Williams A J, Dittmer I D, McArley A, Clarke J
Department of Renal Medicine, Gloucestershire Royal Hospital, UK.
Nephrol Dial Transplant. 1997 Dec;12(12):2633-7. doi: 10.1093/ndt/12.12.2633.
Metabolic acidosis adversely affects both protein and bone metabolism in patients with chronic renal failure, and could also affect morbidity and mortality. This trial aimed to investigate the effects of different dialysate bicarbonate concentrations on control of acid base balance, and nutritional status.
Forty-six stable haemodialysis patients were dialysed using LowBic. (30 mmol/l) or HighBic. (40 mmol/l) bicarbonate dialysate in a single blind double crossover trial, of two consecutive six-month periods. Blood gas analysis, anthropometric indices and dialysis dose were measured, in addition to biochemical indices.
Predialysis 'arterial' plasma pH values were significantly higher when using the HighBic. dialysate (LowBic. 7.38 +/- 0.05, HighBic. 7.43 +/- 0.04, P < 0.001), as was predialysis serum total CO2 at all times during the study (P < 0.01). Kt/V, (LowBic. 1.27 +/- 0.19, HighBic. 1.27 +/- 0.25), urea generation rates (UGR) (LowBic. 1.99 +/- 0.77, HighBic. 1.92 +/- 0.77 mmol/min), and normalized protein catabolic rate (NPCR) (LowBic. 1.04 +/- 0.26, HighBic. 0.99 +/- 0.28 g/kg/day) did not differ, and values of parathroid hormone (PTH) were comparable. Triceps skinfold thickness (TSF) showed a significant change (LowBic. 14.8 +/- 6.9-11.8 +/- 5.5, HighBic. 14.9 +/- 6.3-15.8 +/- 6.4 mm, P < 0.05) which was reversed following dialysate change (HighBic. 11.8 +/- 5.5-13.3 +/- 7.2, LowBic. 15.8 +/- 6.4-13.8 +/- 6.7 mm, P < 0.05). No differences in mid upper arm circumference were found.
Bicarbonate dialysate concentrations of 40 mmol/l were safe, well tolerated, and produced better control of acidosis, with an increase in TSF, compared to a bicarbonate concentration of 30 mmol/l.
代谢性酸中毒对慢性肾衰竭患者的蛋白质和骨代谢均产生不利影响，还可能影响发病率和死亡率。本试验旨在研究不同透析液碳酸氢盐浓度对酸碱平衡控制及营养状况的影响。
46例稳定的血液透析患者在一项单盲双交叉试验中，先后使用低碳酸氢盐（30 mmol/L）或高碳酸氢盐（40 mmol/L）透析液进行为期两个连续6个月的透析。除生化指标外，还测量了血气分析、人体测量指标和透析剂量。
使用高碳酸氢盐透析液时，透析前“动脉”血浆pH值显著更高（低碳酸氢盐组7.38±0.05，高碳酸氢盐组7.43±0.04，P<0.001），研究期间各时间点的透析前血清总二氧化碳水平也更高（P<0.01）。Kt/V（低碳酸氢盐组1.27±0.19，高碳酸氢盐组1.27±0.25）、尿素生成率（UGR）（低碳酸氢盐组1.99±0.77，高碳酸氢盐组1.92±0.77 mmol/min）和标准化蛋白分解代谢率（NPCR）（低碳酸氢盐组1.04±0.26，高碳酸氢盐组0.99±0.28 g/kg/天）无差异，甲状旁腺激素（PTH）值相当。肱三头肌皮褶厚度（TSF）有显著变化（低碳酸氢盐组14.8±6.9 - 11.8±5.5，高碳酸氢盐组14.9±6.3 - 15.8±6.4 mm，P<0.05），透析液更换后这种变化逆转（高碳酸氢盐组11.8±5.5 - 13.3±7.2，低碳酸氢盐组15.8±6.4 - 13.8±6.7 mm，P<0.05）。上臂中部周长无差异。
与30 mmol/L的碳酸氢盐浓度相比，40 mmol/L的碳酸氢盐透析液安全、耐受性良好，能更好地控制酸中毒，且TSF增加。
