現在位置 :  腎病 > 腎臟病與蛋白質的攝取

Click here to edit.
腎臟病患補太多 恐提早洗腎
腎臟病患常喝雞精 恐提早洗腎
台灣新生報    記者蘇湘雲／台北報導    2013年8月13日
       常有慢性腎臟病患者認為自己腎不好、身體虛，所以需要用雞精補一補，這種做法反而會增加腎臟負擔，可能導致提早洗腎。
      台北慈濟醫院腎臟科主治醫師郭克林指出，雞精蛋白質含量很高，鈉含量也很高，腎臟病患者若常食用高蛋白、高鹽食物，不但容易水腫，腎臟功能也很容易惡化。
       郭克林醫師表示，慢性腎臟病患者飲食上要減少蛋白質比例，為了避免發生水腫問題，也不宜吃太鹹，必要時，可搭配酮酸胺基酸營養劑來延緩洗腎時機，酮酸胺基酸是人體必需胺基酸前驅物，可與含氮尿毒素結合，轉化為必需胺基酸。必須搭配低蛋白飲食，才能發揮作用。
       郭克林醫師強調，常有人希望吃一種藥就馬上好，就亂吃偏方、不明中草藥，導致腎臟提早壞掉。事實上，治療慢性腎臟病時，患者必須同時調整飲食、生活習慣，才能延緩病情惡化。
       另有不少民眾因腰痛、懷疑有腎臟病看門診，郭克林醫師對此表示，腰痛不等於有腎臟病，腎臟跟肝臟一樣沒有神經，一開始受損時，並沒有特別症狀，因此不易初期察覺。
       患者往往等到第三期慢性腎臟病，才開始有些抽血指數才開始出現異常，但絕大多數的患者是拖到慢性腎臟病達較嚴重的第四期或第五期，已出現水腫、疲倦、貧血等症狀，或因尿毒症產生皮膚癢，才就醫確診。醫師建議，民眾可接受驗尿檢查，以確認是否有蛋白尿、血尿、尿糖等腎臟疾病異常徵兆。

低蛋白飲食可使大鼠腎功能衰竭發生率減低，並延長壽命。
慢性腎炎科學選擇飲食
東方網    飲食營養   發佈日期：2006-11-29
　　食物中主要有三大營養物質，即蛋白質、脂肪和碳水化合物。對腎臟病病情有影響者主要是蛋白質。一些研究證實，給予腎病大鼠高蛋白飲食，可以促進腎小球硬化發生；而予低蛋白飲食卻可使大鼠腎功能衰竭發生率減低，並延長壽命。80年代又在臨床作了如下觀察，給肌酐清除率在60—30毫升／分鐘的腎功能不全患者，予每日每公斤(千克)體重0．6克蛋白質攝入，或給肌酐清除率小于30毫升／分鐘的患者每日每公斤(千克)體重0．4克蛋白質，觀察兩年，與不限制蛋白質攝入的對照組比較，證實限制蛋白質入量能明顯延緩病人腎功能損害進展，而隨訪4年後，發現限制蛋白質攝入對肌酐清除率小于30毫升／分鐘的患者更為有益。4年內進入終末期腎功能衰竭者，在沒有限制蛋白質攝入組達47．5％，而限制蛋白攝入組僅15．4％，兩者差別具有高度顯著性。腎功能不全時，高蛋白飲食能造成腎小球高灌注及高濾過，這可能是高蛋白飲食促進腎小球硬化、加速腎功能損害的主要機制。

　　但是蛋白質又是人體必需的營養物，如果缺少會造成營養不良及機體免疫力低下，對健康不利。因此，要針對患者的不同情況來調整飲食蛋白質入量。一般認為，腎功能正常的慢性腎炎患者應該攝入正常量蛋白質，即每日每公斤(千克)體重1克。當腎功能不全出現時，才限制蛋白質入量，一般限制在每日每公斤(千克)體重0．6克左右。不能過度限制飲食蛋白質，以防造成營養不良；而且在所限制的蛋白質入量範圍內，要優先選擇優質蛋白質進食，如牛奶、雞蛋、新鮮瘦肉及魚等。非優質蛋白質如豆腐、豆類製品等植物蛋白不是不能吃，但其比例不應超過蛋白質總千克人量的1／3。

