsis muaj protein ntau thaum kho hemodialysis [86]. Cov lus qhia pom zoo kom noj cov protein ntau dua hauv cov neeg mob ESRDkev kho mob dialysis(1.2 txog 1.4 g / kg / hnub), piv rau lub sijhawm ua ntej lim ntshav, kom tsis txhob muaj qhov hnyav ntawm PEW [87]. Kev kawm rau kev saib xyuas tus kheej kom tsis txhob muaj kev noj zaub mov tsis zoo thiab kev tawm tswv yim zoo ib yam los ntawm CKD-tus kws kho mob tshwj xeeb, uas muab cov cuab yeej pragmatic thiab cov ntaub ntawv qhia txog kev noj zaub mov zoo thiab kev txawj ntse yog qhov tsim nyog los siv lub luag haujlwm ntawm LPD rau lub raum noj qab haus huv yam tsis muaj kev pheej hmoo ntawm PEW.

Cov lus xaus

Hauv kev tswj hwm ntawm cov neeg mob nrog CKD, cov txiaj ntsig zoo ntawm cov nroj tsuag-dominant LPD kom tsis txhob muaj glomerular hyperfiltration thiab txo qis cov khoom pov tseg ntawm cov protein ntau tau xav tias yuav muaj txiaj ntsig zoo rau kev tswj hwm cov tsos mob ntawm uremic thiab cov teeb meem metabolic, pab txhawb kev ncua ntawm kev pib lim ntshav. kev kho mob (Table 3) [15,17-19,21,26-29,31,35,36,41,44,45,47,49,63,{15}}]. Txawm li cas los xij, kev txhawj xeeb txog PEW tau cuam tshuam qhov kev siv dav dav ntawm cov tswv yim no los ntawm cov kws kho mob. Kev ua raws li LPD raws li kev noj zaub mov noj yuav tsum tau pom zoo nrog rau kev saib xyuas zoo thiab kev ntsuam xyuas tsis tu ncua ntawm kev noj zaub mov zoo. Multidirectional txoj hauv kev, suav nrog kev noj zaub mov zoo, yuav tsum tau txiav txim siab kom ntseeg tau qhov txiaj ntsig zoo tshaj plaws rau cov neeg mob CKD.

Kev tsis sib haum xeeb

Tsis muaj peev xwm tsis sib haum xeeb ntawm kev txaus siab cuam tshuam rau kab lus no tau tshaj tawm.

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