Lin Shih-Hua, Lin Yuh-Feng, Chin Huei-Min, Wu Chia-Chao
Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Nephrol Dial Transplant. 2002 Nov;17(11):2006-10. doi: 10.1093/ndt/17.11.2006.
Metabolic acidosis was evaluated in the past as an independent variable of catabolism in haemodialysis (HD) patients. Nevertheless, it could in theory reflect a higher acid production from protein oxidation. The aim of this study was to evaluate the incidence and basis of metabolic acidosis in conjunction with a nutritional assessment in a HD population (n=120).
Three groups were identified based on three consecutive monthly predialysis plasma bicarbonate concentrations (P(HCO3)) and pH values. The effect of correction of metabolic acidosis on nutritional parameters was also studied in acidotic patients.
The mean P(HCO3) ranged from 19.2+/- 0.4 mmol/l in group A (n=21) to 24.4+/-0.3 mmol/l in group B (n=80) and 27.5+/-0.4 mmol/l in group C (n=19). The adequency of dialysis (Kt/V) and ultrafiltration rates was comparable in the three groups. When compared with group B, group A had significantly higher body mass index (BMI), triceps skin fold thickness (TSF), dietary protein intake (DPI), normalized protein catabolic rate (nPCR) as well as serum creatinine, K(+) and intact parathyroid hormone (I-PTH). In contrast, when compared with group B, group C had a significantly lower DPI, nPCR, plasma creatinine and albumin. There was no significant difference in plasma inflammatory markers such as C-reactive protein (CRP) and interleukin 6 (IL-6) among all three groups. There was a significant negative correlation between P(HCO3) and nPCR (P<0.001), DPI (P<0.001), creatinine (P<0.001). Over a period of 6 months, the correction of metabolic acidosis in the HD patients did not affect nutritional parameters.
These findings suggest that metabolic acidosis as a result of a higher protein intake does not detrimentally affect nutritional status.
过去曾将代谢性酸中毒作为血液透析（HD）患者分解代谢的一个独立变量进行评估。然而，从理论上讲，它可能反映了蛋白质氧化产生的更高酸产量。本研究的目的是结合营养评估，对HD人群（n = 120）中代谢性酸中毒的发生率及基础进行评估。
根据连续三个月的透析前血浆碳酸氢盐浓度（P(HCO3)）和pH值确定三组。还对酸中毒患者中代谢性酸中毒纠正对营养参数的影响进行了研究。
A组（n = 21）的平均P(HCO3)为19.2 ± 0.4 mmol/L，B组（n = 80）为24.4 ± 0.3 mmol/L，C组（n = 19）为27.5 ± 0.4 mmol/L。三组的透析充分性（Kt/V）和超滤率相当。与B组相比，A组的体重指数（BMI）、肱三头肌皮褶厚度（TSF）、膳食蛋白质摄入量（DPI）、标准化蛋白质分解代谢率（nPCR）以及血清肌酐、钾（K+）和完整甲状旁腺激素（I-PTH）显著更高。相反，与B组相比，C组的DPI、nPCR、血浆肌酐和白蛋白显著更低。三组间血浆炎症标志物如C反应蛋白（CRP）和白细胞介素6（IL-6）无显著差异。P(HCO3)与nPCR（P < 0.001）、DPI（P < 0.001）、肌酐（P < 0.001）之间存在显著负相关。在6个月的时间里，HD患者代谢性酸中毒的纠正未影响营养参数。
这些发现表明，因蛋白质摄入量增加导致的代谢性酸中毒不会对营养状况产生不利影响。
