Advances in chronic kidney disease最新文献_第3页

Review of Clinical Disorders Causing Metabolic Acidosis 代谢性酸中毒的临床疾病研究进展

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.07.004

Michael Emmett

引用次数: 5

Clinical Approach to Assessing Acid-Base Status: Physiological vs Stewart 评估酸碱状态的临床方法:生理vs斯图尔特

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.04.008

Horacio J. Adrogué , Bryan M. Tucker , Nicolaos E. Madias

{"title":"Clinical Approach to Assessing Acid-Base Status: Physiological vs Stewart","authors":"Horacio J. Adrogué , Bryan M. Tucker , Nicolaos E. Madias","doi":"10.1053/j.ackd.2022.04.008","DOIUrl":"10.1053/j.ackd.2022.04.008","url":null,"abstract":"<div>Evaluation of acid-base status depends on accurate measurement of acid-base variables and their appropriate assessment. Currently, 3 approaches are utilized for assessing acid-base variables. The physiological or traditional approach, pioneered by Henderson and Van Slyke in the early 1900s, considers acids as H+ donors and bases as H+ acceptors. The acid-base status is conceived as resulting from the interaction of net H+ balance with body buffers and relies on the H2CO3/HCO3− buffer pair for its assessment. A second approach, developed by Astrup and Siggaard-Andersen in the late 1950s, is known as the base excess approach. Base excess was introduced as a measure of the metabolic component replacing plasma [HCO3−]. In the late 1970s, Stewart proposed a third approach that bears his name and is also referred to as the physicochemical approach. It postulates that the [H+] of body fluids reflects changes in the dissociation of water induced by the interplay of 3 independent variables—strong ion difference, total concentration of weak acids, and PCO2. Here we focus on the physiological approach and Stewart's approach examining their conceptual framework, practical application, as well as attributes and drawbacks. We conclude with our view about the optimal approach to assessing acid-base status.</div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10626293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

The Importance of Recognizing and Addressing the Spectrum of Acid Stress 认识和处理酸胁迫谱的重要性

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.06.001

Donald E. Wesson

{"title":"The Importance of Recognizing and Addressing the Spectrum of Acid Stress","authors":"Donald E. Wesson","doi":"10.1053/j.ackd.2022.06.001","DOIUrl":"10.1053/j.ackd.2022.06.001","url":null,"abstract":"<div>Acid accumulation sufficient to reduce plasma bicarbonate concentration, thereby recognized as chronic metabolic acidosis, harms bones and muscles and appears to enhance progression of CKD. Evolving evidence supports that progressive acid accumulation that is not enough to cause chronic metabolic acidosis nevertheless has deleterious effects. Measurable acid retention without reduced plasma bicarbonate concentration, called eubicarbonatemic acidosis, also appears to cause kidney injury and exacerbate CKD progression. Furthermore, chronic engagement of mechanisms to mitigate the ongoing acid challenge of net acid-producing diets of developed societies also appears to be deleterious, including for kidney health. This review challenges clinicians to consider the growing evidence for a spectrum of acid-accumulation disorders that include lesser degrees of acid accumulation than metabolic acidosis yet are harmful. Further research will develop clinically useful tools to identify individuals suffering from these earlier stages of acid stress and determine if the straightforward and comparatively inexpensive intervention of dietary acid reduction relieves or eliminates the harm they appear to cause.</div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10571087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Importance of Metabolic Acidosis as a Health Risk in Chronic Kidney Disease 代谢性酸中毒作为慢性肾脏疾病健康风险的重要性

