Palabras clave
insuficiencia renal crónica
nutrición
Cómo citar
Resumen
Introducción:
La dieta con restricción de proteínas parece tener un papel importante en la progresión de la enfermedad renal crónica (ERC) y la aparición anticipada de síntomas urémicos, además la suplementación de aminoácidos esenciales ofrece aparente seguridad para lograr restricciones agresivas de proteínas.
Objetivo:
Realizar una revisión de la literatura para establecer las recomendaciones de uso práctico sobre la dieta con restricción de proteínas en la ERC avanzada.
Materiales y métodos:
Se realizó una búsqueda estructurada rápida de la literatura en la que se incluyeron revisiones sistemáticas y metaanálisis, de los cuales se extrajeron las respuestas de las preguntas con estructura PICOT diseñadas a priori. Los resultados fueron sometidos a consenso para generar recomendaciones prácticas.
Resultados:
Se incluyeron 6 revisiones sistemáticas de la literatura con una evaluación de calidad moderada. Según los hallazgos, una dieta muy baja en proteínas con suplementación de alfacetoanálogos beneficia a los pacientes que ingresan a diálisis o son sometidos a trasplante renal, además reduce la progresión de la enfermedad. No obstante, se requiere de ensayos clínicos con mejor calidad que consideren aspectos como la calidad de vida.
Conclusión:
Aunque la evidencia es de baja calidad, se establece que la dieta muy baja en proteínas y suplementada con alfa-cetoanálogos en pacientes adecuadamente seleccionados reduce el deterioro de la tasa de filtración glomerular y parece reducir el ingreso a diálisis. Por tanto, se recomienda hacer un seguimiento estricto y periódico en el que se vigilen las medidas antropométricas y el perfil de riesgo de desnutrición.
Citas
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