Determinar alternativas dietéticas para pacientes con enfermedad renal crónica terminal en hemodiálisis que presentan hiperfosfatemia
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2014
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Carrera de Tecnología Médica
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La enfermedad renal crónica constituye en la actualidad un importante problema de salud pública. La manifestación más avanzada es la enfermedad renal crónica terminal y por consiguiente la necesidad de tratamiento renal sustitutivo. Como consecuencia de la pérdida renal progresiva se van produciendo una serie de alteraciones bioquímicas como: Alteraciones del metabolismo fosfo-cálcico por la presencia de Hiperfosfatemia que ocurre cuando existen valores de fósforo sérico que sobrepasan de 5.5 mg/dl. Con la presencia de la hiperfosfatemia aumenta la secreción de parathormona y desciende los niveles de calcitriol, el conjunto de estos trastornos favorece la formación de calcificaciones vasculares y a la descalcificación ósea, es por eso que la hiperfosfatemia ejerce un papel importante en las alteraciones sobre el esqueleto y el sistema cardiovascular. Es evidente que la ingesta de fosfatos juega un rol en la aparición del hiperparatiroidismo secundario desde los estadios precoces de la enfermedad renal crónica terminal. El control del fósforo en estos pacientes es necesario para evitar el desarrollo y complicaciones del hiperparatiroidismo secundario y reducir la alta tasa de morbimortalidad de estos pacientes. El control del fósforo requiere restricción dietética. La estrecha relación entre contenido de fósforo y proteína de los alimentos hace difícil la restricción del fósforo sin una restricción de la ingesta proteica, los alimentos vegetales ricos en fósforo como los frutos secos y las legumbres también suelen serlo en ácido fítico, estos alimentos suelen estar reducidos o eliminados de la dieta de los pacientes con enfermedad renal crónica terminal, debido también a su alta proporción de potasio, no obstante, en el caso de las legumbres el remojo la doble cocción pueden reducir la concentración de potasio, mientras que el fósforo no es totalmente asimilable, por lo tanto se puede mantener la recomendación de consumir legumbres al menos dos veces a la semana.
Chronic kidney disease is currently a major public health problem. The most advanced manifestation is terminal chronic kidney disease and therefore the need for renal replacement therapy. As a consequence of progressive renal loss, a series of biochemical alterations are produced such as: Alterations of phospho-calcium metabolism due to the presence of Hyperphosphatemia that occurs when there are serum phosphorus values that exceed 5.5 mg / dl. With the presence of hyperphosphatemia parathormone secretion increases and calcitriol levels decrease, the set of these disorders favors the formation of vascular calcifications and bone decalcification, that is why hyperphosphatemia plays an important role in the alterations on the skeleton and the cardiovascular system. It is evident that the intake of phosphates plays a role in the appearance of secondary hyperparathyroidism from the early stages of end-stage renal disease. The control of phosphorus in these patients is necessary to avoid the development and complications of secondary hyperparathyroidism and reduce the high morbidity and mortality rate of these patients. Control of phosphorus requires dietary restriction. The close relationship between phosphorus content and protein in food makes it difficult to restrict phosphorus without a restriction of protein intake, plant foods rich in phosphorus such as nuts and legumes are also usually found in phytic acid, these foods tend to be reduced or eliminated from the diet of patients with terminal chronic kidney disease, also due to its high proportion of potassium, however, in the case of legumes soaking the double cooking can reduce the concentration of potassium, while phosphorus does not it is totally assimilable, therefore the recommendation to consume vegetables at least twice a week can be maintained.
Chronic kidney disease is currently a major public health problem. The most advanced manifestation is terminal chronic kidney disease and therefore the need for renal replacement therapy. As a consequence of progressive renal loss, a series of biochemical alterations are produced such as: Alterations of phospho-calcium metabolism due to the presence of Hyperphosphatemia that occurs when there are serum phosphorus values that exceed 5.5 mg / dl. With the presence of hyperphosphatemia parathormone secretion increases and calcitriol levels decrease, the set of these disorders favors the formation of vascular calcifications and bone decalcification, that is why hyperphosphatemia plays an important role in the alterations on the skeleton and the cardiovascular system. It is evident that the intake of phosphates plays a role in the appearance of secondary hyperparathyroidism from the early stages of end-stage renal disease. The control of phosphorus in these patients is necessary to avoid the development and complications of secondary hyperparathyroidism and reduce the high morbidity and mortality rate of these patients. Control of phosphorus requires dietary restriction. The close relationship between phosphorus content and protein in food makes it difficult to restrict phosphorus without a restriction of protein intake, plant foods rich in phosphorus such as nuts and legumes are also usually found in phytic acid, these foods tend to be reduced or eliminated from the diet of patients with terminal chronic kidney disease, also due to its high proportion of potassium, however, in the case of legumes soaking the double cooking can reduce the concentration of potassium, while phosphorus does not it is totally assimilable, therefore the recommendation to consume vegetables at least twice a week can be maintained.
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DIETOTERAPIA, INSUFICIENCIA RENAL CRONICA, HIPERFOSFATEMIA, INSTITUTO ECUATORIANO DE DIALISIS Y TRASPLANTE, CANTON GUAYAQUIL, ECUADOR, EPIDEMIOLOGIA DESCRIPTIVA