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.05.002

Anita Vincent-Johnson , Julia J. Scialla

{"title":"Importance of Metabolic Acidosis as a Health Risk in Chronic Kidney Disease","authors":"Anita Vincent-Johnson , Julia J. Scialla","doi":"10.1053/j.ackd.2022.05.002","DOIUrl":"10.1053/j.ackd.2022.05.002","url":null,"abstract":"<div>Human kidneys are well adapted to excrete the daily acid load from diet and metabolism in order to maintain homeostasis. In approximately 30% of patients with more advanced stages of CKD, these homeostatic processes are no longer adequate, resulting in metabolic acidosis. Potential deleterious effects of chronic metabolic acidosis in CKD, including muscle wasting, bone demineralization, hyperkalemia, and more rapid progression of CKD, have been well cataloged. Based primarily upon concerns related to nutrition and bone disease, early Kidney Disease Outcomes Quality Initiative guidelines recommended treating metabolic acidosis with alkali therapy targeting a serum bicarbonate ≥22 mEq/L. More recent guidelines have suggested similar targets based upon potential slowing of CKD progression. However, appropriately powered, long-term, randomized controlled trials to study efficacy and safety of alkali therapy for these outcomes are largely lacking. As a result, practice among physicians varies, underscoring the complexity of treatment of chronic metabolic acidosis in real-world CKD practice. Novel treatment approaches and rigorous phase 3 trials may resolve some of this controversy in the coming years. Metabolic acidosis is an important complication of CKD, and where it “falls” in the priority schema of CKD care will depend upon the generation of strong clinical evidence.</div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1548559522000970/pdfft?md5=773d67b401a561c23b0ed79470e58217&pid=1-s2.0-S1548559522000970-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10626292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Dietary Contributions to Metabolic Acidosis 饮食对代谢性酸中毒的影响

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.03.008

Lynda Frassetto , Thomas Remer , Tanushree Banerjee

{"title":"Dietary Contributions to Metabolic Acidosis","authors":"Lynda Frassetto , Thomas Remer , Tanushree Banerjee","doi":"10.1053/j.ackd.2022.03.008","DOIUrl":"10.1053/j.ackd.2022.03.008","url":null,"abstract":"<div>Eating a net acid-producing diet can produce an “acid stress” of severity proportional to the diet net acid load, as indexed by the steady-state renal net acid excretion rate. Depending on how much acid or base is ingested or produced from endogenous metabolic processes and how well our homeostatic mechanisms can buffer or eliminate the additional acids or bases, we can alter our systemic acid-base balance. With increasing age, the kidney's ability to excrete daily net acid loads declines (a condition similar to that of mild CKD), invoking increased utilization of potential base stores (eg, bone, skeletal muscle) on a daily basis to mitigate the acid accumulation, thereby contributing to development of osteoporosis, loss of muscle mass, and age-related renal insufficiency. Patients suffering from more advanced CKD often present with more severe acid stress or metabolic acidosis, as the kidney can no longer excrete the entire acid load. Alkaline diets based on fruits and vegetables may have a positive effect on long-term preservation of renal function while maintaining nutritional status. This chapter discusses the biochemistry of dietary precursors that affect acid or base production.</div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10571088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Preclinical and Clinical Evidence of Effect of Acid on Bone Health 酸对骨骼健康影响的临床前和临床证据

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.07.007

Orson W. Moe , Naim M. Maalouf , Khashayar Sakhaee , Eleanor Lederer

引用次数: 1

Acid-Mediated Kidney Injury Across the Spectrum of Metabolic Acidosis 代谢性酸中毒中酸介导的肾损伤

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.04.009

Naveen P.G. Ravikumar , Alan C. Pao , Kalani L. Raphael

{"title":"Acid-Mediated Kidney Injury Across the Spectrum of Metabolic Acidosis","authors":"Naveen P.G. Ravikumar , Alan C. Pao , Kalani L. Raphael","doi":"10.1053/j.ackd.2022.04.009","DOIUrl":"10.1053/j.ackd.2022.04.009","url":null,"abstract":"<div>Metabolic acidosis affects about 15% of patients with chronic kidney disease. As kidney function declines, the kidneys progressively fail to eliminate acid, primarily reflected by a decrease in ammonium and titratable acid excretion. Several studies have shown that the net acid load remains unchanged in patients with reduced kidney function; the ensuing acid accumulation can precede overt metabolic acidosis, and thus, indicators of urinary acid or potential base excretion, such as ammonium and citrate, may serve as early signals of impending metabolic acidosis. Acid retention, with or without overt metabolic acidosis, initiates compensatory responses that can promote tubulointerstitial fibrosis via intrarenal complement activation and upregulation of endothelin-1, angiotensin II, and aldosterone pathways. The net effect is a cycle between acid accumulation and kidney injury. Results from small- to medium-sized interventional trials suggest that interrupting this cycle through base administration can prevent further kidney injury. While these findings inform current clinical practice guidelines, large-scale clinical trials are still necessary to prove that base therapy can limit chronic kidney disease progression or associated adverse events.</div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10575911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 4

