慢性肾病患者慢性代谢性酸中毒的纠正。
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罗德里克P，威利斯NS，布莱克利S，琼斯C，汤姆逊C
慢性肾病患者慢性代谢性酸中毒的纠正。
Cochrane Database system Rev. 2007; 1 (1):CD001890。
- PubMed ID
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17253467 (PubMed视图]
- 摘要
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背景:代谢性酸中毒是慢性肾脏疾病(CKD)的一个特征，由于肾脏合成氨和排泄氢离子的能力降低。它对蛋白质和肌肉代谢、骨转换和肾性骨营养不良的发展有不良影响。代谢性酸中毒可通过口服补充碳酸氢盐或透析患者通过增加透析液中的碳酸氢盐浓度来纠正。目的:研究在达到终末期肾病(ESRD)之前或在肾脏替代治疗(RRT)期间，用碳酸氢钠或增加透析液的碳酸氢钠浓度治疗CKD患者代谢性酸中毒的利与弊。必威国际app检索策略:我们检索了CENTRAL (Cochrane Library, 2005年第4期)，Cochrane Renal Group的专业注册(2005年10月)，MEDLINE(1966 - 2005年10月)和EMBASE(1980 - 2005年10月)。选择标准:随机对照试验(rct)，交叉rct和准rct调查成人或儿童CKD慢性代谢性酸中毒的纠正。数据收集和分析:使用连续测量的相对危险度(RR)和加权平均差(MD)对结果进行分析。主要结果:我们在成人透析患者中确定了3项试验(n = 117)。meta分析的大多数结果数据不足。在所有三个试验中，干预组的酸中毒得到改善，尽管达到的碳酸氢盐水平有所不同。 There was no evidence of effect on blood pressure or sodium levels. Some measures of nutritional status/protein metabolism (e.g. SGA, NP NA) were significantly improved by correction in the one trial that looked in these in detail. There was heterogeneity of the effect on serum albumin in two trials. Serum PTH fell significantly in the two trials that estimated this, there was no significant effect on calcium or phosphate though both fell after correction. Complex bone markers were assessed in one study, with some evidence for a reduction in bone turnover in those with initial high bone turnover and an increase in low turnover patients. The studies were underpowered to assess clinical outcomes, in the one study that did there was some evidence for a reduction in hospitalisation after correction. AUTHORS' CONCLUSIONS: The evidence for the benefits and risks of correcting metabolic acidosis is very limited with no RCTs in pre-ESRD patients, none in children, and only three small trials in dialysis patients. These trials suggest there may be some beneficial effects on both protein and bone metabolism but the trials were underpowered to provide robust evidence.