Bossola Maurizio, Giungi Stefania, Tazza Luigi, Luciani Giovanna
Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia.
Nephron Clin Pract. 2007;106(1):c51-6. doi: 10.1159/000101484. Epub 2007 Apr 2.
Metabolic acidosis, a frequent event in hemodialysis patients, has been implicated as a potential cause of protein-energy malnutrition. Unfortunately, correction of metabolic acidosis by means of high bicarbonate concentration in the dialysate does not seem to lead to significant changes in nutritional parameters. The project was a single-arm, open-label, 12-month pilot study at a university-based tertiary care center aimed at evaluating whether correction of metabolic acidosis through long-term oral sodium bicarbonate supplementation improves serum albumin levels and other nutritional parameters in patients undergoing maintenance hemodialysis. Twenty highly acidotic hemodialysis patients patients were invited to consume an oral supplementation of sodium bicarbonate (1 g, thrice daily), for 12 months. Patients were followed at baseline and every month, until month 12. At each follow-up visit, dry body weight, BMI, blood pressure, presence of edema, venous bicarbonate, and serum albumin were measured. Total lymphocyte count, fasting total cholesterol and C-reactive protein were assessed every 2 months. At baseline and at 12 months, the subjective global assessment of nutritional status and the protein equivalent of nitrogen appearance normalized to actual body weight were determined. Plasma bicarbonate level rose from 18.1 +/- 2.7 to 22.1 +/- 4.5 mmol/l after 10 months (p = 0.001). Mean serum albumin levels were 3.8 +/- 0.2 mg/dl at baseline and 3.9 +/- 0.2 at the end of the study. Repeated measure ANOVA showed that there was no significant effect of bicarbonate treatment on serum albumin levels (p = 0.29), dry weight (p = 0.1), serum total cholesterol (p = 0.97), total lymphocyte count (p = 0.69), or C-reactive protein (p = 0.85). Mean subjective global assessment score was 4.53 +/- 0.37 at baseline and 4.58 +/- 0.54 at 12 months (p = 0.1). Mean nPNA (g/kg/day) was 0.86 +/- 0.05 at baseline and 0.85 +/- 0.08 at month 12. The present study demonstrates that long-term oral sodium bicarbonate at the dose of 1 gram thrice daily has no significant effect on nutritional status of HD patients.
代谢性酸中毒是血液透析患者常见的情况，被认为是蛋白质 - 能量营养不良的潜在原因。不幸的是，通过在透析液中使用高浓度碳酸氢盐来纠正代谢性酸中毒，似乎并未导致营养参数发生显著变化。该项目是在一家大学附属三级护理中心进行的一项单臂、开放标签的12个月试点研究，旨在评估通过长期口服补充碳酸氢钠来纠正代谢性酸中毒是否能改善维持性血液透析患者的血清白蛋白水平和其他营养参数。邀请了20名高度酸中毒的血液透析患者口服补充碳酸氢钠（1克，每日三次），为期12个月。在基线时以及之后每月对患者进行随访，直至第12个月。每次随访时，测量干体重、体重指数、血压、水肿情况、静脉血碳酸氢盐和血清白蛋白。每2个月评估一次总淋巴细胞计数、空腹总胆固醇和C反应蛋白。在基线和12个月时，确定营养状况的主观全面评定以及根据实际体重标准化的氮呈现蛋白当量。10个月后，血浆碳酸氢盐水平从18.1±2.7 mmol/l升至22.1±4.5 mmol/l（p = 0.001）。基线时平均血清白蛋白水平为3.8±0.2 mg/dl，研究结束时为3.9±0.2 mg/dl。重复测量方差分析显示，碳酸氢盐治疗对血清白蛋白水平（p = 0.29）、干体重（p = 0.1）、血清总胆固醇（p = 0.97）、总淋巴细胞计数（p = 0.69）或C反应蛋白（p = 0.85）均无显著影响。主观全面评定平均得分在基线时为4.53±0.37，12个月时为4.58±0.54（p = 0.1）。平均nPNA（克/千克/天）在基线时为0.86±0.05，第12个月时为0.85±0.08。本研究表明，每日三次1克剂量的长期口服碳酸氢钠对血液透析患者的营养状况无显著影响。
