Chang Tae Ik, Oh Hyung Jung, Kang Ea Wha, Yoo Tae-Hyun, Shin Sug Kyun, Kang Shin-Wook, Choi Kyu Hun, Han Dae Suk, Han Seung Hyeok
Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea.
Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea.
PLoS One. 2013 Dec 12;8(12):e82912. doi: 10.1371/journal.pone.0082912. eCollection 2013.
Metabolic acidosis is common in patients with chronic kidney disease and is associated with increased mortality in hemodialysis patients. However, this relationship has not yet been determined in peritoneal dialysis (PD) patients.
This prospective observational study included a total of 441 incident patients who started PD between January 2000 and December 2005. Using time-averaged serum bicarbonate (TA-Bic) levels, we aimed to investigate whether a low serum bicarbonate concentration can predict mortality in these patients.
Among the baseline parameters, serum bicarbonate level was positively associated with hemoglobin level and residual glomerular filtration rate (GFR), while it was negatively associated with albumin, C-reactive protein (CRP) levels, peritoneal Kt/V urea, and normalized protein catabolic rate (nPCR) in a multivariable linear regression analysis. During a median follow-up of 34.8 months, 149 deaths were recorded. After adjustment for age, diabetes, coronary artery disease, serum albumin, ferritin, CRP, residual GFR, peritoneal Kt/V urea, nPCR, and percentage of lean body mass, TA-Bic level was associated with a significantly decreased risk of mortality (HR per 1 mEq/L increase, 0.83; 95% CI, 0.76-0.91; p < 0.001). In addition, compared to patients with a TA-Bic level of 24-26 mEq/L, those with a TA-Bic level < 22 and between 22-24 mEq/L conferred a 13.10- and 2.13-fold increased risk of death, respectively.
This study showed that a low serum bicarbonate concentration is an independent risk factor for mortality in PD patients. This relationship between low bicarbonate levels and adverse outcome could be related to enhanced inflammation and a more rapid loss of RRF associated with metabolic acidosis. Large randomized clinical trials to correct acidosis are warranted to confirm our findings.
代谢性酸中毒在慢性肾脏病患者中很常见，并且与血液透析患者死亡率增加相关。然而，这种关系在腹膜透析（PD）患者中尚未确定。
这项前瞻性观察性研究共纳入了2000年1月至2005年12月开始进行PD的441例新发病例。我们旨在利用时间平均血清碳酸氢盐（TA-Bic）水平，研究低血清碳酸氢盐浓度是否可预测这些患者的死亡率。
在多变量线性回归分析中，在基线参数中，血清碳酸氢盐水平与血红蛋白水平和残余肾小球滤过率（GFR）呈正相关，而与白蛋白、C反应蛋白（CRP）水平、腹膜Kt/V尿素和标准化蛋白分解代谢率（nPCR）呈负相关。在中位随访34.8个月期间，记录到149例死亡。在调整年龄、糖尿病、冠状动脉疾病、血清白蛋白、铁蛋白、CRP、残余GFR、腹膜Kt/V尿素、nPCR和瘦体重百分比后，TA-Bic水平与死亡率风险显著降低相关（每增加1 mEq/L的HR为0.83；95%CI为0.76 - 0.91；p < 0.001）。此外，与TA-Bic水平为24 - 26 mEq/L的患者相比，TA-Bic水平< 22 mEq/L和22 - 24 mEq/L的患者死亡风险分别增加13.10倍和2.13倍。
本研究表明，低血清碳酸氢盐浓度是PD患者死亡的独立危险因素。低碳酸氢盐水平与不良结局之间的这种关系可能与炎症增强以及与代谢性酸中毒相关的残余肾功能更快丧失有关。有必要进行大型随机临床试验来纠正酸中毒以证实我们的发现。
