Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Am J Nephrol. 2010;32(6):549-56. doi: 10.1159/000321461. Epub 2010 Nov 2.
BACKGROUND/AIMS: metabolic acidosis (MA) in chronic kidney disease (CKD) associates with protein energy malnutrition, osteoporosis, abnormal endocrine function and increased mortality. Oral sodium bicarbonate has been shown to improve nutritional status and preserve renal function in CKD. Depressed thyroid function has been described in CKD and was believed to be related to MA. This is a prospective randomized study that examined the effect of oral sodium bicarbonate on thyroid function in predialysis CKD with MA.
predialysis CKD patients with serum total CO(2) ≤ 22 mM were randomized into two groups. The treatment group received increasing dose of oral sodium bicarbonate until serum total CO(2) was ≥ 24 mM. Control patients were kept on the same medications. Thyroid function tests were measured at baseline and again after 8-12 weeks.
all patients had a glomerular filtration rate <35 ml/min/1.73 m(2). Serum total CO(2) increased significantly in the treatment group and was unchanged in the control group. At baseline, over half of the patients had T3 below the lower limit of normal. At study completion, free T3 declined further in the control group, whereas free T3, total T3, free T4 and TSH rose significantly in the treatment group. Percentage changes of total CO(2) from baseline were strongly associated with the changes of T3 parameters. Glomerular filtration rate was maintained in the treatment group but declined significantly in the control group.
oral sodium bicarbonate, through correction of MA, improved thyroid function in predialysis CKD.
背景/目的：慢性肾脏病（CKD）中的代谢性酸中毒（MA）与蛋白质能量营养不良、骨质疏松症、异常内分泌功能和死亡率增加有关。口服碳酸氢钠已被证明可改善 CKD 患者的营养状况并保护肾功能。CKD 患者甲状腺功能减退已被描述，并被认为与 MA 有关。这是一项前瞻性随机研究，研究了口服碳酸氢钠对 MA 合并 CKD 透析前患者甲状腺功能的影响。
将血清总 CO₂≤22mM 的 CKD 透析前患者随机分为两组。治疗组接受递增剂量的口服碳酸氢钠，直至血清总 CO₂≥24mM。对照组患者继续服用相同的药物。在基线和 8-12 周后测量甲状腺功能检查。
所有患者的肾小球滤过率均<35ml/min/1.73m²。治疗组血清总 CO₂显著升高，对照组无变化。基线时，超过一半的患者 T3 低于正常值下限。研究结束时，对照组游离 T3 进一步下降，而治疗组游离 T3、总 T3、游离 T4 和 TSH 显著升高。从基线开始的总 CO₂百分比变化与 T3 参数的变化密切相关。治疗组肾小球滤过率保持稳定，而对照组显著下降。
口服碳酸氢钠通过纠正 MA 改善了 CKD 透析前患者的甲状腺功能。
