{"id":5571,"date":"2016-04-21T10:55:28","date_gmt":"2016-04-21T08:55:28","guid":{"rendered":"https:\/\/www.zdravstvena.info\/preventiva\/?p=5571"},"modified":"2016-05-20T12:44:35","modified_gmt":"2016-05-20T10:44:35","slug":"prehrana-po-presaditvi-ledvice","status":"publish","type":"post","link":"https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html","title":{"rendered":"Prehrana po presaditvi ledvice"},"content":{"rendered":"

\"day_after_transplant\"Z napredovanjem kroni\u010dne ledvi\u010dne bolezni (KLB) se pove\u010dujejo presnovne spremembe, ki vodijo v katabolizem. Nanj vpliva tudi dializna odvisnost, predvsem zaradi izgube beljakovin in ostalih hranil v dializatu in zaradi aktivacije blagega kroni\u010dnega vnetja. Katabolizem je izrazitej\u0161i pri akutni kot pri kroni\u010dni ledvi\u010dni bolezni. Prehrano bolnika s KLB je potrebno prilagajati potrebam, ki so zna\u010dilne za dolo\u010deno stopnjo KLB, vrsto ledvi\u010dne okvare in na\u010dina zdravljenja.<\/p>\n

Na prehrano bolnikov po presaditvi ledvic vplivajo razni dejavniki kot je \u010das po presaditvi, stopnja ledvi\u010dnega delovanja (KLB 1-5T), razvoj oku\u017eb, prebavne te\u017eave, stranski u\u010dinki imunosupresivnih in ostalih zdravil, mo\u017ene interakcije med zdravili in hrano ter imunomodulatorni u\u010dinki raznih prehranskih dodatkov.<\/p>\n

V zgodnjem posttransplantacijskem obdobju je zadostna in ustrezna prehrana pomembna zaradi celjenja ran, prepre\u010devanja oku\u017eb in uravnavanja elektrolitskih in metabolnih odklonov, do katerih pride zaradi dobrega ledvi\u010dnega delovanja in imunosupresivne terapije. V kasnej\u0161em obdobju pa pravilna prehrana pomaga pri prepre\u010devanju poslab\u0161anja ledvi\u010dnega delovanja, nastanka debelosti, dislipidemije, anemije, sladkorne bolezni, arterijske hipertenzije in kostne bolezni.<\/p>\n

S prehrano posku\u0161amo vplivati na nekatere stranske u\u010dinke, ki jih povzro\u010dajo imunosupresivna zdravila. Kortikosteroidi povzro\u010dajo osteoporozo, zadr\u017eevanje vode in povi\u0161an krvni tlak, dislipidemijo, novo nastalo sladkorno bolezen po presadivi (NODAT), pove\u010devanje apetita in telesne te\u017ee. Dislipidemijo povzo\u010data tudi kalcinevrinska inhibitorja takrolimus in ciklosporin ter mTOR inhibitorja everolimus in sirolimus. Tudi takrolimus je mo\u017een povzro\u010ditelj NODAT. Hipomagnezemijo so opisali ob jemanju ciklosporina, everolimusa, takrolimusa; hiperkaliemijo pa pri takrolimusu in ciklosporinu. Oba kalcinevrinska inhibitorja bolj kot mikofenolat ali mTOR inhibitorja povi\u0161ujeta incidenco hiperurikemije.<\/p>\n

Prehranski staus bolnikov pred presaditvijo ledvice je pomemben za uspeh presaditve. Prejemniki z BMI < 18 (podhranjenost) in tisti z BMI > 35 (debelost) imajo v primerjavi s tistimi, ki imajo normalen BMI, ve\u010djo obolevnost in smrtnost. Uspe\u0161nost celjenja ran in imunska obramba sta odvisna od \u00bbde-novo\u00ab sinteze beljakovin, ki je v primeru negativne energijske in du\u0161ikove bilance nezadostna. Medtem ko je debelost v \u010dasu presaditve povezana z ve\u010djim tveganjem za zakasnelo delovanje presadka in zapleti pri celjenju pooperativnih ran, je podhranjenost povezana s slab\u0161im pre\u017eivetjem presadka in bolnika. U\u010dinki nenormalnega prehranskega statusa se indirektno ka\u017eejo tudi kot sladkorna bolezen, osteoporoza in sr\u010dno – \u017eilne bolezni. Zaradi tega je pomembno, da bolniki, uvr\u0161\u010deni na listo \u010dakajo\u010dih na presaditev ledvice, vzdr\u017eujejo optimalen prehranski status.<\/p>\n

