PURPOSE:Tolvaptan, a vasopressin V2 receptor antagonist, slows the decline in renal function in autosomal dominant polycystic kidney disease (ADPKD). However, it increases urine output such that patient adherence could be compromised. In a cohort of patients with ADPKD on tolvaptan, we aimed to identify the contribution of sodium and urea excretion rate to daily urine output, and to evaluate the effectiveness of dietary counseling on sodium and urea excretion rates. METHODS:Retrospective analysis of 30 ADPKD patients who underwent a single session of personalized dietary counseling to reduce sodium and protein intake before initiation of tolvaptan. Creatinine and 24-h urine were obtained regularly on treatment. Generalized estimation equations were used. RESULTS:Mean age and median eGFR were 44 ± 11 years and 52 (43-74) ml/min/1.73 m2. Tolvaptan increased diuresis from 2.5 to 5.2 l/day. After adjusting for the dose of tolvaptan, an increase in sodium and urea excretion rate by 50 mmol/day was associated with an estimated additional urine volume of 0.6 l/day (95% CI 0.4-0.8 l/day; P < 0.001) and 0.25 l/day (95% CI 0.11-0.39 l/day; P < 0.001), respectively. Dietary counseling resulted in a transient reduction of sodium excretion by 19 mmol/day during the first 4 months (P = 0.016) but resulted in a more sustained reduction in urea excretion by 69 mmol/day (P = 0.008). CONCLUSION:Both sodium and urea excretion rates contribute significantly to daily urine volume in patients treated with tolvaptan, and a single session of dietary counseling was transiently effective in reducing sodium intake but achieved a more sustained reduction in protein intake. Dietary counseling should be considered in the management of ADPKD patients treated by tolvaptan.

译文

目的:托伐普坦,一种血管加压素V2受体拮抗剂,可延缓常染色体显性遗传性多囊肾(ADPKD)肾功能的下降。但是,它会增加尿量,从而可能损害患者的依从性。在一群接受托伐普坦治疗的ADPKD患者中,我们旨在确定钠和尿素排泄率对每日尿量的贡献,并评估饮食咨询对钠和尿素排泄率的有效性。
方法:对30例ADPKD患者进行回顾性分析,这些患者在开始使用托伐普坦之前接受了一次个性化饮食咨询以减少钠和蛋白质的摄入。治疗期间定期获取肌酐和24小时尿液。使用了广义估计方程。
结果:平均年龄和平均eGFR为44±11岁,52(43-74)ml / min / 1.73m2。托伐普坦的利尿作用从2.5升/天增加到5.2升/天。调整托伐普坦的剂量后,钠和尿素排泄速率增加50 mmol /天与估计的额外尿量0.6升/天有关(95%CI 0.4-0.8升/天; P <0.001)和分别为0.25 l /天(95%CI 0.11-0.39 l /天; P <0.001)。饮食咨询在头四个月内使钠排泄瞬时减少了19 mmol /天(P = 0.016),但导致尿素排泄更持久地减少了69 mmol / day(P = 0.008)。
结论:托伐普坦治疗的患者每日尿液中钠和尿素的排泄率显着提高,并且一次饮食咨询可以暂时有效地减少钠的摄入量,但可以更持久地减少蛋白质的摄入量。在托伐普坦治疗的ADPKD患者的治疗中应考虑饮食咨询。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录