A Pilot Study of the Safety and Efficacy of Alkali Therapy on Vascular Function in Kidney Transplant Recipients.
A Pilot Study of the Safety and Efficacy of Alkali Therapy on Vascular Function in Kidney Transplant Recipients.
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DOI：
10.1016/j.ekir.2021.06.006
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发表时间：
2021-09
影响因子：
6
通讯作者：
Kendrick J
中科院分区：
文献类型：
--
作者：
Bohling R;Grafals M;Moreau K;You Z;Tommerdahl KL;Bjornstad P;Stenson EK;Andrews E;Ramirez-Renteria L;Kendrick J
代谢性酸中毒与肾移植受者（KTRs）的心血管事件、移植物功能和死亡率相关。我们研究了碱疗法对肾移植受者血管内皮功能的影响。
我们进行了一项为期18周的随机、双盲、安慰剂对照交叉试点研究，以检查碳酸氢钠疗法与安慰剂对20名成年肾移植受者（移植后至少1年，估计肾小球滤过率[eGFR]≥45 ml/min/1.73 m²且血清碳酸氢盐水平为20 - 26 mEq/L）血管功能的影响。每个治疗期为8周，治疗之间有2周的洗脱期。主要结局是碳酸氢钠治疗与安慰剂之间肱动脉血流介导的舒张（FMD）的变化。
20名患者完成了研究并被纳入主要分析。参与者的平均（标准差）基线eGFR分别为75（22）ml/min/1.73 m²。治疗后血清碳酸氢盐水平没有显著升高（0.3 [1.5] mEq/L，P = 0.37）。碳酸氢钠疗法与血压恶化、体重增加或低钾血症无关。与安慰剂相比，碳酸氢钠治疗8周后FMD没有显著增加（FMD平均变化2.2%，95%置信区间 -0.1至4.6，P = 0.06）。治疗期间高敏C反应蛋白、白细胞介素 - 6、eGFR或尿白蛋白 - 肌酐比没有显著变化。使用碳酸氢钠时，尿铵排泄量降低了9 mmol/d（P = 0.003）。
碳酸氢钠疗法在肾移植受者中是安全可行的，我们的结果强调了进行更大规模随机对照试验的必要性。
Metabolic acidosis is associated with cardiovascular events, graft function, and mortality in kidney transplant recipients (KTRs). We examined the effect of alkali therapy on vascular endothelial function in KTRs. We performed an 18-week, randomized, double-blind, placebo-controlled crossover pilot study examining the effect of sodium bicarbonate therapy versus placebo on vascular function in 20 adult KTRs at least 1 year from transplant with an estimated glomerular filtration rate (eGFR) ≥45 ml/min per 1.73 m2 and a serum bicarbonate level of 20 to 26 mEq/L. Each treatment period was 8 weeks in duration with a 2-week washout period between treatments. The primary outcome was change in brachial artery flow-mediated dilation (FMD) between sodium bicarbonate treatment and placebo. Twenty patients completed the study and were included in the primary analysis. The mean (SD) baseline eGFR of participants was 75 (22) ml/min per 1.73 m2, respectively. Serum bicarbonate levels did not increase significantly with treatment (0.3 [1.5] mEq/L, P = 0.37). Sodium bicarbonate therapy was not associated with worsening blood pressure, weight gain, or hypokalemia. There was no significant increase in FMD after 8 weeks of sodium bicarbonate therapy compared to placebo (mean change in FMD 2.2%, 95% CI –0.1 to 4.6, P = 0.06). There were no significant changes in high-sensitivity C-reactive protein, interleukin-6, eGFR, or urinary albumin-to-creatinine ratio during treatment. Urinary ammonium excretion decreased by 9 mmol/d (P=0.003), with sodium bicarbonate. Sodium bicarbonate therapy is safe and feasible in KTRs, and our results strengthen the need for a larger randomized controlled trial.
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影响因子：
13.6
作者：
de Brito-Ashurst, Ione;Varagunam, Mira;Yaqoob, Muhammad M.
通讯作者：
Yaqoob, Muhammad M.
影响因子：
1.2
作者：
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DOI：
10.1152/ajprenal.90489.2008
发表时间：
2009-08-01
影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
6.2
作者：
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