{"id":5408,"date":"2022-12-29T09:00:00","date_gmt":"2022-12-29T02:00:00","guid":{"rendered":"https:\/\/ahligizi.id\/blog\/?p=5408"},"modified":"2022-12-24T18:45:33","modified_gmt":"2022-12-24T11:45:33","slug":"plado-diet-rekomendasi-untuk-gagal-ginjal-kronis","status":"publish","type":"post","link":"https:\/\/ahligizi.id\/blog\/2022\/12\/29\/plado-diet-rekomendasi-untuk-gagal-ginjal-kronis\/","title":{"rendered":"PLADO Diet, Rekomendasi untuk Gagal Ginjal Kronis"},"content":{"rendered":"\n
\"\"\/
Plant Based Diet, Komponen penting dalam PLADO Diet<\/figcaption><\/figure>\n\n\n\n

Fungsi Ginjal dalam Tubuh<\/h2>\n\n\n\n

Ginjal berfungsi dalam menyaring produk sisa metabolisme dalam darah dan membuang kelebihan cairan tubuh dalam bentuk urine. Penurunan fungsi ginjal secara perlahan dan progresif selama beberapa tahun menyebabkan terjadinya gagal ginjal kronis (GGK). Penurunan fungsi ginjal dinilai dari kemampuan glomelurus menyaring darah. Dalam hal ini, Laju Filtrasi Glomerulus atau estimasi Glomerular Filtration Rate (eGFR)<\/em> dipilih. Penilaian tersebut juga dapat menentukan tingkat keparahan\/stage <\/em>penyakit, di mana pada stage awal nilai eGFR berkisar di 60-89ml\/menit. Semakin menurun nilai eGFR semakin lanjut pula tingkat keparahan pada penyakit GGK ditambah dengan ditemukannya protein pada urin. Pada stage<\/em> 5, pasien telah disarankan untuk menjalani tindakan dialisis\/cuci darah.  <\/p>\n\n\n\n

Kerusakan ginjal seseorang akibat GGK biasanya bersifat permanen. Namun, beberapa terapi dapat membantu mengendalikan gejala, mengurangi risiko komplikasi, dan memperlambat perkembangan kondisi tersebut. Diketahui Perhimpunan Nefrologi Indonesia menerbitkan Konsensus Nutrisi pada penyakit gagal ginjal kronis pre-dialisis. Regimen diet yang dianjurkan adalah energi sebesar 35 kkal\/kg berat badan ideal. Protein 0,6 \u2013 0,75 gram\/kg berat badan ideal. Lemak 25 \u2013 30% dari total kalori. Karbohidrat sisa dari perhitungan protein dan lemak.1<\/sup><\/p>\n\n\n\n

Baca Juga : Pedoman Untuk Penyakit Ginjal<\/a><\/p>\n\n\n\n

Kandungan Biologis Protein Nabati<\/h2>\n\n\n\n

Rekomendasi komposisi asupan protein turut dijelaskan yaitu minimal 50% protein hewani (kandungan biologis tinggi). Protein hewani memiliki daya serap di saluran pencernaan yang tinggi sehingga asupan asam amino esensial terpenuhi dengan baik.2<\/sup> Penggunaan protein nabati kurang begitu menguntungkan biasanya memiliki kadar kalium yang lebih tinggi, kecuali bahan makanan yang berasal dari kedelai (tahu, tempe).<\/mark><\/strong><\/p>\n\n\n\n

Kendati demikian, beberapa ahli menyatakan bahan makanan bernilai biologis tinggi tidak selalu terkandung dalam protein hewani. Pengukuran kandungan biologis dalam protein yang lebih akurat rekomendasi FAO dan WHO yaitu PDCAAS (protein digestibility-corrected amino acid score<\/em>) menunjukkan sumber protein nabati juga memberikan skor yang tinggi. Diartikan protein nabati juga adekuat untuk dikonsumsi terutama bila dikonsumsi tidak hanya dari satu sumber protein nabati saja<\/mark><\/strong>. 5,6<\/sup><\/p>\n\n\n\n

