Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, VA, USA.
Nephrol Dial Transplant. 2012 Aug;27(8):3056-62. doi: 10.1093/ndt/gfs291.
Metabolic acidosis is a common complication associated with progressive loss of kidney function. The diminishing ability of the kidneys to maintain acid-base homeostasis results in acid accumulation, leading to various complications such as impairment in nutritional status, worsened uremic bone disease and an association with increased mortality. In addition to these adverse effects which are related to acid retention, metabolic acidosis may also cause kidney damage, possibly through the stimulation of adaptive mechanisms aimed at maintaining acid-base homeostasis in the face of decreasing kidney function. Recent clinical trials have suggested that correction or prevention of metabolic acidosis by alkali administration is able to attenuate kidney damage and to slow progression of chronic kidney disease (CKD), and may hence offer an effective, safe and affordable renoprotective strategy. We review the physiology and pathophysiology of acid-base homeostasis in CKD, the mechanisms whereby metabolic acidosis may be deleterious to kidney function, and the results of clinical trials suggesting a benefit of alkali therapy, with special attention to details related to the practical implementation of the results of these trials.
代谢性酸中毒是与肾功能进行性丧失相关的常见并发症。肾脏维持酸碱平衡的能力下降会导致酸积累，从而导致各种并发症，如营养状况受损、尿毒症骨病恶化以及与死亡率增加相关。除了与酸潴留有关的这些不利影响外，代谢性酸中毒还可能导致肾脏损伤，这可能是通过刺激适应机制以维持肾功能下降时的酸碱平衡所致。最近的临床试验表明，通过碱剂治疗纠正或预防代谢性酸中毒能够减轻肾脏损伤并减缓慢性肾脏病（CKD）的进展，因此可能提供一种有效、安全且负担得起的肾脏保护策略。我们综述 CKD 酸碱平衡的生理学和病理生理学、代谢性酸中毒可能对肾功能有害的机制，以及提示碱治疗有益的临床试验结果，特别注意与实施这些试验结果相关的细节。
