Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland.
Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland,
Kidney Blood Press Res. 2020;45(6):863-872. doi: 10.1159/000508980. Epub 2020 Oct 16.
Metabolic acidosis (MA) is one of the most common consequences of CKD. MA is also a risk factor of CKD progression and increased mortality in these patients.
The aim of this retrospective, cross-sectional study was to assess the prevalence of MA in different stages of CKD and renal replacement therapy (RRT) modalities - haemodialysis (HD) and peritoneal dialysis (PD). Additionally, the relationship between the prevalence of MA and aetiology of kidney disease was analysed.
One thousand five patients in different stages of CKD, or modalities of RRT were enrolled into this single-centre cross-sectional study. Forty-one patients were ruled out because of oral bicarbonate supplementation. In the remaining 964 patients (698 CKD stages 1-5, 226 HD, 40 PD), venous blood HCO3- concentration, as well as serum Cr and urea concentrations were assessed. MA was diagnosed when blood HCO3- concentration was below 22 mmol/L.
The prevalence of MA increased among all stages of CKD. Patients on HD had lower prevalence of MA in comparison with CKD 5 patients with no RRT (38.5 vs. 56.0%; p = 0.02) In PD patients, the prevalence of MA was significantly lower than in HD patients (2.5 vs. 38.5%; p < 0.001). In the whole study group, there were no significant differences in the prevalence of MA between different aetiologies of CKD (glomerulonephritis 24%, hypertension 23%, diabetes 25%, and tubule-interstitial diseases 24%). Also, when only patients in stages CKD 3-5 were compared, no significant differences in the prevalence of acidosis were found (glomerulonephritis 28%, hypertension 22%, diabetes 24%, and tubule-interstitial 21%).
(1) MA is more frequent in patients with more advanced stages of CKD. (2) RRT reduces the prevalence of MA. (3) In PD patients, MA is rare. (4) Aetiology of CKD seems not to have a significant impact on MA prevalence.
代谢性酸中毒（MA）是慢性肾脏病（CKD）最常见的后果之一。MA 也是 CKD 进展和这些患者死亡率增加的危险因素。
这项回顾性、横断面研究的目的是评估不同 CKD 阶段和肾脏替代治疗（RRT）方式——血液透析（HD）和腹膜透析（PD）中 MA 的患病率。此外，还分析了 MA 的患病率与肾脏疾病病因之间的关系。
这项单中心横断面研究纳入了 1500 名处于不同 CKD 阶段或 RRT 方式的患者。由于口服碳酸氢盐补充，有 41 名患者被排除在外。在其余 964 名患者（698 名 CKD 1-5 期、226 名 HD、40 名 PD）中，评估了静脉血 HCO3-浓度以及血清 Cr 和尿素浓度。当血液 HCO3-浓度低于 22mmol/L 时，诊断为 MA。
所有 CKD 阶段的 MA 患病率均增加。与未接受 RRT 的 CKD 5 期患者相比，HD 患者的 MA 患病率较低（38.5%比 56.0%；p=0.02）。PD 患者的 MA 患病率明显低于 HD 患者（2.5%比 38.5%；p<0.001）。在整个研究组中，不同病因的 CKD 患者 MA 的患病率没有显著差异（肾小球肾炎 24%、高血压 23%、糖尿病 25%和肾小管-间质疾病 24%）。此外，当仅比较 CKD 3-5 期患者时，酸中毒的患病率没有显著差异（肾小球肾炎 28%、高血压 22%、糖尿病 24%和肾小管-间质 21%）。
（1）MA 在 CKD 更晚期的患者中更为常见。（2）RRT 降低 MA 的患病率。（3）在 PD 患者中，MA 很少见。（4）CKD 的病因似乎对 MA 的患病率没有显著影响。
