Zentrum Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg (MHB), Brandenburg, Germany,
Zentrum Innere Medizin 1, Kardiologie, Angiologie, Nephrologie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg (MHB), Brandenburg, Germany.
Kidney Blood Press Res. 2020;45(6):812-822. doi: 10.1159/000510829. Epub 2020 Dec 2.
Metabolic acidosis may be diagnosed as chronic (cMA) if it persists for at least 5 days, although an exact definition has not been provided by any guidelines yet. The most common cause is CKD; numerous less-known diseases can also account for cMA.
In recent years, CKD-associated cMA has been proposed to induce several clinical complications. The aim of the article was to assess the current clinical evidence for complications and the respective management of CKD-associated cMA. In summary, cMA in CKD most likely promotes protein degradation and loss of bone mineral density. It aggravates CKD progression as indicated by experimental and (partly) clinical data. Therefore, cMA control must be recommended. Besides oral bicarbonate, dietary interventions potentially offer an alternative. Veverimer is a future option for cMA control; further systematic data are needed.
The most common cause of cMA is CKD. CKD-associated cMA most likely induces a negative protein balance; the exact role on bone metabolism remains uncertain. It presumably aggravates CKD progression. cMA control is recommendable; the serum bicarbonate target level should range around 24 mEq/L. Veverimer may be established as future option for cMA control; further systematic data are needed.
代谢性酸中毒如果持续至少 5 天，可能被诊断为慢性（cMA），尽管目前还没有任何指南对此进行明确定义。最常见的病因是 CKD；许多不太知名的疾病也可能导致 cMA。
近年来，有人提出 CKD 相关的 cMA 可引起多种临床并发症。本文旨在评估 CKD 相关 cMA 并发症的现有临床证据和相应的治疗方法。总之，CKD 中的 cMA 很可能会促进蛋白质降解和骨矿物质密度的丧失。实验和（部分）临床数据表明，cMA 会加重 CKD 的进展。因此，必须建议控制 cMA。除了口服碳酸氢盐外，饮食干预可能是一种替代方法。Veverimer 是控制 cMA 的一种未来选择；需要进一步的系统数据。
cMA 最常见的病因是 CKD。CKD 相关的 cMA 很可能会导致负氮平衡；其对骨代谢的确切作用仍不确定。cMA 可能会加重 CKD 的进展。建议控制 cMA；血清碳酸氢盐的目标水平应在 24 mEq/L 左右。Veverimer 可能会成为 cMA 控制的未来选择；需要进一步的系统数据。
