Role of an improvement in acid-base status and nutrition in CAPD patients
Role of an improvement in acid-base status and nutrition in CAPD patients
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DOI：
10.1038/ki.1997.433
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发表时间：
1997-10-01
影响因子：
19.6
通讯作者：
Walls, J
中科院分区：
文献类型：
--
作者：
Stein, A;Moorhouse, J;Walls, J
短期纠正正常和尿毒症受试者的代谢性酸中毒可减少蛋白质降解，但改善酸中毒纠正对ESRF患者营养的长期影响尚不清楚。这项研究的目的是评估在持续非卧床腹膜透析(CAPD)治疗的第一年，改善酸中毒纠正的营养状态和发病率的可能益处。200名连续入选的新CAPD患者采用单盲随机方法接受高(HA；乳酸40 mmol/升)或低(LA；乳酸35 mmol/升)碱透析液，为期一年。HA组同时应用碳酸钙和碳酸氢钠纠正酸中毒。1年时，HA组静脉血碳酸氢盐和动脉血pH分别为7.44+/-0.004和27.2+/-0.3mmolL/L，LA组分别为23.0mmoL/L和7.4mmoL/L(P<；0.001)。透析剂量在一年或离开研究时(HA 8.0+/-0.1升/天与LA 8.5+/-0.3升/天)无显著差异(P=0.18)。一年后，HA组体重增长(6.1±0.66 kg)高于LA组(3.71±0.56 kg，P<；0.05)。HA患者的中臂周长增加(1.26±0.16 cm)显著高于LA患者(0.61±0.16 cm，P<；0.05)。三头肌皮皱厚度增加差异无统计学意义(HA 2.5+/-0.41 mm vs.LA 1.24+/-0.38 mm，P=0.1)。血清白蛋白：HA组为37.8+/-0.4g/dl，LA组为38.2+/-0.5g/dl。一年的膳食蛋白质摄入量(HA 0.9+/-0.2g/kg/d与LA 1.0+/-0.1g/kg/d)无显著差异。与LA组(每名患者每年1.71+/-0.22)相比，HA组的入院率(每名患者每年1.13+/-0.16)较少(P<；0.05)。医管局患者每年住院天数少于LA患者(16.4+/-1.4天/年比21.2+/-1.9天/年；P<；0.05)。结论：在CAPD的第一年，纠正代谢性酸中毒会导致体重和中臂周长的增加，但不会导致三头肌皮褶厚度的增加。发病率的改善，就每年的入院人数和住院天数而言，可能与营养状况的改善有关。
Short-term correction of metabolic acidosis in normal and uremic subjects has been shown to decrease protein degradation, but the lone-term effects of better correction of acidosis on nutrition in ESRF are unknown. The aim of this study was to assess the possible benefits, in the nutritional state and morbidity, of improved correction of acidosis in the first year of treatment with continuous ambulatory peritoneal dialysis (CAPD). Two hundred consecutive new CAPD patients were randomized, in a single-blind fashion, to receive a high (HA; lactate 40 mmol/liter) or low (LA; lactate 35 mmol/liter) alkali dialysate for one year. Calcium carbonate and sodium bicarbonate were also used to correct acidosis in the HA group. Ar one year, the venous serum bicarbonate and arterial pH were 7.44 +/- 0.004 and 27.2 +/- 0.3 mmol/liter in the HA group, and 23.0 +/- 0.3 mmol/liter and 7.4 +/- 0.004 in the LA group (P < 0.001). Dialysis dose, at one year or at the point of leaving the study (HA 8.0 +/- 0.1 liters/day vs. LA 8.5 +/- 0.3 liters/day) was not significantly different (P = 0.18). At one year, the increase in body weight in the HA group (6.1 +/- 0.66 kg) was higher than in the LA group (3.71 +/- 0.56 kg, P < 0.05). The increase in midarm circumference in the HA patients (1.26 +/- 0.16 cm) was significantly higher than the increase in the LA patients (0.61 +/- 0.16 cm, P < 0.05). The increase in triceps skinfold thickness were not significantly different (HA 2.5 +/- 0.41 mm vs. LA 1.24 +/- 0.38 mm, P = 0.1). Serum albumin was 37.8 +/- 0.4 g/dl at one year in the HA group, and 38.2 +/- 0.5 g/dl in the LA group (NS). Dietary protein intake at one year (HA 0.9 +/- 0.2 g/kg/day vs. LA 1.0 +/- 0.1 g/kg/day) was not significantly different. There were fewer hospital admissions in the HA group (1.13 +/- 0.16 per patient per year) compared to the LA group (1.71 +/- 0.22 per patient per year, P < 0.05). The HA patients spent less days in hospital per year than the LA patients (16.4 +/- 1.4 days/year vs. 21.2 +/- 1.9 days/year; P < 0.05). It is concluded that better correction of metabolic acidosis leads to greater increases in body weight and midarm circumference, but not triceps skinfold thickness, in the first year of CAPD. The improvement in morbidity, in terms of number of admissions and days in hospital per year, may be associated with the improvement in nutritional state.