Barts and the London NHS Trust and William Harvey Research Institute, London, UK.
Curr Opin Nephrol Hypertens. 2010 Sep;19(5):489-92. doi: 10.1097/MNH.0b013e32833b64fa.
Chronic kidney disease progressively impairs the ability of kidneys to excrete hydrogen ions owing to the reduced capacity of the kidney to synthesize ammonia resulting in metabolic acidosis. There is good experimental evidence that metabolic acidosis contributes to protein energy wasting disorder and progression of chronic kidney disease (CKD). However, there was a lack of robust clinical evidence to support these experimental observations.
Three recent publications have confirmed the experimental evidence and the only randomized controlled study of its kind has suggested that the correction of acidosis by sodium bicarbonate in patients with advanced CKD is associated with attenuation of the rate of decline of renal function, reduction in the incidence of end stage renal disease and improvement of nutritional parameters.
In light of these recent studies, it appears that this cheap and simple strategy, which is in line with current renal recommendations, has the potential of translating into significant economic, quality of life and clinical outcome benefits in an expanding pool of patients with CKD.
慢性肾脏病（CKD）会逐渐损害肾脏排泄氢离子的能力，这是由于肾脏合成氨的能力降低，导致代谢性酸中毒。有充分的实验证据表明，代谢性酸中毒会导致蛋白质能量消耗障碍和 CKD 的进展。然而，缺乏强有力的临床证据来支持这些实验观察。
三项最近的研究证实了这一实验证据，而且唯一一项此类随机对照研究表明，在晚期 CKD 患者中用碳酸氢钠纠正酸中毒与减缓肾功能下降速度、降低终末期肾病的发生率以及改善营养参数有关。
鉴于这些最近的研究，这种廉价且简单的策略似乎具有潜力，可能会为不断扩大的 CKD 患者群体带来显著的经济效益、生活质量和临床结局改善，因为它符合当前的肾脏建议。
