Consequences and therapy of the metabolic acidosis of chronic kidney disease.
Consequences and therapy of the metabolic acidosis of chronic kidney disease.
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DOI：
10.1007/s00467-010-1564-4
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发表时间：
2011-01
影响因子：
3
通讯作者：
Madias, Nicolaos E.
中科院分区：
文献类型：
--
作者：
Kraut, Jeffrey A.;Madias, Nicolaos E.
代谢性酸中毒在慢性肾病（CKD）患者中很常见，尤其是当肾小球滤过率（GFR）福尔斯降至25 ml/min/1.73 m2以下时。通常为轻度至中度，血清碳酸氢盐浓度（[HCO 3 −]）范围为12至23 mEq/l。即便如此，它也可能产生大量不良反应，包括骨骼疾病的发展或加重、儿童生长迟缓、肌肉退化增加伴肌肉萎缩、白蛋白合成减少伴低白蛋白血症倾向、胰岛素抵抗伴葡萄糖耐量受损、CKD进展加速、炎症刺激和β2-微球蛋白生成增加。此外，它的存在与死亡率增加有关。在开始透析之前或之后给予患者碱可改善许多这些不良反应。国家肾脏基金会肾脏疾病结局质量倡议（NKF KDOQI）目前的建议是将血清[HCO 3-]提高至≥22 mEq/l，而澳大利亚肾损害护理组织（CARI）建议将血清[HCO 3-]提高至>22 mEq/l。碱给药可能导致容量超负荷和高血压加重以及组织中的转移性钙沉淀。然而，当给予碳酸氢钠和氯化钠同时限制摄入时，钠潴留较少。各种研究的结果表明，在保守性碱给药期间达到的pH值不太可能导致转移性钙化增强，但临床医生应注意不要将血清[HCO 3 −]升高至正常范围以外的值。
Metabolic acidosis is common in patients with chronic kidney disease (CKD), particularly once the glomerular filtration rate (GFR) falls below 25 ml/min/1.73 m2. It is usually mild to moderate in magnitude with the serum bicarbonate concentration ([HCO3−]) ranging from 12 to 23 mEq/l. Even so, it can have substantial adverse effects, including development or exacerbation of bone disease, growth retardation in children, increased muscle degradation with muscle wasting, reduced albumin synthesis with a predisposition to hypoalbuminemia, resistance to the effects of insulin with impaired glucose tolerance, acceleration of the progression of CKD, stimulation of inflammation, and augmentation of β2-microglobulin production. Also, its presence is associated with increased mortality. The administration of base to patients prior to or after initiation of dialysis leads to improvement in many of these adverse effects. The present recommendation by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) is to raise serum [HCO3−] to ≥22 mEq/l, whereas Caring for Australians with Renal Impairment (CARI) recommends raising serum [HCO3−] to >22 mEq/l. Base administration can potentially contribute to volume overload and exacerbation of hypertension as well as to metastatic calcium precipitation in tissues. However, sodium retention is less when given as sodium bicarbonate and sodium chloride intake is concomitantly restricted. Results from various studies suggest that enhanced metastatic calcification is unlikely with the pH values achieved during conservative base administration, but the clinician should be careful not to raise serum [HCO3−] to values outside the normal range.
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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：
1.6
作者：
Chauveau, P;Fouque, D;Leverve, X
通讯作者：
Leverve, X
影响因子：
15.9
作者：
BURNELL, JM
通讯作者：
BURNELL, JM
影响因子：
13.6
作者：
Carbajo, E;López, JM;Rodríguez, J
通讯作者：
Rodríguez, J
影响因子：
13.2
作者：
COBURN, JW;MISCHEL, MG;SALUSKY, IB
通讯作者：
SALUSKY, IB