Asupan protein dan fosfor, rasio fosfor-protein, dan kadar fosfor darah pada pasien gagal ginjal kronis dengan hemodialisis
Abstract: Hyperphosphatemia
has become one of the main causes of death in CKD patients on HD. Thus,
correction and prevention of hyperphospatemia is a major component in the
management of HD patients. High protein diet in HD patients may lead to
increased serum phosphate level due to mineral metabolism disorder associated
with decreased glomerular filtration rate. In addition, high protein intake
often followed by high phosphate intake as high protein foods also contains
high phosphate and may cause hyperphosphatemia. Meanwhile, reduction of protein
intake to control phosphate level was associated with decreased health and
nutritional status in CKD patients. Therefore, appropriate phosphate-protein
ratio is essential to provide adequate protein intake and avoid
hyperphosphatemia.
Objective: To investigate the association between protein and phosphate
intake, phosphate-protein ratio and blood phosphate level in CKD patients on
routine HD.
Method: The study used an analytic observational method with cross
sectional design. There were 100 subjects involved in this study. Subject
characteristics, protein and phosphate intake, phosphate-protein ratio and
intake of phosphate binders were obtained through interview and 3 x24 hour food
record. Serum phosphate level was analyzed by inorganic phosphorus quantification
method. Food processor was used to analyze the intake of protein and phosphate.
Bivariate and multivariate tests with 95% confidence interval were used to
analyze the data.
Results: Adequate protein intake was observed among 38% subjects, while
46% of them have excess phosphate intake.High phosphate-protein ratio was found
in 20% subjects. Most subjects did not take phosphate binders regularly (61%)
and have hyperphosphatemia (66%). The average protein intake, phosphate intake,
phosphate-protein ratio, and blood phosphate level were 1.1 g/kg/d, 13.5
mg/kg/d, 12.8 mg/g, and 5.6 mg/dl, respectively. Bivariate test showed that
there was a significant association between protein intake (p=0.037; RP=2.78),
phosphate intake (p=0.005; RP=3.54), phosphate-protein ratio (p=0.045;
RP=3.85), and blood phosphate level in CKD patients on routine HD. Multivariate
analysis revealed that high phosphate intake and did not consume phosphate
binders regularly were risk factors of hyperphosphatemia
(p=0.000; OR=6.543; CI 95%:2.357-18.164 dan p=0.024; OR=3.413; CI 95%:1.179;
R2=0.42).
Conclusion: Consumtion of low phosphate foods and phosphate binders may
reduce the risk of hyperphosphatemia in CKD patients on routine HD.
Keywords: hyperphosphatemia;
protein intake; phosphate intake; phosphate-protein ratio; chronic renal
failure; hemodialysis
Penulis: Ahmad Syauqy,
Susetyowati ., Suhardi
Kode Jurnal: jpkesmasdd120427
