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研究生:黃泰傑
研究生(外文):Tai-Chieh Huang
論文名稱:營養師介入對腹膜透析病人 營養和飲食攝取狀態影響
論文名稱(外文):Effect Of Nutrition Counseling on Nutrition And Dietary Intake Status In Patients Receiving Peritoneal Dialysis
指導教授:謝淑玲謝淑玲引用關係黃孟娟黃孟娟引用關係
指導教授(外文):Shu-Ling HsiehMeng-Chuan Huang
口試委員:黃尚志謝淑玲黃孟娟
口試委員(外文):Shang-Jyh HuangShu-Ling HsiehMeng-Chuan Huang
口試日期:2014-07-24
學位類別:碩士
校院名稱:國立高雄海洋科技大學
系所名稱:水產食品科學研究所
學門:農業科學學門
學類:食品科學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:82
中文關鍵詞:腹膜透析營養衛教
外文關鍵詞:Peritoneal DialysisNutrition Counseling
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本研究目的為探討剛開始腹膜透析病人接受營養師個別化的飲食指導,並由營養師衛教建議0.8 g/kg/day蛋白飲食加上補充0.1 g/kg/day酮酸胺基酸及單純建議1.0 g/kg/day蛋白飲食12個月後對於營養狀態、腎臟相關指標及殘餘腎功能的影響。本研究為隨機對照試驗,介入組15位剛接受腹膜透析病人,建議0.8 g/kg/day蛋白質飲食並補充0.1 g/kg/day酮酸胺基酸,對照組則為15位剛接受腹膜透析病人,建議1.0 g/kg/day蛋白質飲食,沒有補充酮酸胺基酸,兩組皆有營養師每三個月進行個別化的衛教,追蹤12個月之營養狀態、腎臟功能指標及飲食攝取。結果發現尿量在介入組為-237±401 cc/day,對照組為-535±190 cc/day (P=0.032),兩組有顯著不同,而尿素氮透析效率 (Kt/V)、白蛋白、氮平衡、正常化尿素氮出現率之蛋白質當量 (nPNA) 在介入組和對照組的改變量皆無差異,均符合美國腎臟基金會 (KDOQI) 所建議的腹膜透析指標。本研究結論為營養師衛教能使腹膜透析病人維持良好的腎功能指標、血磷控制、營養狀態,藉此突顯營養師在腹膜透析病患衛教上的重要性,而補充酮酸胺基酸能維持腹膜透析病人較好的殘餘腎功能。
Purpose: We conducted a randomized trial to test whether a low-protein diet with keto acids would be changing in nutritional status, kidney-related indicators, and associated with a preserved residual renal function (RRF) in initial peritoneal dialysis (PD) patients. Methods: 30 initial PD patients were randomized to receive either a low-protein diet, keto acid-supplemented (sLP: 0.8g/kg/day with 0.1g/kg/day keto acid-supplemented) or a normal protein diet (NP: 1.0 g/kg/day). The groups were followed for 1 year by dietitians and nutritional status, RRF, kidney-related indicators was evaluated serially. Results: The decrease of urine volume in NP group was more than sLP (NP: -535±190 cc/day vs. sLP: -273±401 cc/day, P = 0.032). There was no significant difference in Kt/V, albumin, nitrogen balance, nPNA between the two groups during follow-up and achieve the KDOQI guidelines recommended.Conclusions: Nutritional education is effective in PD patient maintains a good nutritional status and kidney-related indicators. A diet containing protein 0.8 g/kg/day combined with keto acids is associated with an improved preservation of RRF in relatively new PD patients.
目錄
摘要
Abstract
誌謝
表目錄
圖目錄
壹、前言
一、研究背景
二、研究目的
貳、文獻探討
一、腹膜透析流行病學及現況
二、腹膜透析病人熱量及蛋白質的攝取
三、 酮酸胺基酸對於腎臟病人的益處
四、糖化終產物對腎臟功能的影響
五、營養師的介入對腎臟病人的影響
參、材料與方法
一、 研究對象
二、研究設計
三、飲食衛教
四、資料收集
五、統計分析方法
肆、結果
一、基線之基本資料、理學檢查和臨床生化值之分析
二、腹膜透析病人在接受營養師及酮酸胺基酸12個月介入後腎功能相關數值、營養指標、體位測量、身體組成、營養素攝取的變化
三、介入組和對照組在基線和12個月後的飲食習慣改變
伍、討論
一、營養師衛教對於腹膜透析病人腎功能指標的影響
二、營養師衛教對於腹膜透析病人營養狀態及身體組成的影響
三、營養師衛教對於腹膜透析病人營養素攝取的影響
四、補充酮酸胺基酸對腹膜透析病人殘餘腎功能的影響
陸、研究限制
柒、研究優勢
捌、結論
玖、參考文獻

台灣腎臟醫學會。2010。慢性腎臟病防治手冊。台北縣新莊市: 行政院衛生署國民健康局。
李宜哲、彭聖。2007。酮酸及氨基酸在慢性腎衰竭的使用。腎臟與透析, 19(4), 177-179。
李素慧、林金鵬。2011。錯誤的公衛政策─ 透析總額零成長。
林偉弘、郭冠良、夏清智、吳岱穎、陳建志。2013。淺談慢性腎臟病。北市醫學雜誌, 10(2), 101-109。
潘文涵、章雅惠、陳正義、吳幸娟、曾明淑、高美丁。1993。國民營養健康狀況變遷調查 1993~ 1996,以二十四小時飲食回顧法評估國人膳食營養狀況。國民營養現況, 1996, 29-51.