Potreben energijski vnos po transplantaciji ledvice je 30 \u2013 35 kcal\/ kg ITM\/ dan, tako v zgodnjem kot tudi poznem posttransplantacijskem obdobju. Beljakovinske potrebe v zgodnjem obdobju zna\u0161ajo 1.4 g\/ kg ITM\/ dan in 0.75 \u2013 1.0 g\/ kg ITM\/ dan v poznem obdobju. Ma\u0161\u010dobe naj ne bi predstavljale ve\u010d kot 30 % celokupnih energijskih virov, od tega 8 \u2013 10 % v obliki w-6 polinenasi\u010denih ma\u0161\u010dob. Pomembne so tudi w-3 polinenasi\u010dene ma\u0161\u010dobe tako rastlinskega kot morskega izvora. Pribli\u017eno 20 % ma\u0161\u010dobe naj bi bilo mononenasi\u010dene in manj kot 10 % nasi\u010denih in trans ma\u0161\u010dob. Priporo\u010dljiva vsebnost ogljikovih hidratov je pribli\u017eno 50 % celokupne energije. Imeti morajo nizek glikemi\u010dni indeks. Vsebovati morajo veliko dietnih vlaknin. Omejiti je potrebno enostavne sladkorje. Priporo\u010den dnevni vnos (RDA) kalcija je 1000 – 1300 mg, fosfata 1000 – 1300 mg, natrija 80 – 100 mmol (brez dodane soli), kalij je potrebno omejiti, \u010de vztraja hiperkaliemija. \u017delezo 10 – 15 mg\/ dan, vitamin D 5 – 15 \u03bcg\/ dan, vlaknine\u00a0 25 – 30 g\/ dan. Koli\u010dina vitaminov in mineralov, zlasti B6, B12, magnezija in cinka, mora biti v skladu z RDA za splo\u0161no populacijo, oziroma glede na starost in spol, upo\u0161tevaje velikost telesa, stanje prehranjenosti in stopnjo fizi\u010dne aktivnosti. Priporo\u010dljiv vnos teko\u010dine je 2.0 – 2.5 l\/ dan, alkohola < 20 g\/ dan, < 5 dni\/ teden.<\/p>\n

Prehransko oceno je potrebno narediti \u010dimprej po presaditvi ledvice in nato enkrat mese\u010dno v prvih treh mesecih, nato pa enkrat letno, razen \u010de ne pride do zdravstvenih zapletov. Bolniki imajo lahko optimalen posttransplantacijski potek, ki popravi presnovno okvaro nastalo v \u010dasu napredovale ledvi\u010dne okvare lastnih ledvic, ali pa pride do zakasnelega ledvi\u010dnega delovanja, slabega celjenja pooperativnih ran, oku\u017eb in prebavnih te\u017eav, ki doprinesejo k podhranjenosti. Prehranske zahteve se spreminjajo s \u010dasom. Potrebna je individualna obravnava.<\/p>\n

Doc.dr. Gregor Mlin\u0161ek dr. med.<\/strong><\/p>\n

Center za transplantacijo ledvic, KO za nefrologijo, UKC Ljubljana<\/p>\n

Reference<\/h2>\n
    \n
  1. Chadban, S., Chan, M., Fry, K., Patwardhan, A., Ryan, C., Trevillian, P., & Westgarth, F. (2010). Nutritional management of dyslipidaemia in adult kidney transplant recipients. Nephrology, 15(June 2008), 62\u201367.<\/li>\n
  2. Group, K. W. (2009). KDIGO clinical practice guideline for the care of kidney transplant recipients. American Journal of Transplantation\u202f: Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 9 Suppl 3, S1\u2013155.<\/li>\n
  3. Hwang, J. H., Ryu, J., An, J. N., Kim, C. T., Kim, H., Yang, J., \u2026 Lee, J. P. (2015). Pretransplant malnutrition, inflammation, and atherosclerosis affect cardiovascular outcomes after kidney transplantation. BMC Nephrology, 16, 109.<\/li>\n
  4. Knoll, G. a., Blydt-Hansen, T. D., Campbell, P., Cantarovich, M., Cole, E., Fairhead, T., \u2026 Prasad, G. V. R. (2010). Canadian Society of Transplantation and Canadian Society of Nephrology commentary on the 2009 KDIGO clinical practice guideline for the care of kidney transplant recipients. American Journal of Kidney Diseases, 56(2), 219\u2013246.<\/li>\n
  5. Kopple, J. D., Massry, S. G., & Kalantar-Zadeh, K. (2013). Nutritional Management of Renal Disease (Kindle book., Chapter 34, pp 28230\u201329126 of 39452).<\/li>\n<\/ol>\n

