Urinary ammonia and long-term outcomes in chronic kidney disease
Urinary ammonia and long-term outcomes in chronic kidney disease
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DOI：
10.1038/ki.2015.52
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发表时间：
2015-07-01
影响因子：
19.6
通讯作者：
Houillier, Pascal
中科院分区：
文献类型：
--
作者：
Vallet, Marion;Metzger, Marie;Houillier, Pascal
最近的研究表明，碱化治疗可以改善慢性肾脏疾病（CKD）的病程，即使对没有明显代谢性酸中毒的患者也是如此。在这里，我们测试了排泄尿酸的能力下降而不是明显的代谢性酸中毒是否可能对CKD的病程有害。我们研究了1065例CKD 1-4期肾试验队列患者的基线静脉总CO2浓度或尿氨排泄与长期CKD结局之间的关系。所有患者均通过51Cr-EDTA肾清除率测量肾小球滤过率（mGFR）。基线时的中位mGFR为37.6 ml/min / 1.73 m(2)。尿氨排泄量随GFR的增加而减少，而净内源性酸产量则没有。中位随访4.3年后，201名患者达到终末期肾病（ESRD）， 114名患者在ESRD前死亡。26%的患者mGFR年下降率大于10%。与尿氨排泄最高分位数的患者相比，最低分位数的患者ESRD的风险比显著增加，为1.82 (95% CI, 1.06-3.13)，且mGFR快速下降的优势比更高，为1.84(0.98-3.48)，独立于mGFR和其他混杂因素。静脉总CO2浓度最低的患者发生mGFR快速下降的风险显著增加，但发生ESRD的风险没有增加。这些生物标志物都与死亡率无关。因此，这些结果表明不能排出每日酸负荷对肾脏结果有害。
Recent studies suggest that alkalinizing treatments improve the course of chronic kidney disease (CKD), even in patients without overt metabolic acidosis. Here, we tested whether a decreased ability in excreting urinary acid rather than overt metabolic acidosis may be deleterious to the course of CKD. We studied the associations between baseline venous total CO2 concentration or urinary ammonia excretion and long-term CKD outcomes in 1065 patients of the NephroTest cohort with CKD stages 1-4. All patients had measured glomerular filtration rate (mGFR) by 51Cr-EDTA renal clearance. Median mGFR at baseline was 37.6 ml/min per 1.73 m(2). Urinary ammonia excretion decreased with GFR, whereas net endogenous acid production did not. After a median follow-up of 4.3 years, 201 patients reached end-stage renal disease (ESRD) and 114 died before ESRD. Twenty-six percent of the patients had mGFR decline rate greater than 10% per year. Compared with patients in the highest tertile of urinary ammonia excretion, those in the lowest tertile had a significantly increased hazard ratio for ESRD, 1.82 (95% CI, 1.06-3.13), and a higher odds ratio of fast mGFR decline, 1.84 (0.98-3.48), independent of mGFR and other confounders. Patients in the lowest tertile of venous total CO2 had significantly increased risk of fast mGFR decline but not of ESRD. None of these biomarkers was associated with mortality. Thus, these results suggest that the inability to excrete the daily acid load is deleterious to renal outcomes.