Soleymanian Tayebeh, Ghods Ahad
Division of Nephrology, Tehran University of Medical Sciences, Tehran, Iran.
Saudi J Kidney Dis Transpl. 2011 Nov;22(6):1149-54.
One of the main causes of protein-energy malnutrition in patients on maintenance hemodialysis (MHD) is metabolic acidosis. The aim of this study was to evaluate the effect of metabolic acidosis on nutritional status in a group of MHD patients with adequately delivered dialysis treatment. Of 165 eligible anuric MHD outpatients with Kt/V ≥ 1 and no underlying inflammatory diseases, 47 subjects were enrolled. In order to evaluate the effect of different parameters on serum albumin, we measured the pre-dialysis serum albumin, blood pH, serum bicarbonate (HCO 3‾ ), Kt/V, normalized protein catabolic rate (nPCR) and body mass index (BMI) in these patients. The mean age of the study patients was 55 ± 13.8 years; there were 22 females and six diabetics. The average Kt/V was 1.22 ± 0.16, pH was 7.40 ± 0.15, serum HCO 3‾ was 23.18 ± 2.38 mEq/L, serum albumin was 4.03 ± 0.56 g/dL, nPCR was 1.00 ± 0.16 g/kg/day, post-dialysis body weight was 58.50 ± 11.50 kg and BMI was 23.47 ± 2.70 kg/m 2 . There was a statistically significant direct correlation between serum albumin and BMI (r = 0.415, P = 0.004), and between serum albumin and serum HCO 3 (r = 0.341, P = 0.019). On multiple regression analysis, the predictors of serum albumin were serum HCO3‾ and BMI (direct effect) and nPCR (inverse effect). In 17 patients on MHD with serum HCO3‾ <22 mEq/L, there was a significant inverse correlation between HCO 3 and nPCR (r = 0.492, P = 0.045), and these patients had significantly lower serum albumin compared with patients with serum HCO3‾ >22 mEq/L (P = 0.046). These data demonstrate that patients on MHD with metabolic acidosis had a lower serum albumin concentration despite adequate dialysis treatment. The inverse effect of nPCR on serum albumin concentration in acidotic MHD patients may be due to hypercatabolism in the setting of metabolic acidosis, leading to deleterious effects on the nutritional status of patients on MHD.
维持性血液透析（MHD）患者蛋白质 - 能量营养不良的主要原因之一是代谢性酸中毒。本研究的目的是评估代谢性酸中毒对一组接受充分透析治疗的MHD患者营养状况的影响。在165名符合条件的无尿MHD门诊患者中，Kt/V≥1且无潜在炎症性疾病，47名受试者被纳入研究。为了评估不同参数对血清白蛋白的影响，我们测量了这些患者透析前的血清白蛋白、血液pH值、血清碳酸氢盐（HCO₃⁻）、Kt/V、标准化蛋白分解代谢率（nPCR）和体重指数（BMI）。研究患者的平均年龄为55±13.8岁；有22名女性和6名糖尿病患者。平均Kt/V为1.22±0.16，pH值为7.40±0.15，血清HCO₃⁻为23.18±2.38 mEq/L，血清白蛋白为4.03±0.56 g/dL，nPCR为1.00±0.16 g/kg/天，透析后体重为58.50±11.50 kg，BMI为23.47±2.70 kg/m²。血清白蛋白与BMI之间存在统计学上显著的正相关（r = 0.415，P = 0.004），血清白蛋白与血清HCO₃之间也存在正相关（r = 0.341，P = 0.019）。多元回归分析显示，血清白蛋白的预测因素是血清HCO₃⁻和BMI（直接效应）以及nPCR（反向效应）。在17名血清HCO₃⁻<22 mEq/L的MHD患者中，HCO₃⁻与nPCR之间存在显著的负相关（r = 0.492，P = 0.045），与血清HCO₃⁻>22 mEq/L的患者相比，这些患者的血清白蛋白显著降低（P = 0.046）。这些数据表明，尽管进行了充分的透析治疗，但患有代谢性酸中毒的MHD患者血清白蛋白浓度较低。nPCR对酸中毒MHD患者血清白蛋白浓度的反向影响可能是由于代谢性酸中毒情况下的高分解代谢，对MHD患者的营养状况产生有害影响。
