维持性血液透析患者代谢性酸中毒的研究进展

当慢性肾脏病(CKD)患者肾小球滤过率(GFR)下降至25 mL/(min·1.73 m2)时会出现代谢性酸中毒。CKD患者代谢性酸中毒未纠正会引起蛋白能量消耗、骨疾病、胰岛素抵抗、加速CKD进展。对血液透析患者,代谢性酸中毒可增加其死亡风险。有效透析的目标之一即纠正尿毒症患者的代谢性酸中毒,但目前维持性血液透析治疗并不能有效地纠正酸中毒。透析患者在透析间期辅以补碱治疗可改善其预后,每日透析的模式亦可有效地改善患者的营养状况。

Research Progress of Metabolic Acidosis in Maintenance Hemodialysis Patients

Metabolic acidosis is common in patients with chronic kidney disease （CKD）, particularly once the glomerular fihration rate（GFR） falls below 25 mL/（ min · 1.73 m^2 ）. In patients with CKD ,uncorrected metabolic acidosis leads to clinically significant consequences like protein energy wasting and bone disease,resistance to insulin ,acceleration of the progression of CKD and so on. In maintenance hemodialysis （MHD） patients, metabolic acidosis is associated with an increased risk for death. Correction of metabolic acidosis is one of the goals of effective dialysis. MHD therapies are not able to completely correct the base deficit. The administration of base to patients after initiation of dialysis leads to improvement in many of these adverse effects. Daily hemodialysis may also improve the nutritional status of the patients.