【5A版】开同专家会议.ppt

《【5A版】开同专家会议.ppt》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。

1、KetoacidtherapyandCKDmetaboliccomplications3rdInternationalKetoanaloguesymposiumSeoul,March30-31,2007M.AparicioM.DIntroductionCRFresultsinnumerousmetabolicdisorderswhichaccountforseverecomplicationsresponsibleformajormorbidityandmortalitycondition.Preventionofthesec

2、omplicationsshouldbetheaimwhilemanagingCKDpatientsinordertoimproveausuallypooroutcome.PhysiopathologyofmetabolicdisordersinCRF°Accumulationofwasteproductsusuallyexcretedbythekidneys:-nitrogenouswasteproducts,H+ions,phosphate….°Iontransportabnormalities°Decreasedhormo

3、neproduction:-EPO,calcitriol°Decreasedhormoneclearance:-insulin,glucagon,leptin°InflammationWhybeneficialeffectsonmetabolicdisorderscanbeexpectedfromSVLPDSVLPDpermitstherestrictionoftheintakeoroftheproductionofnitrogenouswasteproducts,phosphate,inorganicionsandhydrog

4、enions.SVLPDimprovesNa+K+ATPaseactivityinCRFpatientsLastly,itislikelythatSVLPDiseffectiveincorrectinginflammationassuggestedbyrecentnutritionalinterventionsusingaconventionalLPDorMediterranean-styledietCaloricsupply(kcal/kgbw/day)30-35%fromcarbohydrates67%fromlipids3

5、0%fromproteins3Proteincontent(g/kgbw/day)0.3-0.4(max.0.6)Phosphoruscontent(mg/kgbw/day)5-7Supplementedwith:Calcium(g/day)0.5-1.0VitaminD(IU/day)1,000Iron(mg/day)100mg/kgbw/day10-15DietarymanagementinCKDCompositionofaKetoAcidTherapyKA/AA(Ketosteril®)EffectsofSVLPDonc

6、arbohydratemetabolismdisordersInsulinresistanceinCKDpatientsOccursearlyinthecourseofCRFandispresentinmorethan50%ofCKDpatients.Isfavouredby:-accumulationofproteinwasteproducts-metabolicacidosis-inflammation-2ndHPTInsulinresistanceinCKDpatientseffectsoncarbohydratemeta

7、bolismInsulinresistance:-decreasedglucosestorage-decreasedglucoseoxidation-increasedendogenousglucoseproduction-decreasedmetabolicclearancerateofinsulin-elevatedfastingglucoseandinsulinlevelsInsulinresistanceintypeIIdiabetesandinCRFtypeIIdiabetesCRFglycemia+++insuli

8、nlevels++++glucosestorage----glucoseoxidation--EGP++++Invivoexplorationofglucosemetabolism:thetoolsOralglucosetolerancetest:overal