    Ramani, G., Abraham, G., Mathew, M., & Lesley, N. (2014). Nutritional Disorders & Therapy Nutritional Assessment of Renal Transplant Recipients Using DEXA and Biochemical Parameters. J Nutr Disorders Ther, 4(1), 1\u20137.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Z napredovanjem kroni\u010dne ledvi\u010dne bolezni (KLB) se pove\u010dujejo presnovne spremembe, ki vodijo v katabolizem. Nanj vpliva tudi dializna odvisnost, predvsem zaradi izgube beljakovin in ostalih hranil v dializatu in zaradi aktivacije blagega kroni\u010dnega vnetja. Katabolizem je izrazitej\u0161i pri akutni kot pri kroni\u010dni ledvi\u010dni bolezni. Prehrano bolnika s KLB je potrebno prilagajati potrebam, ki so zna\u010dilne […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[52,12],"tags":[1400,1401,1399,1398,1316],"class_list":["post-5571","post","type-post","status-publish","format-standard","hentry","category-izobrazevanje","category-prehrana","tag-kronicna-ledvicna-bolezen","tag-prehrana-in-presaditev-ledvice","tag-prehrana-po-presaditvi-ledvice","tag-presaditev-ledvice","tag-preventiva"],"yoast_head":"\nPrehrana po presaditvi ledvice - Nasveti za zdravo \u017eivljenje!<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Prehrana po presaditvi ledvice - Nasveti za zdravo \u017eivljenje!\" \/>\n<meta property=\"og:description\" content=\"Z napredovanjem kroni\u010dne ledvi\u010dne bolezni (KLB) se pove\u010dujejo presnovne spremembe, ki vodijo v katabolizem. Nanj vpliva tudi dializna odvisnost, predvsem zaradi izgube beljakovin in ostalih hranil v dializatu in zaradi aktivacije blagega kroni\u010dnega vnetja. Katabolizem je izrazitej\u0161i pri akutni kot pri kroni\u010dni ledvi\u010dni bolezni. 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Nanj vpliva tudi dializna odvisnost, predvsem zaradi izgube beljakovin in ostalih hranil v dializatu in zaradi aktivacije blagega kroni\u010dnega vnetja. Katabolizem je izrazitej\u0161i pri akutni kot pri kroni\u010dni ledvi\u010dni bolezni. Prehrano bolnika s KLB je potrebno prilagajati potrebam, ki so zna\u010dilne […]","og_url":"https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html","og_site_name":"Nasveti za zdravo \u017eivljenje!","article_publisher":"https:\/\/www.facebook.com\/Zdravstvena.info\/","article_published_time":"2016-04-21T08:55:28+00:00","article_modified_time":"2016-05-20T10:44:35+00:00","og_image":[{"url":"https:\/\/www.zdravstvena.info\/preventiva\/wp-content\/uploads\/2016\/04\/day_after_transplant-209x150.jpg","type":"","width":"","height":""}],"author":"admin","twitter_card":"summary_large_image","twitter_misc":{"Written by":"admin","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html#article","isPartOf":{"@id":"https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html"},"author":{"name":"admin","@id":"https:\/\/www.zdravstvena.info\/preventiva\/#\/schema\/person\/c45a4cf849f166a770b7f807da7819c7"},"headline":"Prehrana po presaditvi ledvice","datePublished":"2016-04-21T08:55:28+00:00","dateModified":"2016-05-20T10:44:35+00:00","mainEntityOfPage":{"@id":"https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html"},"wordCount":904,"commentCount":0,"publisher":{"@id":"https:\/\/www.zdravstvena.info\/preventiva\/#organization"},"image":{"@id":"https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html#primaryimage"},"thumbnailUrl":"https:\/\/www.zdravstvena.info\/preventiva\/wp-content\/uploads\/2016\/04\/day_after_transplant-209x150.jpg","keywords":["kroni\u010dna ledvi\u010dna bolezen","prehrana in presaditev ledvice","prehrana po presaditvi ledvice","presaditev ledvice","Preventiva"],"articleSection":["Izobra\u017eevanje","Zdrava prehrana"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html#respond"]}]},{"@type":"WebPage","@id":"https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html","url":"https:\/\/www.zdravstvena.info\/preventiva\/prehrana-po-presaditvi-ledvice.html","name":"Prehrana po presaditvi ledvice - 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