慢性肾脏病(CKD)的保守治疗包括营养治疗(NT),目的是减少蛋白质的摄入。磷,有机酸,钠,钾,同时确保充足的热量摄入。虽然有证据表明NT可能有助于预防和控制CKD的代谢改变,在CKD中实施低蛋白治疗方案的标准仍存在争议.关于饮食的组成没有最终的共识,也不适应特定患者设置或不同阶段的CKD。此外,何时以及如何开始CKD中不同营养素的饮食操作还没有很好的定义。一组意大利肾脏病学家参加了会议,在意大利肾脏病学会的主持下,在Delphi练习中,探讨了有关意大利CKD营养治疗的一些悬而未决的问题的共识,就以下23项陈述达成共识意见:(1)NT的一般原则;(2)NT的适应症和开始;(3)无蛋白产品的作用;(4)NT安全性;(5)NT的综合管理。此Delphi练习表明,在广泛的管理领域中,关于CKD中的NT存在广泛的共识。这些临床医生主导的共识声明为CKD患者NT的适当指导提供了框架,并尽可能作为决策的指南。
The conservative management of chronic kidney disease (CKD) includes nutritional therapy (NT) with the aim to reduce the intake of proteins, phosphorus, organic acids, sodium, and potassium, while ensuring adequate caloric intake. While there is evidence that NT may help to prevent and control metabolic alterations in CKD, the criteria for implementing a low-protein regimen in CKD are still debated. There is no final
consensus on the composition of the diet, nor indications for specific patient settings or different stages of CKD. Also when and how to start dietary manipulation of different nutrients in CKD is not well defined. A group of Italian nephrologists participated, under the auspices of the Italian Society of Nephrology, in a Delphi exercise to explore the
consensus on some open questions regarding the nutritional treatment in CKD in Italy, generating a
consensus opinion for 23 statements on: (1) general principles of NT; (2) indications for and initiation of NT; (3) role of protein-free products; (4) NT safety; (5) integrated management of NT. This Delphi exercise shows that there is broad
consensus regarding NT in CKD across a wide range of management areas. These clinician-led
consensus statements provide a framework for appropriate guidance on NT in patients with CKD, and are intended as a guide in decision-making whenever possible.