\"\"
Daftar skor PDCAAS sumber protein hewani dan nabati, menunjukkan kedelai (sumber protein nabati) memiliki skor yang juga tinggi bersama dengan daging, telur, susu (sumber protein hewani)<\/mark><\/mark> (Sumber : doi:10.1053\/j.jrn.2018.06.006)<\/mark><\/figcaption><\/figure><\/div>\n\n\n\n

Penelitian terbaru tentang PLADO diet dapat memberikan pengetahuan tentang peranan komposisi protein nabati pada regimen diet pasien gagal ginjal kronis pre-dialisis yang bermanfaat dalam membantu memperlambat progestifitas ginjal. <\/p>\n\n\n\n

Pengertian PLADO Diet <\/h2>\n\n\n\n
\"\"<\/figure><\/div>\n\n\n\n

PLADO merupakan singkatan dari Plant-Dominant Low Protein Diet yang dimaksudkan <\/strong>pola makan rendah protein (0,6 \u2013 0,8 g\/kg\/hari) dengan komposisi >50% protein nabati yang berasal dari bahan makanan utuh tanpa diproses serta kaya serat.<\/strong><\/mark> Anjuran lain pada PLADO adalah mengurangi asupan natrium <3 gram\/hari, meningkatkan asupan serat minimal 25 \u2013 30 gram\/hari, dan asupan energi 30 \u2013 35 kkal\/kg berat badan ideal\/hari. <\/mark><\/strong><\/p>\n\n\n\n

Munculnya rekomendasi PLADO didasari pengamatan bahwa diet pada pasien GGK dengan pilihan asupan protein hewani daging yang tinggi tidak hanya menimbulkan risiko penyakit kardiovaskular, tetapi juga perkembangan penyakit GGK yang lebih cepat. Hal ini disebabkan peningkatan tekanan intraglomerulus dan hiperfiltrasi glomerulus. Asupan daging meningkatkan pembentukan produk akhir nitrogen, memperburuk uremia, dan meningkatkan risiko konstipasi berujung pada hiperkalemia akibat asupan serat yang rendah.2<\/sup><\/p>\n\n\n\n

Keuntungan PLADO Diet<\/h2>\n\n\n\n

PLADO dinilai baik sebagai opsi strategi manajemen penyakit gagal ginjal kronis pre-dialisis, hal ini disebabkan sumber protein nabati dapat mengurangi hiperfiltrasi di glomerulus, berpengaruh baik pada mikrobioma usus sehingga memperlambat perkembangan penyakit gagal ginjal dengan mekanisme pengurangan senyawa nitrogen sehingga produksi amonia dan toksin uremik juga dapat ditekan, hal ini dianggap dapat efektif dalam mengendalikan uremia.3<\/sup> <\/p>\n\n\n\n

Penerapan PLADO Diet pada Pasien Gagal Ginjal Kronis<\/h2>\n\n\n\n

Contohnya, berat badan pasien 80 kg, maka dari itu kebutuhan protein direkomendasikan sebesar 46 – 64 gram\/hari. Persentase protein nabati berkisar dari 50 – 70% (24 – 45 gram) dengan sumber protein nabati yang sesuai preferensi. <\/p>\n\n\n\n

\"\"
Rekomendasi PLADO (Sumber : doi: 10.3390\/nu12071931<\/a>)<\/figcaption><\/figure><\/div>\n\n\n\n

Beberapa hal yang perlu diperhatikan PLADO untuk pasien GGK adalah kemungkinan terjadinya kekurangan energi protein dan sarkopenia, meskipun sedikit temuan yang terjadi pada pasien GGK. 4<\/sup> Risiko hiperkalemia juga menjadi perhatian, namun terdapat bukti yang menunjukkan kalium yang berasal dari protein nabati, tidak berkorelasi erat dengan serum kalium. Diet tinggi serat dapat membantu keadaan hiperkalemia dengan cara meningkatkan motilitas usus dan mencegah penyerapan kalium yang berlebih. Mekanisme alkalisasi protein nabati juga menurunkan risiko hiperkalemia. 6<\/sup><\/p>\n\n\n\n

