口服碳酸氢钠对慢性肾病进程的影响

Effect of Oral Sodium Bicarbonate on Progression of Chronic Kidney Disease

关键词:  代谢性酸中毒  慢性肾病  碳酸氢钠  肾小球滤过率  蛋白尿  血压

Key words:  metabolic acidosis  chronic kidney disease  bicarbonate  glomeralar filtration rate  proteinuria  blood pressure

摘要:

目的 探讨口服碳酸氢钠能否延缓慢性肾病(chronic kidney disease，CKD)肾功能下降的速率。方法 110例CKD患者随机分为碳酸氢钠组或安慰剂组，分别口服碳酸氢钠或安慰剂治疗2年，估算治疗前后肾小球滤过率(eGFR)下降的速率，eGFR快速下降[>3 mL·min^-1·(1.73 m)^-2·y^-1]和发展成终末期肾病(ESRD)患者人数[eGFR<10 mL·min^-1·(1.73 m)^-2]比。同时测量血清白蛋白和饮食蛋白摄入。结果 治疗2年后，与安慰剂组相比，碳酸氢钠组eGFR下降较慢(P<0.05)，快速进展的患者少(P<0.05)，发展成ESRD的患者也少(P<0.05)。碳酸氢钠组营养参数明显改善。结论 碳酸氢钠可延缓CKD发展成ESRD的速率，且可改善CKD患者的营养状态。

Abstract:

OBJECTIVE To study whether orally administrated sodium bicarbonate slows the decline of renal function in chronic kidney disease (CKD). METHODS All of 110 patients with CKD were randomly divided into sodium bicarbonate group and placebo group, and received the treatment with sodium bicarbonate or placebo for 2 years. Decline rate of glomerular filtration rate (eGFR), the ratio of patients with rapid decline of eGFR[>3 mL·min^-1·(1.73 m)^-2·y^-1] developed to end stag renal disease(ESRD) [eGFR<10 mL·min^-1·(1.73 m)^-2] were estimated before and after the treatment. Serum albumin and dielary protein intake were measured at the same time. RESULTS Compared with placebo group, decline in eGFR was slower in sodium bicarbonate group(P<0.05) after treatment of 2 years. Patients in bicarbonate group were significantly less than experience rapid progression(P<0.05). Fewer patients in bicarbonate group developed ESRD(P<0.05). Nutritional parameters improved significantly in bicarbonate group. CONCLUSION Bicarbonate slows the rate of progression of CKD to ESRD and it improves nutrition status among patients with CKD.