Chauveau, P., Couzi, L., Vendrely, B., de Précigout, V., Combe, C., Fouque, D., Aparicio, M. (2009). Long-term outcome on renal replacement therapy in patients who previously received a keto acid–supplemented very-low-protein diet. The American journal of clinical nutrition, 90(4), 969-974.
Chen, W., Lu, X.h., Wang, T. (2006). Menu suggestion: an effective way to improve dietary compliance in peritoneal dialysis patients. Journal of renal nutrition, 16(2), 132-136.
Churchill, D. (1998). Implications of the Canada-USA (CANUSA) study of the adequacy of dialysis on peritoneal dialysis schedule. Nephrology dialysis transplantation, 13, 158-163.
Diaz-Buxo, J.A., Lowrie, E.G., Lew, N.L., Zhang, S., Zhu, X., Lazarus, J.M. (1999). Associates of mortality among peritoneal dialysis patients with special reference to peritoneal transport rates and solute clearance. American journal of kidney diseases, 33(3), 523-534.
Ervin, R.B., Wang, C.Y., Wright, J.D., Kennedy-Stephenson, J. (2004). Dietary intake of selected minerals for the United States population: 1999–2000. U.S. Department of health and human services, 1(5),1-6.
Gilmore, J. (2005). KDOQI clinical practice guidelines and clinical practice recommendations-2006 updates. Nephrology nursing journal, 33(5), 487-488.
Hidaka, H., Nakao, T. (2003). Preservation of residual renal function and factors affecting its decline in patients on peritoneal dialysis. Nephrology, 8(4), 184-191.
Jaar, B.G., Coresh, J., Plantinga, L.C., Fink, N.E., Klag, M.J., Levey, A. S., Powe, N. R. (2005). Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. Annals of internal medicine, 143(3), 174-183.
Jiang, N., Qian, J., Lin, A., Fang, W., Zhang, W., Wang, Q., Yao, Q. (2011). Low-protein diet supplemented with keto acids is associated with suppression of small-solute peritoneal transport rate in peritoneal dialysis patients. International journal of nephrology, 2011. 1-6
Jiang, N., Qian, J., Sun, W., Lin, A., Cao, L., Wang, Q., Axelsson, J. (2009). Better preservation of residual renal function in peritoneal dialysis patients treated with a low-protein diet supplemented with keto acids: a prospective, randomized trial. Nephrology dialysis transplantation, 24(8), 2551-2558.
Kanno, Y. (2007). Diet therapy in patients receiving peritoneal dialysis. Contrib nephrol, 155, 72-81.
Konings, C. J., Kooman, J. P., Schonck, M., Struijk, D. G., Gladziwa, U., Hoorntje, S. J., Leunissen, K. M. (2003). Fluid status in CAPD patients is related to peritoneal transport and residual renal function: evidence from a longitudinal study. Nephrology dialysis transplantation, 18(4), 797-803.
Kopple, J.D., Marsha, W., Chertow, G.M., Salusky, I.B. (2000). K/DOQI Nutrition in chronic renal failure. American journal of kidney diseases, 35(6), S1-S3.
Koschinsky, T., He, C.J., Mitsuhashi, T., Bucala, R., Liu, C., Buenting, C., Vlassara, H. (1997). Orally absorbed reactive glycation products (glycotoxins): an environmental risk factor in diabetic nephropathy. Proceedings of the national academy of sciences, 94(12), 6474-6479.
Leon, J.B., Albert, J.M., Gilchrist, G., Kushner, I., Lerner, E., Mach, S., Sperry, L. (2006). Improving albumin levels among hemodialysis patients: a community-based randomized controlled trial. American journal of kidney diseases, 48(1), 28-36.
Levey, A.S., Greene, T., Beck, G. J., Caggiula, A.W., Kusek, J.W., Hunsicker, L.G., Klahr, S. (1999). Dietary protein restriction and the progression of chronic renal disease what have all of the results of the MDRD study shown? Journal of the american society of nephrology, 10(11), 2426-2439.
Li, H., Long, Q., Shao, C., Fan, H., Yuan, L., Huang, B., Chen, J. (2010). Effect of short-term low-protein diet supplemented with keto acids on hyperphosphatemia in maintenance hemodialysis patients. Blood purification, 31(1-3), 33-40.
