Effects of Oral Sodium Bicarbonate Supplementation on Protein Metabolism and Inflammation in Iraqi Hemodialysis Patients: An Open-Label Randomized Controlled Trial.

IF 1.7 Q3 UROLOGY & NEPHROLOGY
Zina A Rasheed, Ban A Al-Hashemi, Ala A Ali
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引用次数: 1

Abstract

Background: The effect of correcting metabolic acidosis on protein metabolism in hemodialysis patients is controversial.

Objectives: To study the effects of oral sodium bicarbonate on protein metabolism and markers of inflammation in acidotic hemodialysis patients. Patients and Methods. An open-label randomized controlled trial was conducted at a single center. Sixty-six clinically stable adult hemodialysis patients were recruited with an average predialysis serum bicarbonate level of <22 mmol/l and a dialysate bicarbonate concentration of 35 mmol/l. Forty-nine participants have completed the study. Oral sodium bicarbonate tablets of 500 mg were given daily in the intervention group (n = 25) for 12 weeks versus the standard of care in the control group (n = 24). Outcomes compared intervention versus nonintervention in both groups at equivalent time points (0 and 3 months). The clinical data, anthropometry, dialysis adequacy, albumin, normalized protein catabolism rate, blood gas analysis, and bicarbonate were recorded at 0 and 3 months. In addition, muscle mass and handgrip strength were measured. Finally, IL-6 as a marker of inflammation was measured at randomization and three months.

Results: Serum bicarbonate and pH increased significantly from 17.57 ± 3.34 mmol/L to 20.69 ± 2.54 mmol/L and from 7.26 ± 0.06 to 7.34 ± 0.04, respectively (p < 0.0001). Serum albumin was significantly higher in the intervention group at three months than in the control group, 4.11 ± 0.45 vs. 3.79 ± 0.47 (p value 0.011). Serum potassium significantly decreased in the intervention group at three months compared to the control group, 5.00 ± 0.43 mEq/l vs. 5.33 ± 0.63 mEq/l (p value 0.03). Muscle strength expressed as handgrip has improved significantly in the intervention group at three months compared to the control group, 45.01 ± 19.19 vs. 33.93 ± 15.06 (p value 0.03). The IL-6 values were less in the intervention group at 3 months with a p value of 0.01. The interdialytic weight of the intervention group at three months was 2.42 ± 0.64 compared to the 2.20 ± 1.14 control group, but this did not reach statistical significance (p value of 0.4). The composite of (albumin + nPCR) at three months was achieved in 59.18% of the intervention group compared to 14.28% with a p value of 0.01.

Conclusions: Correcting metabolic acidosis in hemodialysis patients improved serum albumin and nPCR without hypokalemia or significant interdialytic weight gain. This was particularly evident in patients with minimal inflammation with low IL-6 values.

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口服碳酸氢钠对伊拉克血液透析患者蛋白质代谢和炎症的影响:一项开放标签随机对照试验。
背景:纠正代谢性酸中毒对血液透析患者蛋白质代谢的影响存在争议。目的:探讨口服碳酸氢钠对酸性血液透析患者蛋白质代谢及炎症标志物的影响。患者和方法。在单中心进行开放标签随机对照试验。招募66名临床稳定的成人血液透析患者,透析前平均血清碳酸氢盐水平为n = 25),为期12周,对照组为标准护理(n = 24)。结果比较两组在相同时间点(0和3个月)的干预和不干预。在0和3个月记录临床资料、人体测量、透析充分性、白蛋白、标准化蛋白质分解代谢率、血气分析和碳酸氢盐。此外,还测量了肌肉质量和握力。最后,在随机分组和三个月时测量IL-6作为炎症标志物。结果:血清碳酸氢盐由17.57±3.34 mmol/L升高至20.69±2.54 mmol/L, pH由7.26±0.06升高至7.34±0.04,差异均有统计学意义(p < 0.0001)。干预组3个月时血清白蛋白水平(4.11±0.45比3.79±0.47)明显高于对照组(p值0.011)。干预组3个月时血清钾水平明显低于对照组,分别为5.00±0.43 mEq/l和5.33±0.63 mEq/l (p值0.03)。与对照组相比,干预组在3个月时握力(45.01±19.19)比对照组(33.93±15.06)有明显改善(p值0.03)。干预组在3个月时IL-6值明显低于对照组,p值为0.01。干预组3个月时透析间期体重为2.42±0.64,对照组为2.20±1.14,但差异无统计学意义(p值为0.4)。干预组3个月(白蛋白+ nPCR)复合阳性率为59.18%,干预组为14.28%,p值为0.01。结论:纠正血透患者代谢性酸中毒可改善血清白蛋白和nPCR,且无低钾血症或显著的透析间期体重增加。这在IL-6值较低的轻度炎症患者中尤为明显。
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来源期刊
International Journal of Nephrology
International Journal of Nephrology UROLOGY & NEPHROLOGY-
CiteScore
3.40
自引率
4.80%
发文量
44
审稿时长
17 weeks
期刊介绍: International Journal of Nephrology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies focusing on the prevention, diagnosis, and management of kidney diseases and associated disorders. The journal welcomes submissions related to cell biology, developmental biology, genetics, immunology, pathology, pathophysiology of renal disease and progression, clinical nephrology, dialysis, and transplantation.
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