Interpretation of the KDOQI Clinical Practice Guideline for Nutrition in CKD：2020 Update

doi:10.12114/j.issn.1007-9572.2021.00.166

Abstract

Abstract: CHENG Gaiping1，QIN Wei2，LIU Jing1，LIU Yuan1*
In September 2020，The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative（KDOQI）updated its clinical practice guideline for nutrition in CKD.Since the publication of the initial KDOQI nutrition guideline 20 years ago，there has been a great accumulation of new evidence about the nutritional management of kidney disease.The guideline was expanded to include patients with end-stage kidney disease or advanced CKD，patients with stages 1-5 CKD without ongoing dialysis and patients with a functional kidney transplant.The updated guideline statements cover 6 primary areas：nutritional assessment，medical nutrition therapy，dietary protein and energy intake，nutritional supplementation，micronutrients，and electrolytes.The guidelines mainly include dietary management rather than all possible nutritional interventions.Focusing on the main contents of the guideline，the paper interpreted main recommendations and discussed the application in light of the actual situation in China.

Key words: Kidney Diseases, Chronic kidney disease, Nutrition nutrition, Guidebooks

摘要： 2020年9月，国家肾脏基金会肾病预后质量倡议（KDOQI）发布《KDOQI慢性肾病营养临床实践指南2020更新版》。20年前KDOQI发布首个终末期肾病患者营养指南，20年来营养管理的新证据不断出现。更新指南不仅包括终末期肾病或晚期慢性肾脏病（CKD）患者，还包括未接受透析的1~5期CKD患者和肾移植患者。更新指南内容涵盖6个领域：营养评估、医学营养治疗、膳食蛋白质和能量摄入、营养补充剂、微量营养素和电解质。主要包括饮食管理，而不是所有可能的营养干预。本文对其中主要内容进行解读，并结合我国实际情况进行讨论。

关键词: 肾疾病, 慢性肾脏病, 营养治疗, 指南

CHENG Gaiping,QIN Wei,LIU Jing, et al. Interpretation of the KDOQI Clinical Practice Guideline for Nutrition in CKD：2020 Update　[J]. Chinese General Practice, 2021, 24(11): 1325-1332. DOI: 10.12114/j.issn.1007-9572.2021.00.166.
程改平,秦伟,刘婧等. 《KDOQI慢性肾脏病营养临床实践指南2020更新版》解读[J]. 中国全科医学, 2021, 24(11): 1325-1332. DOI: 10.12114/j.issn.1007-9572.2021.00.166.

