Ruggieri Fabio, Caso Giuseppe, Wegmann Marlene, McNurlan Margaret A, Wahl Christoph, Imoberdorf Reinhard, Garlick Peter J, Ballmer Peter E
Department of Internal Medicine, Kantonsspital, Winterthur, Switzerland.
Nephron Clin Pract. 2009;112(4):c276-83. doi: 10.1159/000224795. Epub 2009 Jun 16.
Although the mechanism of muscle wasting in end-stage renal disease is not fully understood, there is increasing evidence that acidosis induces muscle protein degradation and could therefore contribute to the loss of muscle protein stores of patients on hemodialysis, a prototypical state of chronic metabolic acidosis (CMA). Because body protein mass is controlled by the balance between synthesis and degradation, protein loss can occur as result of either increased breakdown, impaired synthesis, or both. Correction of acidosis may therefore help to maintain muscle mass and improve the health of patients with CMA. We evaluated whether alkalizing patients on hemodialysis might have a positive effect on protein synthesis and on nutritional parameters.
Eight chronic hemodialysis patients were treated daily with oral sodium bicarbonate (NaHCO(3)) supplementation for 10-14 days, yielding a pre-dialytic plasma bicarbonate concentration of 28.6 +/-1.6 mmol/l. The fractional synthesis rates (FSR) of muscle protein and albumin were obtained by the L-[(2)H(5)ring]phenylalanine flooding technique.
Oral NaHCO(3 )supplementation induced a significant increase in serum bicarbonate (21.5 +/- 3.4 vs. 28.6 +/- 1.6 mmol/l; p = 0.018) and blood pH (7.41 vs. 7.46; p = 0.041). The FSR of muscle protein and the FSR of albumin did not change significantly (muscle protein: 2.1 +/- 0.2 vs. 2.0 +/- 0.5% per day, p = 0.39; albumin: 8.3 +/- 2.2 vs. 8.6 +/- 2.5% per day, p = 0.31). Plasma concentrations of insulin-like growth factor 1 decreased significantly (33.4 +/- 21.3 vs. 25.4 +/- 12.3 nmol/l; p = 0.028), whereas thyroid-stimulating hormone, free thyroxin and free triiodothyronine did not change significantly and nutritional parameters showed no improvement.
In contrast to other findings, raising the blood pH of dialysis patients was not associated with a positive effect on albumin and muscle protein synthesis, or nutritional and endocrinal parameters.
尽管终末期肾病中肌肉萎缩的机制尚未完全明确，但越来越多的证据表明酸中毒会诱导肌肉蛋白质降解，因此可能导致血液透析患者肌肉蛋白储备的流失，血液透析是慢性代谢性酸中毒（CMA）的典型状态。由于机体蛋白质质量受合成与降解之间平衡的控制，蛋白质流失可能是由于分解增加、合成受损或两者兼而有之。因此，纠正酸中毒可能有助于维持肌肉质量并改善CMA患者的健康状况。我们评估了对血液透析患者进行碱化治疗是否可能对蛋白质合成及营养参数产生积极影响。
8例慢性血液透析患者每天口服补充碳酸氢钠（NaHCO₃），持续10 - 14天，使透析前血浆碳酸氢盐浓度达到28.6±1.6 mmol/L。采用L-[(²)H(₅)环]苯丙氨酸灌注技术测定肌肉蛋白和白蛋白的分数合成率（FSR）。
口服NaHCO₃导致血清碳酸氢盐显著升高（21.5±3.4 vs. 28.6±1.6 mmol/L；p = 0.018）以及血液pH值升高（7.41 vs. 7.46；p = 0.041）。肌肉蛋白的FSR和白蛋白的FSR无显著变化（肌肉蛋白：每天2.1±0.2 vs. 2.0±0.5%，p = 0.39；白蛋白：每天8.3±2.2 vs. 8.6±2.5%，p = 0.31）。胰岛素样生长因子1的血浆浓度显著降低（33.4±21.3 vs. 25.4±12.3 nmol/L；p = 0.028），而促甲状腺激素、游离甲状腺素和游离三碘甲状腺原氨酸无显著变化，且营养参数未得到改善。
与其他研究结果相反，提高透析患者的血液pH值对白蛋白和肌肉蛋白合成、营养及内分泌参数并无积极影响。
Zotero 插件