ALKALI SUPPLEMENTATION AS A THERAPEUTIC IN CHRONIC KIDNEY DISEASE: WHAT MEDIATES PROTECTION?
ALKALI SUPPLEMENTATION AS A THERAPEUTIC IN CHRONIC KIDNEY DISEASE: WHAT MEDIATES PROTECTION?
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DOI：
10.1152/ajprenal.00343.2020
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发表时间：
2020-11
期刊：
影响因子：
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通讯作者：
Elinor C. Mannon;P. O’Connor
中科院分区：
文献类型：
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作者：
Elinor C. Mannon;P. O’Connor
Sodium bicarbonate (NaHCO3) has been recognized as a possible therapy to target chronic kidney disease (CKD) progression. Several small clinical trials have demonstrated that supplementation with NaHCO3 or other alkalizing agents slow renal functional decline in patients with CKD. While the benefits of NaHCO3 treatment have been thought to result from improving pH status, a number of studies now indicate that NaHCO3 or other alkali may provide benefit regardless of the presence of metabolic acidosis. This data has raised questions as to how NaHCO3 protects the kidneys. To date, the physiological mechanism(s) that mediate the reported protective effect of NaHCO3 in CKD remain unclear. In this review, we first examine the evidence from clinical trials in support of a beneficial effect of NaHCO3 and other alkali in slowing kidney disease progression and their relationship to acid-base status. We then discuss the physiological pathways that have been proposed to underlie these reno-protective effects and highlight strengths and weaknesses in the data supporting each pathway. Finally, we discuss how answering key questions regarding the physiological mechanism(s) mediating the beneficial actions of NaHCO3 therapy in CKD is likely to be important in the design of future clinical trials. We conclude that basic research in animal models is likely to be critical in identifying the physiological mechanisms underlying the benefits of NaHCO3 treatment in CKD. Gaining an understanding of these pathways may lead to the improved implementation of NaHCO3 as a therapy in CKD and perhaps other disease states.