References

［1］KOPPLE J D.National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure［J］．Am J Kidney Dis，2001，37（1 Suppl 2）：S66-70．DOI：10.1053/ajkd.2001.20748.
［2］IKIZLER T A，BURROWES J D，BYHAM-GRAY L D，et al．KDOQI clinical practice guideline for nutrition in CKD：2020 update［J］．Am J Kidney Dis，2020，76（3 Suppl 1）：S1-107．DOI：10.1053/j.ajkd.2020.05.006.
［3］Kidney Disease：Improving Global Outcomes （KDIGO） Diabetes Work Group.KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease［J］．Kidney Int，2020，98（4S）：S1-115．DOI：10.1016/j.kint.2020.06.019.
［4］CANO N J，APARICIO M，BRUNORI G，et al．ESPEN Guidelines on Parenteral Nutrition：adult renal failure［J］．Clin Nutr，2009，28（4）：401-414．DOI：10.1016/j.clnu.2009.05.016.
［5］CANO N，FIACCADORI E，TESINSKY P，et al．ESPEN guidelines on enteral nutrition：adult renal failure［J］．Clin Nutr，2006，25（2）：295-310．DOI：10.1016/j.clnu.2006.01.023.
［6］WRIGHT M，SOUTHCOTT E，MACLAUGHLIN H，et al．Clinical practice guideline on undernutrition in chronic kidney disease［J］．BMC Nephrol，2019，20（1）：370．DOI：10.1186/s12882-019-1530-8.
［7］林善锬，谌贻璞，钱家麒，等．慢性肾脏病蛋白营养治疗共识［J］．实用糖尿病杂志，2005，1（5）：3-6．DOI：10.3969/j.issn.1673-9191.2005.05.001.
LIN S T，CHAN Y P，QIAN J Q，et al．Consensus on protein nutritional therapy for chronic kidney disease［J］．J Pract Diab，2005，1（5）：3-6．DOI：10.3969/j.issn.1673-9191.2005.05.001.
［8］中华人民共和国国家卫生和计划生育委员会.WS/T 557—2017慢性肾脏病患者膳食指导［S］．2017.
［9］王陇德.中国居民营养与健康状况调查报告之一——2002综合报告［M］．北京：人民卫生出版社，2005.
［10］高春娟，崔俊，王好，等．生物电阻抗法人体成分测量对慢性肾脏病非透析患者营养状态评估［J］．中国中西医结合肾病杂志，2011，12（12）：1076-1078.
GAO C J，CUI J，WANG H，et al．Early detection of malnutritional status in non-Dialysis CKD patients by bioimpedance analysis［J］．Chinese Journal of Integrated Traditional and Western Nephrology，2011，12（12）：1076-1078.
［11］崔红蕊，李明明，杨洪娟，等．生物电阻抗技术评价终末期肾脏病患者人体成分及营养状况的研究［J］．中国现代医学杂志，2016，26（19）：75-79.
CUI H R，LI M M，YANG H J，et al．Assessment of human body composition and nutritional status in patients with end-stage renal disease by biological electrical impedance technology［J］．China Journal of Modern Medicine，2016，26（19）：75-79.
［12］LIU X H，ZHENG X H，YI C Y，et al．Gender-specific associations of skeletal muscle mass and arterial stiffness among peritoneal Dialysis patients［J］．Sci Rep，2018，8（1）：1351．DOI：10.1038/s41598-018-19710-6.
［13］GREENHALL G H，DAVENPORT A.Screening for muscle loss in patients established on peritoneal Dialysis using bioimpedance［J］．Eur J Clin Nutr，2017，71（1）：70-75．DOI：10.1038/ejcn.2016.202.
［14］YANISHI M，KIMURA Y，TSUKAGUCHI H，et al．Factors associated with the development of sarcopenia in kidney transplant recipients［J］．Transplant Proc，2017，49（2）：288-292．DOI：10.1016/j.transproceed.2016.12.015.
［15］SEZER S，KARAKAN S，ACAR N ?.Association of conicity index and renal progression in pre-Dialysis chronic kidney disease［J］．Ren Fail，2012，34（2）：165-170．DOI：10.3109/0886022X.2011.642790.
［16］RUPERTO M，BARRIL G，SáNCHEZ-MUNIZ F J.Conicity index as a contributor marker of inflammation in haemodialysis patients［J］．Nutr Hosp，2013，28（5）：1688-1695．DOI：10.3305/nh.2013.28.5.6626.
［17］RUPERTO M，BARRIL G，SáNCHEZ-MUNIZ F J.Usefulness of the conicity index together with the conjoint use of adipocytokines and nutritional-inflammatory markers in hemodialysis patients［J］．J Physiol Biochem，2017，73（1）：67-75．DOI：10.1007/s13105-016-0525-1.
［18］ANDRASSY K M.Comments on ‘KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease'［J］．Kidney Int，2013，84（3）：622-623．DOI：10.1038/ki.2013.243.
［19］CHEN X R，WEI G，JALILI T，et al．The associations of plant protein intake with all-cause mortality in CKD［J］．Am J Kidney Dis，2016，67（3）：423-430．DOI：10.1053/j.ajkd.2015.10.018.
［20］HARING B，SELVIN E，LIANG M L，et al．Dietary protein sources and risk for incident chronic kidney disease：results from the atherosclerosis risk in communities （ARIC） study［J］．J Ren Nutr，2017，27（4）：233-242．DOI：10.1053/j.jrn.2016.11.004．
［21］LEW Q J，JAFAR T H，KOH H W，et al．Red meat intake and risk of ESRD［J］．J Am Soc Nephrol，2017，28（1）：304-312．DOI：10.1681/ASN.2016030248.
［22］FRANKEL A H，KAZEMPOUR-ARDEBILI S，BEDI R，et al．Management of adults with diabetes on the haemodialysis unit：summary of guidance from the Joint British Diabetes Societies and the Renal Association［J］．Diabet Med，2018，35（8）：1018-1026．DOI：10.1111/dme.13676.
［23］LOCHS H，ALLISON S P，MEIER R，et al．Introductory to the ESPEN guidelines on enteral nutrition：terminology，definitions and general topics［J］．Clin Nutr，2006，25（2）：180-186．DOI：10.1016/j.clnu.2006.02.007.
［24］FRIEDMAN A N，YU Z S，TABBEY R，et al．Low blood levels of long-chain n-3 polyunsaturated fatty acids in US hemodialysis patients：clinical implications［J］．Am J Nephrol，2012，36（5）：451-458．DOI：10.1159/000343741.
［25］GOPALAKRISHNAN N，ABRAHAM G.Management of hypertension in chronic kidney disease：consensus statement by an expert panel of Indian nephrologists［J］．J Assoc Physicians India，2017，65（2 Suppl）：5.
［26］中国营养学会.中国居民膳食指南-2016［M］．北京：人民卫生出版社，2016.

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