Movilli Ezio, Viola Battista Fabio, Camerini Corrado, Mazzola Giuseppe, Cancarini Giovanni C
Division of Nephrology, Spedali Civili and University of Brescia, Brescia, Italy.
J Ren Nutr. 2009 Mar;19(2):172-7. doi: 10.1053/j.jrn.2008.08.012.
The effect of the correction of metabolic acidosis (MA) on serum albumin concentrations (sAlbs) in hemodialysis (HD) patients is controversial. This study evaluated the role of the correction of MA on sAlb concentrations, normalized protein catabolic rate (nPCR), and the effect of the concomitant inflammatory status, in a group of acidotic HD patients.
The correction of MA by oral supplementation with sodium bicarbonate, and the evaluation of its effect on sAlb, nPCR, and high-sensitivity C-reactive protein (hsCRP), were performed in 29 patients on bicarbonate dialysis for a median of 30 months. Other variables included pre-HD arterial pH, serum bicarbonate, serum creatinine, serum Na, body weight, interdialytic weight gain, pre-HD systolic and diastolic blood pressure, and Kt/V.
Serum bicarbonate and pH increased significantly (P < .0001), from 19.1 +/- 0.7 mmol/L to 24.6 +/- 1.1 mmol/L and from 7.33 +/- 0.03 to 7.39 +/- 0.02, respectively (all values with +/- are SD). The nPCR decreased from 1.13 +/- 0.14 g/kg/day to 1.05 +/- 0.14 g/kg/day (P < .0001). The other variables did not change significantly. In 17 patients with high-sensitivity C-reactive protein <10 mg/L, sAlb increased from 3.7 +/- 0.3 g/dL to 4.0 +/- 0.3 g/dL (P < .01), whereas in 12 with high-sensitivity C-reactive protein >or=10 mg/L, sAlb did not change (3.5 +/- 0.17 g/dL vs. 3.4 +/- 0.13 g/dL; P = NS).
Oral sodium bicarbonate supplementation is effective in correcting MA in HD patients and does not affect interdialytic weight gain, plasma Na, and blood pressure. The correction of MA is effective in reducing protein catabolism (nPCR) in both inflamed and less inflamed HD patients, but increases sAlb only in patients without inflammation. In inflamed patients, the correction of MA is not sufficient per se to improve sAlb concentrations.
代谢性酸中毒（MA）的纠正对血液透析（HD）患者血清白蛋白浓度（sAlb）的影响存在争议。本研究评估了MA的纠正对一组酸中毒HD患者的sAlb浓度、标准化蛋白分解代谢率（nPCR）的作用以及伴随的炎症状态的影响。
对29例接受碳酸氢盐透析中位数为30个月的患者，通过口服补充碳酸氢钠来纠正MA，并评估其对sAlb、nPCR和高敏C反应蛋白（hsCRP）的影响。其他变量包括透析前动脉血pH值、血清碳酸氢盐、血清肌酐、血清钠、体重、透析间期体重增加、透析前收缩压和舒张压以及Kt/V。
血清碳酸氢盐和pH值显著升高（P <.0001），分别从19.1±0.7 mmol/L升至24.6±1.1 mmol/L，从7.33±0.03升至7.39±0.02（所有带±的值均为标准差）。nPCR从1.