Pada akhirnya, komposisi dan pola makan PLADO dapat dirancang dan disesuaikan berdasarkan kebutuhan individu dengan penyakit GGK. Tetap konsultasikan pada dokter\/ahli gizi untuk mendapatkan panduan diet yang tepat dikarenakan faktor-faktor lain menyangkut kondisi pasien seperti penyakit komorbid yang dapat mempengaruhi keseluruhan regimen diet.<\/p>\n\n\n\n

Referensi<\/h1>\n\n\n\n
  1. Konsensus Nutrisi pada Penyakit Gagal Ginjal Kronik [Internet]. KONSENSUS Nutrisi pada Penyakit Ginjal Kronik. PERNEFRI (Perhimpunan Nefrologi Indonesia); 2013 [cited 2022Dec9]. Available from: https:\/\/www.pernefri.org\/konsensus\/Konsensus%20Nutrisi.pdf <\/li><\/ol>\n\n\n\n
    1. Kalantar-Zadeh K, Moore LW, Tortorici AR, Chou JA, St-Jules DE, Aoun A, Rojas-Bautista V, Tschida AK, Rhee CM, Shah AA, Crowley S. North American experience with low protein diet for non-dialysis-dependent chronic kidney disease. BMC nephrology. 2016 Dec;17(1):1-1. https:\/\/doi.org\/10.1186\/s12882-016-0304-9<\/a> <\/li><\/ol>\n\n\n\n
      1. Kalantar-Zadeh K, Joshi S, Schlueter R, Cooke J, Brown-Tortorici A, Donnelly M, Schulman S, Lau WL, Rhee CM, Streja E, Tantisattamo E. Plant-dominant low-protein diet for conservative management of chronic kidney disease. Nutrients. 2020 Jun 29;12(7):1931. https:\/\/doi.org\/10.3390\/nu12071931<\/a> <\/li><\/ol>\n\n\n\n
        1. Rhee CM, Ahmadi SF, Kovesdy CP, Kalantar\u2010Zadeh K. Low\u2010protein diet for conservative management of chronic kidney disease: a systematic review and meta\u2010analysis of controlled trials. Journal of cachexia, sarcopenia and muscle. 2018 Apr;9(2):235-45. https:\/\/doi.org\/10.1002\/jcsm.12264<\/a> <\/li><\/ol>\n\n\n\n
          1. Joshi, S., Shah, S., & Kalantar-Zadeh, K. (2018). Adequacy of Plant-Based Proteins in Chronic Kidney Disease. Journal of Renal Nutrition. doi:10.1053\/j.jrn.2018.06.006. https:\/\/doi.org\/10.1053\/j.jrn.2018.06.006<\/a> .<\/li><\/ol>\n\n\n\n
            1. Food and Agriculture Organization\/World Health Organization. FAO Food Nutr Paper 51. Rome, Italy: Food and Agriculture Organization of the United Nations; 1991<\/li><\/ol>\n\n\n\n
              1. Noori N, Kalantar-Zadeh K, Kovesdy CP, Bross R, Benner D, Kopple JD. Association of dietary phosphorus intake and phosphorus to protein ratio with mortality in hemodialysis patients. Clinical Journal of the American Society of Nephrology. 2010 Apr 1;5(4):683-92. https:\/\/doi.org\/10.2215%2FCJN.08601209<\/a> <\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

                Fungsi Ginjal dalam Tubuh Ginjal berfungsi dalam menyaring produk sisa metabolisme dalam darah dan membuang kelebihan cairan tubuh dalam bentuk<\/p>\n","protected":false},"author":63,"featured_media":5432,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"colormag_page_layout":"default_layout","footnotes":"","_wpscppro_custom_social_share_image":0,"_facebook_share_type":"","_twitter_share_type":"","_linkedin_share_type":"","_pinterest_share_type":"","_linkedin_share_type_page":"","_instagram_share_type":"","_medium_share_type":"","_threads_share_type":"","_selected_social_profile":[]},"categories":[19,2],"tags":[480,481,479],"class_list":["post-5408","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-diet-penyakit","category-kesehatan-dan-gizi-lainnya","tag-gagal-ginjal-kronis","tag-ggk","tag-plado-diet"],"yoast_head":"\nPLADO Diet, Rekomendasi untuk Gagal Ginjal Kronis 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