Metabolic acidosis of chronically hemodialyzed patients

被引:22
作者
Kovacic, V
Roguljic, L
Kovacic, V
机构
[1] Hlth Ctr Trogir, Hemodialysis Dept, Trogir, Croatia
[2] Med Klin & Poliklin 2, Klin Forschergrp Resp Insuffizienz, Giessen, Germany
关键词
hemodialysis; metabolic acidosis; bicarbonate;
D O I
10.1159/000070205
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Metabolic acidosis is a condition that is commonly encountered in both chronic renal failure and in end-stage renal disease. Metabolic acidosis is associated with many adverse effects: negative nitrogen balance, increased protein decomposition, anorexia, fatigue, bone lesions, impaired function of the cardiovascular system, impaired function of the gastrointestinal system, hormonal disturbances, insulin resistance, hyperkalemia, altered gluconeogenesis and triglyceride metabolism, increased progression of chronic renal failure, and growth retardation in children. Even 'minor' degrees of metabolic acidosis are deleterious. Metabolic acidosis of end-stage renal patients could be successfully corrected with bicarbonate hemodialysis and with peroral bicarbonate-containing phosphate binders, i.e. calcium carbonate. Bicarbonate powder compared with bicarbonate solutions has some advantages and enables a stabile composition of electrolytes. 'High' dialysate bicarbonate (40-42 mmol/l) is a safe, well-tolerated and useful tool for better correction of the metabolic acidosis and must become a standard of hemodialysis treatment. Measured postdialysis blood bicarbonate concentration should be obtained at least every month and correction of metabolic acidosis by maintaining serum bicarbonate greater than or equal to 22 mmol/l should be a goal of the management of patients undergoing chronic hemodialysis. Copyright (C) 2003 S. Karger AG, Basel.
引用
收藏
页码:158 / 164
页数:7
相关论文
共 88 条
[1]   Management of life-threatening acid-base disorders - First of two parts [J].
Adrogue, HJ ;
Madias, NE .
NEW ENGLAND JOURNAL OF MEDICINE, 1998, 338 (01) :26-34
[2]   Relationship between interdialytic weight gain and acid-base status in hemodialysis by bicarbonate [J].
Agroyannis, B ;
Fourtounas, C ;
Tzanatos, H ;
Dalamangas, A ;
Vlahakos, DV .
ARTIFICIAL ORGANS, 2002, 26 (04) :385-387
[3]  
AHMAD S, 1980, T AM SOC ART INT ORG, V26, P318
[4]   SUBSTITUTION OF CALCIUM-CARBONATE FOR ALUMINUM HYDROXIDE IN PATIENTS ON HEMODIALYSIS - EFFECTS ON ACIDOSIS, ON PARATHYROID FUNCTION, AND ON CALCEMIA [J].
ANELLI, A ;
BRANCACCIO, D ;
DAMASSO, R ;
PADOVESE, P ;
GALLIENI, M ;
GARELLA, S .
NEPHRON, 1989, 52 (02) :125-132
[5]   The acidosis of chronic renal failure activates muscle proteolysis in rats by augmenting transcription of genes encoding proteins of the ATP-dependent ubiquitin-proteasome pathway [J].
Bailey, JL ;
Wang, XN ;
England, BK ;
Price, SR ;
Ding, XY ;
Mitch, WE .
JOURNAL OF CLINICAL INVESTIGATION, 1996, 97 (06) :1447-1453
[6]   CHRONIC METABOLIC-ACIDOSIS DECREASES ALBUMIN SYNTHESIS AND INDUCES NEGATIVE NITROGEN-BALANCE IN HUMANS [J].
BALLMER, PE ;
MCNURLAN, MA ;
HULTER, HN ;
ANDERSON, SE ;
GARLICK, PJ ;
KRAPF, R .
JOURNAL OF CLINICAL INVESTIGATION, 1995, 95 (01) :39-45
[7]   PLASMA AND MUSCLE FREE AMINO-ACIDS IN MAINTENANCE HEMODIALYSIS-PATIENTS WITHOUT PROTEIN-MALNUTRITION [J].
BERGSTROM, J ;
ALVESTRAND, A ;
FURST, P .
KIDNEY INTERNATIONAL, 1990, 38 (01) :108-114
[8]  
Berland Y, 1995, NEPHROL DIAL TRANSPL, V10, P45
[9]   A review of the effects of correction of acidosis on nutrition in dialysis patients [J].
Brady, JP ;
Hasbargen, JA .
SEMINARS IN DIALYSIS, 2000, 13 (04) :252-255
[10]   EFFECTS OF ACIDOSIS AND ALKALOSIS ON HYPOXIC PULMONARY VASOCONSTRICTION IN DOGS [J].
BRIMIOULLE, S ;
LEJEUNE, P ;
VACHIERY, JL ;
LEEMAN, M ;
MELOT, C ;
NAEIJE, R .
AMERICAN JOURNAL OF PHYSIOLOGY, 1990, 258 (02) :H347-H353