Blair Debra, Bigelow Carol, Sweet Stephen J
Renal Dietitian, Fresenius Medical Care-Western Mass. Kidney Center, Springfield, MA 01103, USA.
J Ren Nutr. 2003 Jul;13(3):205-11. doi: 10.1016/s1051-2276(03)00092-x.
Metabolic acidosis is common in patients with end-stage renal disease (ESRD). Studies suggest that correction of acidosis may improve nutritional status and patient outcomes. The purpose of this study was to examine the effects of increasing delivered bicarbonate dose from 35 mmol/L to 39 mmol/L with respect to nutrition-related outcomes in maintenance hemodialysis patients (MHD).
This was a longitudinal, observational study conducted at 4 dialysis centers in western Massachusetts. Patients were followed for 6 months after change in bicarbonate dose protocol.
The study sample consisted of 248 patients who had been on MHD for at least 1 year on the standard bicarbonate dialysate of 35 mmol/L without oral bicarbonate supplements.
Measures of interest included predialysis serum bicarbonate, albumin, hemoglobin, potassium, phosphorus, calcium, and parathyroid hormone (iPTH), as well as protein catabolic rate (nPCR). A subset of patients (n = 35) was examined for changes via Subjective Global Assessment (SGA).
Serum bicarbonate improved significantly from baseline (21.7 +/- 2.8 mmol/L; mean +/- SD) at 3 months (23.3 +/- 3.3) and 6 months (23.1 +/- 3.3) (P <.0001). Phosphorus decreased from 6.0 +/- 2.0 mmol/L at baseline to 5.7 +/- 1.7 mmol/L (P =.02) at 6 months, although calcium, iPTH, and potassium remained relatively stable. Serum bicarbonate was inversely and significantly correlated with nPCR at baseline (r = -0.23; P <.05) and 3 months (r = -0.22; P <.05). The nPCR decreased significantly (P =.001) from baseline (0.99 +/- 0.26) at 6 months (0.93 +/- 0.23), whereas the serum albumin and SGA scores did not differ.
Increasing delivered bicarbonate dose improves serum bicarbonate and may decrease catabolism. Further study is needed to confirm the potential nutritional benefits.
代谢性酸中毒在终末期肾病（ESRD）患者中很常见。研究表明，纠正酸中毒可能改善营养状况和患者预后。本研究的目的是探讨将维持性血液透析患者（MHD）的碳酸氢盐输送剂量从35 mmol/L增加到39 mmol/L对营养相关结局的影响。
这是一项在马萨诸塞州西部4个透析中心进行的纵向观察性研究。在改变碳酸氢盐剂量方案后，对患者进行了6个月的随访。
研究样本包括248例接受MHD至少1年、使用35 mmol/L标准碳酸氢盐透析液且未补充口服碳酸氢盐的患者。
感兴趣的指标包括透析前血清碳酸氢盐、白蛋白、血红蛋白、钾、磷、钙和甲状旁腺激素（iPTH），以及蛋白质分解代谢率（nPCR）。通过主观全面评定法（SGA）对一部分患者（n = 35）的变化进行了检查。
血清碳酸氢盐在3个月时（23.3±3.3）和6个月时（23.1±3.3）较基线水平（21.7±2.8 mmol/L；均值±标准差）有显著改善（P <.0001）。磷从基线时的6.0±2.0 mmol/L降至6个月时的5.7±1.7 mmol/L（P =.02），尽管钙、iPTH和钾保持相对稳定。血清碳酸氢盐在基线时（r = -0.23；P <.05）和3个月时（r = -0.22；P <.05）与nPCR呈显著负相关。nPCR在6个月时（0.93±0.23）较基线水平（0.99±0.26）显著降低（P =.001），而血清白蛋白和SGA评分无差异。
增加碳酸氢盐输送剂量可改善血清碳酸氢盐水平，并可能减少分解代谢。需要进一步研究以证实潜在的营养益处。