Management of Metabolic Acidosis in Chronic Kidney Disease: Past, Present, and Future Direction 慢性肾脏疾病代谢性酸中毒的管理:过去，现在和未来的方向

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.02.011

Nimrit Goraya , Mohanram Narayanan , Donald E. Wesson

{"title":"Management of Metabolic Acidosis in Chronic Kidney Disease: Past, Present, and Future Direction","authors":"Nimrit Goraya , Mohanram Narayanan , Donald E. Wesson","doi":"10.1053/j.ackd.2022.02.011","DOIUrl":"10.1053/j.ackd.2022.02.011","url":null,"abstract":"<div>Chronic kidney disease (CKD) is a major global epidemic associated with increased morbidity and mortality. Despite the effectiveness of kidney protection strategies of hypertension, diabetes, and lipid control and use of newer hypoglycemic agents and anti-angiotensin II drugs, the nephropathy in CKD continues unabated toward irreversible kidney failure. Thus, interventions targeting modifiable risk factors in CKD such as metabolic acidosis (MA) are needed. Acid reduction with sodium-based alkali has been shown to be an effective kidney-protection strategy for patients with CKD and reduced glomerular filtration rate (GFR). Small-scale studies reveal diets emphasizing ingestion of plant-sourced over animal-sourced protein reduce dietary acid, improve MA, and slow further nephropathy progression in patients with CKD and reduced GFR. Additionally, veverimer, an investigational, nonabsorbed polymer that binds and removes gastrointestinal hydrochloric acid, is being developed as a novel treatment for MA. As further studies define how to best use these interventions for kidney protection, clinicians must become aware of their potential utility in the management of patients with CKD. The aim of the present review is to explore the various intervention strategies that increase or normalize serum [HCO3-] in patients with CKD-associated MA or low normal serum [HCO3-] that may further slow progression of CKD.</div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10575913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Clinical Consequences of Metabolic Acidosis—Muscle 代谢性酸中毒的临床后果-肌肉

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.04.010

Jim Q. Ho , Matthew K. Abramowitz

引用次数: 2

Regulation of Acid-Base Balance in Patients With Chronic Kidney Disease 慢性肾病患者酸碱平衡的调节

IF 2.9 3区医学

Advances in chronic kidney disease Pub Date : 2022-07-01 DOI: 10.1053/j.ackd.2022.05.004

Glenn T. Nagami , Jeffrey A. Kraut MD

{"title":"Regulation of Acid-Base Balance in Patients With Chronic Kidney Disease","authors":"Glenn T. Nagami , Jeffrey A. Kraut MD","doi":"10.1053/j.ackd.2022.05.004","DOIUrl":"10.1053/j.ackd.2022.05.004","url":null,"abstract":"<div>Normallly the kidneys handle the daily acid load arising from net endogenous acid production from the metabolism of ingested animal protein (acid) and vegetables (base). With chronic kidney disease, reduced acid excretion by the kidneys is primarily due to reduced ammonium excretion such that when acid excertion falls below acid porduction, acid accumulation occurs. With even mild reductions in glomerular filtration rate (60 to 90 ml/min), net acid excretion may fall below net acid production resulting in acid retention which may be initially sequestered in interstitial compartments in the kidneys, bones, and muscles resulting in no fall in measured systemic bicarbonate levels (eubicarbonatemic metabolic acidosis). With greater reductions in kidney function, the greater quantities of acid retained spillover systemically resulting in low pH (overt metabolic acidosis). The evaluation of acid-base balance in patients with CKD is complicated by the heterogeneity of clinical acid-base disorders and by the eubicarbonatemic nature of the early phase of acid retention. If supported by more extensive studies, blood gas analyses to confirm the acid-base disorder and newer ways for assessing the presence of acidosis such as urinary citrate measurements may become routine tools to evaluate and treat acid-base disorders in individuals with CKD.</div>","PeriodicalId":7221,"journal":{"name":"Advances in chronic kidney disease","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10571085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1