Nevra KOÇ, Seyit M. MERCANLIGİL, Nazlı KARA, Nilgün ÇAKAR, Mehmet GÜNDÜZ, Erdem KARABULUT

Sürekli Ayaktan Periton Diyalizi Uygulanan Kronik Böbrek Yetmezliği Olan Çocuklarda Diyet Proteini: Bitkisel mi? Hayvansal mı?

Amaç: Bu çalışma sürekli ayaktan periton diyalizli (SAPD) hastalara uygulanacak diyetlerde iki farklı protein kaynağını içeren (bitkisel, hayvansal) diyetin klinik bulgulara etkisini incelemek amacıyla planlanıp yürütülmüştür. Bireyler ve Yöntem: Yaş aralığı 11-18 yıl olan SAPD uygulanan 30 hasta üzerinde çalışılmıştır. Subjektif global değerlendirmelerine göre (SGD) ergenlerin %83.3ü ağır malnütrisyonlu olarak saptanmıştır. İki gruba ayrılan hastalar bir ay 1.5 g/kg/gün protein içeren diyetler almıştır. Verilen protein, 1. grupta yaklaşık %60 bitkisel, 2. grupta yaklaşık %60 hayvansal kaynaklı olmuştur. Her gün telefonla görüşülerek diyetisyen tarafından 24 saatlik besin tüketim kaydı tutulmuştur. Bulgular:Vücut ağırlığı, relatif vücut ağırlığı, boy uzunluğu, triseps deri kıvrım kalınlığı, relatif triseps deri kıvrım kalınlığı, üst orta kol çevresi, üst orta kol kas çevresi ve beden kütle indeksi değerlerinde her iki grupta da önemli artış gözlenmiştir (p

Dietary Protein of the Children on Continuous Ambulatory Peritoneal Dialysis with Chronic Renal Failure: Vegetable or Animal Protein

Aim: This study was conducted to investigate the effects of diets including two different protein sources (vegetable or animal) on anthropometric, biochemical, and hematologic findings of patients receiving continuous ambulatory peritoneal dialysis (CAPD). Subjects and Methods:A total of 30 CAPD patients included in the study, whose ages ranged from 11 to 18 years. The patients, divided into two groups, were administered a diet including 1.5 g/kg/day of protein for one month. The protein administered was approximately 60% of vegetable origin in the 1st group and approximately 60% of animal origin in the 2nd group. Results:The body weight, relative body weight, height, triceps skinfold thickness (TST), relative TST, mid-upper arm circumference, mid-upper arm muscle circumference, and body mass index (BMI) values of the patients were measured and calculated from day 1 to day 30 in both groups, where significant increases (except for BMI in the second group) were observed (p<0.05). The increases in total protein, albumin, prealbumin, transferrin, high density lipoprotein-cholesterol, hemoglobin, hematocrit, and iron levels; and the decreases in triglycerides, total cholesterol, and iron binding capacity were found significant in both groups (p<0.05). While the two patient groups were similar with regard to their energy, protein, vitamin E, folic acid, potassium, magnesium, and phosphorus intake, the groups differed significantly in terms of vegetable protein, animal protein, carbohydrate, fat, dietary fiber, cholesterol, calcium, iron, zinc, and vitamins A, B1, B2, B6 and C intake (p<0.05). It has been found that energy, protein, lipid, carbohydrate consumption amounts were in recommended levels in two groups. Dietary fiber consumption amount was below the recommended level (93.3%) in the second group Conclusion: As a result, it has been concluded that high-protein diet consumption among chronic renal failure patients on CAPD positively affects the treatment course, regardless of the protein source.

