Katalinić Lea, Blaslov Kristina, Đanić-Hadžibegović Ana, Gellineo Lana, Kes Petar, Jelaković Bojan, Basić-Jukić Nikolina
Acta Clin Croat. 2015 Dec;54(4):486-91.
Despite prolonged survival and better quality of life as compared to dialysis, kidney transplantation frequently presents with a complex set of medical issues that require intensive management to protect graft function. Metabolic acidosis has an impact on several metabolic complications such as mineral and muscle metabolism, nutritional status and anemia. It may also have an effect on graft function, possibly through the stimulation of adaptive mechanisms aimed at maintaining acid-base homeostasis. We investigated current practice in the evaluation of metabolic acidosis at one of the largest transplant centers in the Eurotransplant region. Adult renal transplant recipients having received allograft from January 2011 to August 2012 were included in the investigation. We recorded the frequency of measuring the parameters of venous blood gas analysis, as well as creatinine and urea levels, creatinine clearance, proteinuria, calcium, phosphate and potassium blood levels, body mass index and the time spent on dialysis prior to kidney transplantation. Out of 203 patients who had received renal allograft at our institution during the observed period, 191 (124 males and 67 females, age range from 18 to 77 years) were enrolled in the study. Of these, only 92 (48.167%) patients had parameters of venous blood gas analysis measured at some time after kidney transplantation. Acid-base status was determined more often in males (77 males vs. 22 females, p = 0.001). Patients with pH/blood gas analysis performed were found to have significantly higher creatinine and urea levels and significantly lower creatinine clearance (p < 0.001 both). Serum calcium levels were also significantly lower in this group of patients (p < 0.001). Metabolic acidosis is a very important clinical issue that needs to be monitored in every transplant recipient. Its effects on graft function, nutritional status, anemia and bone mass are complex but can be successfully managed. Our study showed metabolic acidosis to be linked with significantly higher creatinine and urea levels, decreased creatinine clearance and lower calcium levels. Nevertheless, metabolic acidosis still stays a highly underestimated problem among nephrologists dealing with transplant recipients. We suggest regular determination of the acid-base status in renal transplant recipients.
与透析相比，肾移植患者生存期延长且生活质量提高，但肾移植常伴有一系列复杂的医学问题，需要强化管理以保护移植肾功能。代谢性酸中毒会影响多种代谢并发症，如矿物质和肌肉代谢、营养状况及贫血。它还可能对移植肾功能产生影响，可能是通过刺激旨在维持酸碱平衡的适应性机制。我们在欧洲移植区域最大的移植中心之一调查了代谢性酸中毒评估的当前做法。纳入了2011年1月至2012年8月接受同种异体肾移植的成年肾移植受者。我们记录了静脉血气分析参数、肌酐和尿素水平、肌酐清除率、蛋白尿、血钙、血磷和血钾水平、体重指数以及肾移植前透析时间的测量频率。在观察期内，我们机构有203例接受肾移植的患者，其中191例（124例男性和67例女性，年龄范围为18至77岁）纳入研究。其中，只有92例（48.167%）患者在肾移植后的某个时间测量了静脉血气分析参数。男性更常测定酸碱状态（77例男性对22例女性，p = 0.001）。进行了pH/血气分析的患者肌酐和尿素水平显著更高，肌酐清除率显著更低（两者p < 0.001）。该组患者的血清钙水平也显著更低（p < 0.001）。代谢性酸中毒是一个非常重要的临床问题，需要在每个移植受者中进行监测。其对移植肾功能、营养状况、贫血和骨量的影响很复杂，但可以成功处理。我们的研究表明，代谢性酸中毒与肌酐和尿素水平显著升高、肌酐清除率降低以及钙水平降低有关。然而，在处理移植受者的肾病学家中，代谢性酸中毒仍然是一个严重被低估的问题。我们建议定期测定肾移植受者的酸碱状态。
