Kim Hyo Jin
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Electrolyte Blood Press. 2021 Dec;19(2):29-37. doi: 10.5049/EBP.2021.19.2.29. Epub 2021 Dec 23.
The kidneys play an important role in regulating the acid-base balance. Metabolic acidosis is common in chronic kidney disease (CKD) patients and can lead to poor outcomes, such as bone demineralization, muscle mass loss, and worsening of renal function. Metabolic acidosis is usually approached with evaluating the serum bicarbonate levels but should be assessed by counting blood pH. Current guidelines recommend oral bicarbonate supplementation to maintain the serum bicarbonate levels within the normal range. However, a slow decline in the glomerular filtration rate might occur, even though the serum bicarbonate levels were in the normal range. Because the serum bicarbonate levels decrease when metabolic acidosis advances, other biomarkers are necessary to indicate acid retention for early diagnosis of metabolic acidosis. For this, urine citrate and ammonium excretion may be used to follow the course of CKD patients. Metabolic acidosis can be treated with an increased fruit and vegetable intake and oral alkali supplementation. Previous studies have suggested that administration of oral sodium bicarbonate may preserve kidney function without significant increases in blood pressure and body weight. Veverimer, a non-absorbed, counterion-free, polymeric drug, is emerging to treat metabolic acidosis, but further researches are awaited. Further studies are also needed to clarify the target therapeutic range of serum bicarbonate and the drugs used for metabolic acidosis.
肾脏在调节酸碱平衡中发挥着重要作用。代谢性酸中毒在慢性肾脏病（CKD）患者中很常见，并且会导致不良后果，如骨质脱矿、肌肉量减少以及肾功能恶化。代谢性酸中毒通常通过评估血清碳酸氢盐水平来处理，但应通过测量血液pH值进行评估。当前指南建议口服补充碳酸氢盐以将血清碳酸氢盐水平维持在正常范围内。然而，即使血清碳酸氢盐水平处于正常范围，肾小球滤过率仍可能缓慢下降。由于代谢性酸中毒进展时血清碳酸氢盐水平会降低，因此需要其他生物标志物来指示酸潴留，以便早期诊断代谢性酸中毒。为此，尿枸橼酸盐和铵排泄可用于追踪CKD患者的病程。代谢性酸中毒可通过增加水果和蔬菜摄入量以及口服碱补充剂来治疗。先前的研究表明，口服碳酸氢钠给药可能在不显著增加血压和体重的情况下保护肾功能。维维美林是一种不被吸收、无抗衡离子的聚合物药物，正在兴起用于治疗代谢性酸中毒，但尚待进一步研究。还需要进一步研究以明确血清碳酸氢盐的目标治疗范围以及用于治疗代谢性酸中毒的药物。