　　所謂優質蛋白是指必需氨基酸含量多的蛋白質。必需氨基酸在腎功能不全時常嚴重缺乏而必須補充。但是，單靠食物補充，哪怕是含必需氨基酸最多的食物(如雞蛋含46．2％，牛奶含44．8％)補充，也難滿足需要。所以在限制蛋白質入量時，應該注意補充藥物性必需氨基酸或其衍生物。目前市售的品種有幾種，最值得推薦的是腎靈，具體劑量是每日3次，每次3至6片。腎靈又稱開同或復方α-酮酸，內含有賴氨酸、蘇氨酸、色氨酸、組氨酸和酪氨酸(組氨酸及酪氨酸並非必需氨基酸，但腎衰時也常缺乏)，同時含有幾種與必需氨基酸相對應的α-酮酸和α-羧酸，(酮-亮氨酸、酮-異亮氨酸，酮-苯丙氨酸，酮-纈氨酸和羥-蛋氨酸)，酮酸或經酸進入體內後，經過生化反應能生成相應的氨基酸。腎靈是目前較理想的適於腎功能不全患者服用的藥物，該藥除能補充必需氨基酸進行營養治療外，配合低蛋白飲食還有延緩腎功能損害進展的作用。

　　在低蛋白飲食加必需氨基酸治療的同時，還必須保證每日進食的食物要有足夠的熱量。這可以通過適當增加飲食中碳水化合物(如麥澱粉、藕粉及食糖等)及植物油來做到。熱量最好能達到每日每公斤(千克)體重146．5幹焦(每克碳水化合物及蛋白質能産熱16．74千焦，每克脂肪能産熱37．7千焦)，以保證攝入的蛋白質能被機體充分利用去合成自身蛋白質(熱量不足時，蛋白質將同碳水化合物及脂肪一樣，被作為“燃料”氧化産熱，而不能在分解成氨基酸後，被再利用合成自身蛋白質)，糾正機體負氮平衡。

