Adamczak Marcin, Masajtis-Zagajewska Anna, Mazanowska Oktawia, Madziarska Katarzyna, Stompór Tomasz, Więcek Andrzej
Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland,
Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Lodz, Poland.
Kidney Blood Press Res. 2018;43(3):959-969. doi: 10.1159/000490475. Epub 2018 Jun 7.
Metabolic acidosis is commonly found in patients with chronic kidney disease (CKD), and its causes are: impaired ammonia excretion, reduced tubular bicarbonate reabsorption and insufficient renal bicarbonate production in relation to the amount of acids synthesised by the body and ingested with food. As the consequence, numerous metabolic abnormalities develop, which may lead to dysfunction of several organs. In observational studies, it has been found that CKD patients with metabolic acidosis are characterised by faster progression of kidney disease towards end stage kidney failure, and by increased mortality. Results of interventional studies suggest that alkali therapy in CKD patients slows progression of kidney disease. In view of these facts, the members of "The Working Group of the Polish Society of Nephrology on Metabolic and Endocrine Abnormalities in Kidney Diseases" have prepared the following statement and guidelines for the diagnosis and treatment of metabolic acidosis in CKD patients. Measurement of bicarbonate concentration in venous plasma or venous blood to check for metabolic acidosis should be performed in all CKD patients and metabolic acidosis in these patients should be diagnosed when the venous plasma or venous blood bicarbonate concentration is lower than 22 mmol/l. In patients with metabolic acidosis and CKD, oral sodium bicarbonate administration is recommended. The goal of such a treatment is to achieve a plasma or blood bicarbonate concentration equal to or greater than 22 mmol/l.
代谢性酸中毒常见于慢性肾脏病（CKD）患者，其病因包括：氨排泄受损、肾小管碳酸氢盐重吸收减少以及与机体合成及食物摄入的酸量相关的肾脏碳酸氢盐生成不足。结果，出现了许多代谢异常，这可能导致多个器官功能障碍。在观察性研究中，发现患有代谢性酸中毒的CKD患者的特点是肾脏疾病向终末期肾衰竭进展更快，且死亡率增加。干预性研究结果表明，CKD患者的碱疗法可减缓肾脏疾病的进展。鉴于这些事实，“波兰肾脏病学会肾脏疾病代谢和内分泌异常工作组”的成员编写了以下关于CKD患者代谢性酸中毒诊断和治疗的声明及指南。所有CKD患者均应检测静脉血浆或静脉血中的碳酸氢盐浓度以检查是否存在代谢性酸中毒，当静脉血浆或静脉血碳酸氢盐浓度低于22 mmol/L时，应诊断这些患者患有代谢性酸中毒。对于患有代谢性酸中毒的CKD患者，建议口服碳酸氢钠。这种治疗的目标是使血浆或血液碳酸氢盐浓度达到或高于22 mmol/L。
