Departments of Internal Medicine, Texas A&M Health Sciences Center College of Medicine, Temple, Texas, USA.
Curr Opin Nephrol Hypertens. 2012 Sep;21(5):552-6. doi: 10.1097/MNH.0b013e328356233b.
Most patients with reduced glomerular filtration rate (GFR) have progressive GFR decline despite currently recommended kidney-protective interventions. Recent studies support that dietary acid reduction with Na(+)-based alkali or food types that yield base when metabolized provides kidney protection that is additive to currently recommended interventions. We review these recent studies in light of current kidney-protective recommendations for chronic kidney disease (CKD).
Animal models of CKD show that metabolic acidosis and/or dietary acid induce intrakidney mechanisms that cause kidney injury and mediate progressive GFR decline. Translational studies in patients show that NaHCO(3) ameliorates kidney injury in patients with CKD and reduced GFR, with and without metabolic acidosis; NaHCO(3) and base-inducing food types each ameliorate kidney injury in patients with reduced GFR without metabolic acidosis; and NaHCO(3) and Na(+) citrate each slow GFR decline in CKD patients with reduced GFR, with and without metabolic acidosis.
Recently published studies in animals and humans suggest that acid-base-related mechanisms mediate nephropathy progression. These studies support that dietary acid reduction with Na(+)-based alkali or alkali-inducing food is an effective kidney-protective adjunct to current strategies and support re-examination of current recommendations for CKD management.
尽管目前推荐了肾脏保护干预措施，但大多数肾小球滤过率（GFR）降低的患者仍存在进行性 GFR 下降。最近的研究支持，用基于钠（+）的碱或代谢时产生碱的食物来减少饮食中的酸，可以提供肾脏保护，这种保护作用与目前推荐的干预措施相加。我们根据慢性肾脏病（CKD）的现行肾脏保护建议来回顾这些最近的研究。
CKD 的动物模型表明，代谢性酸中毒和/或饮食性酸会引起肾内机制，导致肾脏损伤并介导进行性 GFR 下降。在患者中的转化研究表明，碳酸氢钠（NaHCO3）可改善 CKD 和 GFR 降低患者的肾脏损伤，无论是否存在代谢性酸中毒；NaHCO3 和产生碱的食物类型均可改善无代谢性酸中毒的 GFR 降低患者的肾脏损伤；NaHCO3 和柠檬酸纳（Na+）均可减缓 CKD 和 GFR 降低患者的 GFR 下降，无论是否存在代谢性酸中毒。
最近在动物和人类中发表的研究表明，酸碱相关机制介导了肾病进展。这些研究支持用基于钠（+）的碱或产生碱的食物来减少饮食中的酸是对当前策略的有效肾脏保护辅助手段，并支持重新审查当前 CKD 管理建议。