　　患者家屬最好能到書店買一本《食物成分表》以便詳細了解各種食物的蛋白質、碳水化合物及脂肪含量，從而幫助患者安排好每日膳食。

　　此外，若慢性腎炎患者有高血壓或(和)水腫時，限制食鹽人量也很重要，以減輕機體水、鈉潴留，有利降壓及利尿。一般應每日攝入食鹽3克左右為宜。
Diet - chronic kidney disease
MediLinePlus  
You may need to make changes to your diet when you have chronic kidney disease. These changes include:
•Limiting fluids
•Eating a low-protein diet
•Limiting salt, potassium, phosphorous, and other electrolytes
•Getting enough calories if you are losing weight
You may need to alter your diet more if your kidney disease gets worse, or if you need dialysis.
Function
       The purpose of this diet is to keep the levels of electrolytes, minerals, and fluid in your body balanced when you have chronic kidney disease or are on dialysis. People on dialysis need this special diet to limit the buildup of waste products in the body.
       Limiting fluids between dialysis treatments is very important because most people on dialysis urinate very little. Without urination, fluid will build up in the body and cause too much fluid in the heart, lungs, and ankles.
Recommendations
       Ask your doctor to refer you to a registered dietitian to help you with your diet for kidney disease. Some dietitians specialize in kidney diets. Your dietitian can also help you create a diet to fit your other health needs.
       The Kidney Foundation has chapters in most states. It is a good place for people with kidney disease and their families to find programs and information. You need to take in enough calories each day to keep you healthy and prevent the breakdown of body tissue. Ask your doctor and dietitian what your ideal weight should be. Weigh yourself every morning to make sure you are meeting this goal.
CARBOHYDRATES
       If you do not have a problem eating carbohydrates, these foods are a good source of energy. If your health care provider has recommended a low-protein diet, you may replace the calories from protein with:
•Fruits, breads, grains, and vegetables. These foods provide energy, as well as fiber, minerals, and vitamins.
•Hard candies, sugar, honey, and jelly. If needed, you can even eat high-calorie desserts such as pies, cakes, or cookies, as long as you limit desserts made with dairy, chocolate, nuts, or bananas.
FATS
       Fats can be a good source of calories. Make sure to use monounsaturated and polyunsaturated fats (olive oil, canola oil, safflower oil) to protect your heart health. Talk to your doctor, nurse, or dietitian about fats and cholesterol that may increase your risk for heart problems.
PROTEIN
       Low-protein diets may be helpful before you start dialysis. Your doctor or dietitian may recommend a moderate-protein diet (1 gram of protein per kilogram of body weight per day).
       Once you start dialysis, you will need to eat more protein. A high-protein diet with fish, poultry, pork, or eggs at every meal may be recommended. This will help you replace muscles and other tissues that you lose.
       People on dialysis should eat 8 - 10 ounces of high-protein foods each day. Your doctor, dietitian, or nurse may suggest adding egg whites, egg white powder, or protein powder.
CALCIUM AND PHOSPHOROUS
       The minerals calcium and phosphorous will be checked often. Even in the early stages of chronic kidney disease, phosphorous levels in the blood can get too high. This can cause:
•Low calcium. This causes the body to pull calcium from your bones, which can make your bones weaker and more likely to break.
•Itching
       You will need to limit the amount of dairy foods you eat, because they contain large amounts of phosphorous. This includes milk, yogurt, and cheese. Some dairy foods are lower in phosphorous, including tub margarine, butter, cream cheese, heavy cream, ricotta cheese, brie cheese, sherbet, and nondairy whipped toppings.
       Fruits and vegetables contain only small amounts of phosphorous, but may contain large amounts of potassium.
       You may need to take calcium supplements to prevent bone disease, and vitamin D to control the balance of calcium and phosphorous in your body. Ask your doctor, nurse, or dietitian about how best to get these nutrients.
       Your doctor may recommend medicines called "phosphorous binders" if diet changes alone do not work to control the balance of this mineral in your body.
FLUIDS
       In the early stages of kidney failure, you do not need to limit the fluid you drink. But, as your condition gets worse, or when you are on dialysis, you will need to watch the amount of liquid you take in.
       In between dialysis sessions, fluid can build up in the body. Too much fluid will lead to shortness of breath, an emergency that needs immediate medical attention.
       Your doctor and dialysis nurse will let you know how much you should drink every day. Do not eat too much of foods that contain a lot of water, such as soups, Jell-O, Popsicles, ice cream, grapes, melons, lettuce, tomatoes, and celery.
       Use smaller cups or glasses and turn over your cup after you have finished it.
       Tips to keep from becoming thirsty include:
•Avoid salty foods
•Freeze some juice in an ice cube tray and eat it like a Popsicle (you must count these ice cubes in your daily amount of fluids)
•Stay cool on hot days
SALT OR SODIUM
       Reducing sodium in your diet helps you control high blood pressure. It also keeps you from being thirsty, and prevents your body from holding onto extra fluid. It is likely that you will need to cut down the sodium in your diet.
       Look for these words on food labels:
•Low-sodium
•No salt added
•Sodium-free
•Sodium-reduced
•Unsalted
       Check all labels to see how much salt or sodium foods contain per serving. Also, avoid foods that list salt near the beginning of the ingredients. Look for products with less than 100 mg of salt per serving.
       Do not use salt when cooking and take the salt shaker away from the table. Most other herbs are safe, and you can use them to flavor your food instead of salt.
       DO NOT use salt substitutes because they contain potassium. People with chronic kidney disease also need to limit their potassium.
POTASSIUM
       Normal blood levels of potassium help keep your heart beating steadily. However, too much potassium can build up when the kidneys no longer function well. Dangerous heart rhythms may result, which can lead to death.
       Potassium is found in many food groups, including fruits and vegetables. Choosing the right item from each food group can help control your potassium levels.
When eating fruits:
•Choose peaches, grapes, pears, cherries, apples, berries, pineapple, plums, tangerines, and watermelon
•Limit or avoid oranges and orange juice, nectarines, Kiwis, raisins or other dried fruit, bananas, cantaloupe, honeydew, prunes, and nectarines
When eating vegetables:
•Choose broccoli, cabbage, carrots, cauliflower, celery, cucumber, eggplant, green and wax beans, lettuce, onion, peppers, watercress, zucchini, and yellow squash
•Limit or avoid asparagus, avocado, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, avocado, and cooked spinach
IRON
       People with advanced kidney failure also have anemia and usually need extra iron.
       Many foods contain extra iron (liver, beef, pork, chicken, lima and kidney beans, iron-fortified cereals). Talk to your doctor, nurse, or dietitian which foods with iron you can eat because of your kidney disease.
Alternative Names :  Renal disease - diet; Kidney disease - diet
References
Abboud H, Henrich WL. Clinical practice. Stage IV chronic kidney disease. N Engl J Med. 2010;362:56-65.
National Kidney Foundation. Dietary Guidelines for Adults Starting on Hemodialysis. 2009. Accessed September 22, 2009.
Eat right to feel right on hemodialysis. NIH Publication No. 08-4274. September 2, 2010. Accessed August 2, 2011.
Mitch WE. Chronic kidney disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 132.
Update Date: 10/2/2013
Updated by: Scott Miller, MD, Urologist in private practice in Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.