纠正慢性肾脏疾病患者的慢性代谢性酸中毒。
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罗德里克P,威利斯NS,布莱克利正在年代,琼斯C,汤臣C
纠正慢性肾脏疾病患者的慢性代谢性酸中毒。
Cochrane数据库系统启2007年1月24日,(1):CD001890。
- PubMed ID
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17253467 (在PubMed]
- 文摘
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背景:代谢性酸中毒是慢性肾脏疾病(CKD)的特性,由于肾脏的能力降低氨合成出氢离子。它对蛋白质有不良后果和肌肉代谢,骨营业额和肾骨营养不良的发展。代谢性酸中毒可以纠正口语碳酸氢盐透析患者补充或通过增加碳酸氢盐透析液液的浓度。目的:检查的好处和危害治疗CKD患者代谢性酸中毒,达到前两个终末期肾病(ESRD)或在肾脏替代治疗(RRT)、碳酸氢钠或碳酸氢盐透析液的浓度增加。搜索策略:我们在中央(Cochrane图书馆、问题4 2005),科克伦肾组织的专业注册(2005年10月),MEDLINE(1966 - 2005年10月)和EMBASE(1980 - 2005年10月)。相关的选择标准:随机对照试验、交叉相关和quasi-RCTs调查慢性代谢性酸中毒的校正与CKD成人或儿童。数据收集和分析:结果分析了使用相对危险度(RR)和加权平均差(MD)连续的措施。主要结果:我们发现三个试验在成人透析病人(n = 117)。有足够的数据对于大多数荟萃分析的结果。在所有三个试验酸中毒改善干预组虽然取得了碳酸氢盐水平有差异。 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.