Li, H., Long, Q., Shao, C., Fan, H., Yuan, L., Huang, B., Chen, J. (2011). Effect of short-term low-protein diet supplemented with keto acids on hyperphosphatemia in maintenance hemodialysis patients. Blood Purif, 31(1-3), 33-40.
Lou, L., Caverni, A., Gimeno, J., Moreno, R., Pérez, J., Alvarez, R.,Bielsa, S. (2012). Dietary intervention focused on phosphate intake in hemodialysis patients with hyperphosphatemia. Clinical nephrology, 77(6), 201-225.
Mandayam, S., Mitch, W.E. (2006). Dietary protein restriction benefits patients with chronic kidney disease. Nephrology, 11(1), 53-57.
Mehrotra, R., Marsh, D., Vonesh, E., Peters, V., Nissenson, A. (2005). Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis. Kidney international, 68(1), 378-390.
Mircescu, G., Garneata, L., Stancu, S. H., Capusa, C. (2007). Effects of a supplemented hypoproteic diet in chronic kidney disease. Journal of renal nutrition 17(3), 179-188.
Morey, B., Walker, R., Davenport, A. (2008). More dietetic time, better outcome? Nephron clinical practice, 109(3), c173-c180.
Ohkawa, S., Kaizu, Y., Odamaki, M., Ikegaya, N., Hibi, I., Miyaji, K., Kumagai, H. (2004). Optimum dietary protein requirement in nondiabetic maintenance hemodialysis patients. American journal of kidney diseases, 43(3), 454-463.
Paes-Barreto, J.G., Barreto Silva, M.I., Qureshi, A.R., Bregman, R., Cervante, V.F., Carrero, J.J., Avesani, C.M. (2013). Can renal nutrition education improve adherence to a low-protein diet in patients with stages 3 to 5 chronic kidney disease? Journal of renal nutrition, 23(3), 164-171.
Peppa, M., Uribarri, J., Cai, W., Lu, M., Vlassara, H. (2004). Glycoxidation and inflammation in renal failure patients. American journal of kidney diseases, 43(4), 690-695.
Prakash, S., Pande, D.P., Sharma, S., Sharma, D., Bal, C.S., Kulkarni, H. (2004). Randomized, double-blind, placebo-controlled trial to evaluate efficacy of ketodiet in predialytic chronic renal failure. Journal of renal nutrition, 14(2), 89-96.
Roza, A. M., Shizgal, H. M. (1984). The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass. The American journal of clinical nutrition, 40(1), 168-182.
Suliman, M.E., Heimbürger, O., Bárány, P., Anderstam, B., Pecoits-Filho, R., Ayala, E.R., Stenvinkel, P. (2003). Plasma pentosidine is associated with inflammation and malnutrition in end-stage renal disease patients starting on dialysis therapy. Journal of the american society of nephrology, 14(6), 1614-1622.
Tanji, N., Markowitz, G.S., Fu, C., Kislinger, T., Taguchi, A., Pischetsrieder, (2000). Expression of advanced glycation end products and their cellular receptor RAGE in diabetic nephropathy and nondiabetic renal disease. Journal of the american society of nephrology, 11(9), 1656-1666.
Teplan, V., Schück, O., Knotek, A., Hajný, J., Horáčková, M., Kvapil, M. (2003). Enhanced metabolic effect of erythropoietin and keto acids in CRF patients on low-protein diet: Czech multicenter study. American journal of kidney diseases, 41(3), S26-S30.
Uribarri, J., Peppa, M., Cai, W., Goldberg, T., Lu, M., He, C., Vlassara, H. (2003). Restriction of dietary glycotoxins reduces excessive advanced glycation end products in renal failure patients. Journal of the american society of nephrology, 14(3), 728-731.
Uribarri, J., Tuttle, K. R. (2006). Advanced glycation end products and nephrotoxicity of high-protein diets. Clinical journal of the american society of nephrology, 1(6), 1293-1299.
Vlassara, H., Striker, L. J., Teichberg, S., Fuh, H., Li, Y. M., Steffes, M. (1994). Advanced glycation end products induce glomerular sclerosis and albuminuria in normal rats. Proceedings of the national academy of sciences U S A, 91(24), 11704-11708.
Wang, A.Y.M., Sanderson, J., Sea, M.M.M., Wang, M., Lam, C.W.K., Li, P.K.T., Woo, J. (2003). Important factors other than dialysis adequacy associated with inadequate dietary protein and energy intakes in patients receiving maintenance peritoneal dialysis. The American journal of clinical nutrition, 77(4), 834-841.
Wolfe, R.A., Ashby, V.B., Milford, E.L., Ojo, A.O., Ettenger, R.E., Agodoa, L.Y., Port, F.K. (1999). Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. New england journal of medicine, 341(23), 1725-1730.
Yang, W.C., Hwang, S.J. (2008). Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: the impact of national health insurance. Nephrology dialysis transplantation, 23(12), 3977-3982.


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