维持性血液透析患者磷知识、膳食磷摄入量与血清磷水平的关系

R. Emara, Doha Abo Zahra
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引用次数: 0

摘要

背景:维持性血液透析(MHD)患者的肾脏饮食知识,尤其是磷知识普遍较差,这是由于膳食磷信息的复杂性,从而导致对膳食磷指南的依从性较差和高磷血症。目的:探讨MHD患者磷知识、膳食磷摄入量与血清磷水平的关系。方法:对亚历山德里亚大学附属医院血液透析中心110例MHD患者进行横断面研究。采用问卷调查收集人口统计学和临床数据,并进行24小时饮食回忆。对患者进行25项营养知识问卷调查。回顾患者的医疗记录,收集有关终末期肾病(ESRD)的根本原因、透析持续时间和血清生化参数的数据。采用标准方案测量干体重(DBW)和身高,计算体质量指数(BMI)。结果:高磷血症发生率为44.5%。76.4%和74.5%的患者能量摄入和蛋白质摄入不足。高磷血症患者的平均磷摄入量高于对照组(1053.99±420.18 mg/d vs 854.18±353.99 mg/d)。磷摄入量>1000 mg/d的患者有近一半(51.2%)发生高磷血症,全肾饮食知识不佳的患者有61.0%发生高磷血症,磷知识不佳的患者有三分之二(66.7%)发生高磷血症。磷知识是控制血清磷的重要决定因素(OR= 0.545 p=0.005),膳食磷摄入量是高磷血症的危险因素(OR=1.001, p=0.024)。决定饲粮磷粘附性的主要因素是蛋白质摄入量(OR =1.084, p<0.001)。结论:MHD患者肾脏饮食及磷知识均较差。磷知识可以防止高磷血症的发展。蛋白质摄入量高的患者磷摄入量也高。需要教育MHD患者在选择低磷蛋白质的同时如何摄入足够的蛋白质。
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The Relationship between Knowledge about Phosphorus, Dietary Phosphorus Intake and Serum Phosphorus Level in Maintenance Hemodialysis Patients
Background: Renal diet knowledge -especially phosphorus knowledge- is generally poor in Maintenance Hemodialysis (MHD) patients due to the complexity of information about dietary phosphorus thus causing poor compliance to dietary phosphorus guidelines and hyperphosphatemia. Objective(s): This study aimed to investigate the relationship between knowledge about phosphorus, dietary phosphorus intake and serum phosphorus level in MHD patients. Methods: A cross-sectional study was conducted on 110 MHD patients in the hemodialysis center in Alexandria Main University Hospital. A questionnaire was used to collect demographic and clinical data and 24-hour dietary recall. A 25-item nutrition knowledge questionnaire was asked to patients. Patients’ medical records were reviewed to collect data about the underlying cause of End Stage Renal Disease (ESRD), duration of dialysis and serum biochemical parameters. Dry Body Weight (DBW) and height were measured using a stadiometer following a standard protocol and Body Mass Index (BMI) was calculated. Results : Hyperphosphatemia was common (44.5%) in the present sample. Energy intake and protein intake were inadequate in 76.4% and 74.5% of patients. Mean phosphorus intake of hyperphosphatemia patients was higher than controlled patients (1053.99±420.18 mg/d vs 854.18±353.99 mg/d). Almost half of the patients (51.2 %) who consumed phosphorus intake >1000 mg/d had hyperphosphatemia and 61.0 % of patients with poor total renal diet knowledge and two thirds of patients (66.7%) with poor phosphorus knowledge had hyperphosphatemia. Phosphorus knowledge was a strong determinant for controlled serum phosphorus (OR =0.545 p=0.005), dietary phosphorus intake was a risk factor for hyperphosphatemia (OR=1.001, p=0.024). The main determinant of dietary phosphorus adherence was protein intake (OR =1.084, p<0.001). Conclusion: MHD patients have both poor renal diet and phosphorus knowledge. Phosphorus knowledge protects against development of hyperphosphatemia. Patients with higher protein intake had a high phosphorus intake. MHD patients need to be educated how to consume adequate protein while choosing lower phosphorus protein choices.
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