Passfall J, Pai J, Spies K P, Haller H, Luft F C
Franz Volhard Clinic, Humboldt University of Berlin, Germany.
Clin Nephrol. 1997 Feb;47(2):92-8.
Animal studies suggest that alkalinization and increased intake of free water both serve to decrease the rate of progression in chronic renal failure. However, clinicians have been reluctant to apply either strategy because of concerns regarding volume overload and water intoxication. We tested the effects of 2 1 daily water supplementation, with either an electrolyte-poor or a HCO3-rich (47.5 mmol/1) water in 11 patients with chronic renal failure (creatinine clearance 10 +/- 5 ml/min). The patients were brought into balance on a diet containing 80 mmol/24 h Na+, 80 mmol/24 h Cl- and 70 mmol/24 h K+. After a 3-day equilibration period, the patients were randomized to one or the other regimen for 7 days. After a 3-day washout period, the alternate regimen was given for another 7 days. Neither regimen led to weight gain or hyponatremia. The supplemental 95 mmol/24 h HCO3- lowered the serum Cl- concentration and raised the serum HCO3- concentration, as well as the pH value, to normal. Creatinine clearance and protein excretion were not affected. Serum beta 2-microglobulin concentrations decreased with the NaHCO3-containing water. Na+/H(+)-antiporter activity was not consistently influenced since an order effect of the regimens was apparent. We conclude that 2 1/24 h water and NaHCO3 supplementation is well tolerated, causes no deleterious effects, and may evoke improvement in patients with chronic renal failure.
动物研究表明，碱化和增加自由水摄入量均有助于降低慢性肾衰竭的进展速度。然而，临床医生一直不愿采用这两种策略，因为担心容量超负荷和水中毒。我们在11例慢性肾衰竭患者（肌酐清除率10±5 ml/min）中测试了每日补充2升水的效果，分别补充低电解质水或富含HCO3-（47.5 mmol/L）的水。患者采用含80 mmol/24 h Na+、80 mmol/24 h Cl-和70 mmol/24 h K+的饮食使其达到平衡。经过3天的平衡期后，患者被随机分为接受其中一种方案治疗7天。经过3天的洗脱期后，再给予另一种方案治疗7天。两种方案均未导致体重增加或低钠血症。补充的95 mmol/24 h HCO3-降低了血清Cl-浓度，提高了血清HCO3-浓度以及pH值至正常水平。肌酐清除率和蛋白质排泄未受影响。饮用含NaHCO3的水后血清β2-微球蛋白浓度降低。由于方案存在顺序效应，Na+/H(+)-反向转运体活性未受到一致影响。我们得出结论，每天补充2升水和NaHCO3耐受性良好，不会产生有害影响，可能会使慢性肾衰竭患者病情改善。