PDF

___

1.FouqueD, Pelletier J, Mafra D, Chauveau P. Nutrition and chronic kidney disease. Kidney Int 2011;80:348-357.
2.Jadeja YP, Kher V. Protein enrgy wasting in chronic kidney disease: An update with focus on nutritional interventions to improve outcomes. Indıan J Endocrin Metab 2012;16(2): 246-251.
3.Dong J, Li Y, Xu Y, Xu R. Daily protein intake and survival in patients on peritoneal dialysis. Nephrol Dial Transplant 2011;26:3715-3721.
4.Srivats PR, Wong C, Golgstein SL. Nutrition aspects in children receiving maintenance hemodialysis: impact on outcome. Pediatr Nephrol 2009;24:951-957.
5.Dukkipati R, Noori N, Feroze U, Kopple JD. Dietary protein intake in patients with advanced chronic kidney disease and on dialysis. Semin Dial 2010;23(4):365-372.
6.Pablialonga F, Edefonti A. Nutrition assessmet and management in children on peritoneal dialysis . Pediatr Nephrol 2009;24:721-730.
7.Mak RH, Cheung WW, Zhan JY, Shen Q, Foster BJ. Cachexia and protein enrgy wasting in children with chronic kidney disease. Pediatr Nephrol 2012;27:173-181.
8.Sözeri B, Mir S, Kara OD, Dincel N. Growth impairment and nutritional status in children with chronic kidney disease. Iran J Pediatr 2011;21(3):271-277.
9.Kidney Dialysis Outcome Quality Initiative. Clinical practice guideline for nutrition in children with CKD: 2008 update. Am J Kidney Dis 2009;53(3):Suppl 2:48-52.
10.Secker D, Mak R. Nutritional challenges in pediatric chronic kidney disease. Comprehensive Pediatric Nephrology, 2008,1. Edition Chapter 48 pp 743-760.
11.Lopez Martinez J, Sanchez-Izguierdo Riea JA, Jimenez Jimenez FJ. Guidelines for specialized nutritional and metabolic support in the critically ill patient: Update, Concencus SEMICYUC-SENPE: acute renal failure. Nutr Hosp 2011;26(suppl2):21-26.
12.Pekcan G. Beslenme durumunun saptanması (Eds: Baysal A, Besler T, Bozkurt N, Keçecioğlu S, Kutluay Merdol T ve arkadaşları). Diyet El Kitabı. 11. Baskı. Hatiboğlu Basın ve Yayım San. Tic. Ltd. Şti, Ankara, 2011, s. 67-142.
13.Steiber AL, Kalantar-Zadeh K, Secke D, McCarthy M, SSehgal A, McCann L. Subjective global assessment in chronic kidney disease: A review. J Ren Nutr 2004;14(4):191-200.
14.Secker DJ, Jeejeebhoy KN. How to perform subjective global nutritional assessment in children. J Acad Nutr Diet 2012;112:424-436.
15.National Kidney Foundation. Kidney Dialysis Outcome Quality Initiative. Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2000;35(suppl 2):1-140.
16.Mercanlıgil SM.Böbrek Hastalıklarında Diyet Tedavisi, Diyet El Kitabı,2008, 5. Baskı, Hatipoğlu Yayınevi, Ankara
17.Sümbüloğlu K, Sümbüloğlu V. Biyoistatistik, 2010, 10. Baskı, Hatipoğlu Yayınevi, Ankara.
18.SuttonD, Higgins B, Stevens JM. Continuous ambulatory peritoneal dialysis patients are unable to increase dietary intake to reccommended levels. J Ren Nutr 2007;17(5):329- 335.
19.Uribari J. The obsession with high dietary protein intake in ESRD patients on dialysis: is it justified. Nephron 2000;86:105-108.
20.Westra WM, Kopple JD, Kredit RT, Aspell M, Mehrotra R. Dietary protein requirements and dialysate protein losses in chronic peritoneal dialysis patients. Perit Dial Int 2007;27:192-195.
21.Rees L, Shaw V. Nutrition in children with CRF and on dialysis. Pediatr Nephrol 2007;22:1689-1702.
22.Borah MF, Scoenfeld PY, Gotch FA. Nitrogen balance during intermittent dialysis theraphy of uremia. Kidney Int 1978;14:491-500.
23.Ahmed KR, Kopple JD. Nutrition in Maintenance Hemodialysis Patients in Nutritional Management of Renal Disease.1997, Edit: Kopple JD, Nassry S, Baltimore, Williams & Wilkins, 562-600.
24.Dombros N, Dratwa M, Feriani M, Gokal R, Heimbürger O, Krediet R, et al. Europen best practice guidelines for peritoneal dialysis. Nutrition in peritoneal dialysis. Nephrol Dial Transplant 2005;20(suppl 9):ix28-ix33.
25.Sylvestre LC, Fonseca KPD, Stinghen AEM, Pereira AM, Meneses RP, Pecoits-Filho R. The malnutrition and inflamation axis in pediatric patients with chronic kidney disease. Pediatr Nephrol 2007;22:864-873.
26.Alharbi K, Evelyn BE. Malnutrition is prevalent among hemodialysis patients in Jeddah, Saudi Arabia. Saudi J Kidney Dis Transpl 2012;23(3):598-608.
27.Gretz N, Lasserre J, Strauch M. Caloric supplementsfor patients on low protein diets? Nephron 1988;50:129-132.
28.Afşar B, Rengin E, Sezer S. Son dönem böbrek yetmezliği hastalarının nutrisyonel durumlarının değerlendirilmesinde kullanılan yöntemler. Türkiye Klinikleri J Nephrol 2008;3(2):71-77.
29.Blumenkrantz MJ, Kopple JD, Moran JK. Metabolic balance studies and dietrary protein requirements in patients undergoing continuous ambulatory peritoneal dialysis. Kidney Int 1982;21:849-861.
30.Kalista-Richards M. The kidney: Medical nutrition therapyyesterday and today. Nutr Clin Pract 2011;(26):143-150.
31.Bailey JL, Franch HA Getting to the meat of the matter: Beyond protein supplementation in maintenance dialysis. Semin Dial 2009;22(5):512-518.
32.Cianciarusa B, Bellizzi V, Brunari G, Cupisti A, Filippini A, Oldrizzi L, Quintaliani G, Santaro D Low-protein diet in Italy today: the conclisuons of the working Group from the Italian Society of Nephrology. G Ital Nephrol 2008;25(suppl 42):54-57.
33.Agodzhonov. Diet therapy of patients with chronic renal failure in its initial stage. Vopr Pitan 1984;6:28-31.
34.Wu TT, Chang CY, Hsu WM, Wang IK, Hsu CH, Cheng SH, et al. Nutritional status of vegetarians on maintenance haemodialysis. Nephrology 2011;16:582-587.
35.Jenkins JAD, Kendall CWC, Edward V. High protein diets in hyperlipidemia: effect of wheat gluten on serum lipids, uric acid, and renal funtion. Am J Clin Nutr 2001;74(1):57- 63.
36.Noori N, Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Kopple JD. Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clin J Am Soc Nephrol 2010;5:683-692.
37.Noori N, Sims JJ, Kopple JD, Shah SC, Shinaberger CS, Rachelle Bross, et al. Organic and inorganic dietary phosphorus and its management in chronic disease. Int J Kidney Dis 2010;4:89-100.