Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Division of Human Nutrition, Wageningen Centre for Food Sciences, Wageningen University, Wageningen, The Netherlands.
J Cachexia Sarcopenia Muscle. 2023 Dec;14(6):2498-2508. doi: 10.1002/jcsm.13330. Epub 2023 Sep 20.
Metabolic acidosis unfavourably influences the nutritional status of patients with non-dialysis dependent chronic kidney disease (CKD) including the loss of muscle mass and functionality, but the benefits of correction are uncertain. We investigated the effects of correcting metabolic acidosis on nutritional status in patients with CKD in a systematic review and meta-analysis. A search was conducted in MEDLINE and the Cochrane Library from inception to June 2023. Study selection, bias assessment, and data extraction were independently performed by two reviewers. The Cochrane risk of bias tool was used to assess the quality of individual studies. We applied random effects meta-analysis to obtain pooled standardized mean difference (SMD) and 95% confidence intervals (CIs). We retrieved data from 12 intervention studies including 1995 patients, with a mean age of 63.7 ± 11.7 years, a mean estimated glomerular filtration rate of 29.8 ± 8.8 mL/min per 1.73 m , and 58% were male. Eleven studies performed an intervention with oral sodium bicarbonate compared with either placebo or with standard care and one study compared veverimer, an oral HCl-binding polymer, with placebo. The mean change in serum bicarbonate was +3.6 mEq/L in the intervention group and +0.4 mEq/L in the control group. Correcting metabolic acidosis significantly improved muscle mass assessed by mid-arm muscle circumference (SMD 0.35 [95% CI 0.16 to 0.54], P < 0.001) and functionality assessed with the sit-to-stand test (SMD -0.31 [95% CI -0.52 to 0.11], P = 0.003). We found no statistically significant effects on dietary protein intake, handgrip strength, serum albumin and prealbumin concentrations, and blood urea nitrogen. Correcting metabolic acidosis in patients with CKD improves muscle mass and physical function. Correction of metabolic acidosis should be considered as part of the nutritional care for patients with CKD.
代谢性酸中毒会对非透析依赖型慢性肾脏病（CKD）患者的营养状况产生不利影响，包括肌肉质量和功能的丧失，但纠正代谢性酸中毒的益处尚不确定。我们在系统评价和荟萃分析中研究了纠正代谢性酸中毒对 CKD 患者营养状况的影响。检索了 MEDLINE 和 Cochrane 图书馆从建库到 2023 年 6 月的文献。两名评审员独立进行了研究选择、偏倚评估和数据提取。使用 Cochrane 偏倚风险工具评估单个研究的质量。我们应用随机效应荟萃分析获得合并标准化均数差（SMD）和 95%置信区间（CI）。我们从 12 项干预研究中检索数据，共纳入 1995 例患者，平均年龄 63.7±11.7 岁，平均估算肾小球滤过率为 29.8±8.8 mL/min/1.73m ，58%为男性。11 项研究进行了口服碳酸氢钠干预，与安慰剂或标准治疗相比，1 项研究比较了口服 HCl 结合聚合物 veverimer 与安慰剂。干预组血清碳酸氢盐的平均变化为+3.6 mEq/L，对照组为+0.4 mEq/L。纠正代谢性酸中毒显著改善了通过上臂中部肌肉周长评估的肌肉质量（SMD 0.35 [95%CI 0.16 至 0.54]，P<0.001）和通过坐立测试评估的功能（SMD -0.31 [95%CI -0.52 至 0.11]，P=0.003）。我们没有发现对膳食蛋白质摄入、握力、血清白蛋白和前白蛋白浓度以及血尿素氮有统计学意义的影响。纠正 CKD 患者的代谢性酸中毒可改善肌肉质量和身体功能。纠正代谢性酸中毒应被视为 CKD 患者营养护理的一部分。
