Alkalization in patients with metabolic acidosis in the course of chronic kidney disease
 
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Katedra Chorób Wewnętrznych, Diabetologii i Nefrologii, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach
 
2
Oddział Nefrologii, Wojewódzki Szpital Specjalistyczny nr 4 w Bytomiu
 
 
Corresponding author
Beata Łącka-Gaździk   

Katedra Chorób Wewnętrznych, Diabetologii i Nefrologii, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach, 3-go Maja 13/15, 41-800 Zabrze, Polska
 
 
Ann. Acad. Med. Siles. 2017;71:331-338
 
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ABSTRACT
Chronic kidney disease in different stages affects >10% of the general population. Its societal importance is underscored by the ever growing number of patients with end-stage kidney disease requiring renal replacement therapy. A common complication of chronic renal failure is metabolic acidosis which has a row of negative clinical sequelae including acceleration of the progression of chronic nephropathies. The aim of this work was to present the issue of oral alkalization in patients with chronic kidney disease, especially in the context of slowing down the course of chronic kidney disease. The studies in animals and human subjects are quite optimistic in this regard and may have clinical and economic implications. Nevertheless, their relevance is limited by the relatively small numbers of subjects and variable stages of chronic kidney disease studied. In addition, the study durations, types of alkalinizing agents and control group characteristics were inconsistent among the studies. Ongoing clinical trials should be able to provide conclusions in the matter of long-term alkalizing treatment and nephroprotection. Positive outcomes would translate not only into improved patient prognoses with the use of a relatively inexpensive therapeutic option, but also into alleviation of the health care cost burden imposed on the society.
 
REFERENCES (46)
1.
Rutkowski B. (red.) Nefrologia i leczenie nerkozastępcze. Praktyczny przewodnik. Via Medica. Gdańsk 2013; 66: 110–120.
 
2.
Kokot F., Hyla-Klekot L., Łoniewski I. Kwasica nieoddechowa – niedoceniony element leczenia przewlekłej choroby nerek. Nefrol. Dializ Pol. 2012; 16(3): 134–137.
 
3.
Rutkowski B. Przewlekła choroba nerek – diagnostyka i leczenie. Via Medica. Gdańsk 2012; 1–10: 49–50.
 
4.
Rutkowski B., Lichodziejewska-Niemierko M., Grenda R., Czekalski S., Durlik M., Bautembach S. Raport o stanie leczenia nerkozastępczego w Polsce – 2008. Gdańsk 2010.
 
5.
Rutkowski B., Lichodziejewska-Niemierko M., Grenda R., Czekalski S., Durlik M., Bautembach S. Raport o stanie leczenia nerkozastępczego w Polsce – 2009. Gdańsk 2012.
 
6.
Myśliwiec M. Wielka Interna Nefrologia. Medical Tribune Polska. Warszawa 2009, 351–354.
 
7.
Nath K.A., Hostetter M.K., Hostetter T.H. Pathophysiology of chronic tubulo-interstitial disease in rats. Interactions of dietary acid load, ammonia, and complement component C3. J. Clin. Invest. 1985; 76(2): 667–675.
 
8.
Gadola L., Noboa O., Marquez M.N., Rodriguez M.J., Nin N., Boggia J., Ferreiro A., García S., Ortega V., Musto M.L., Ponte P., Sesser P., Pizarrosa C., Ravaglio S., Vallega A. Calcium citrate ameliorates the progression of chronic renal injury. Kidney Int. 2004; 65(4): 1224–1230.
 
9.
de Brito-Ashurst I., Varagunam M., Raftery M.J., Yaqoob M.M. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J. Am. Soc. Nephrol. 2009; 20(9): 2075–2084.
 
10.
Phisitkul S., Khanna A., Simoni J., Broglio K., Sheather S., Rajab M.H., Wesson D.E. Amelioration of metabolic acidosis in patients with low GFR reduced kidney endothelin production and kidney injury, and better preserved GFR. Kidney Int. 2010; 77(7): 617–623.
 
11.
Rutkowski B., Ciechanowski K. Rola alkalizacji w nefroprotekcji – nowe spojrzenie na stary problem. Forum Nefrologiczne 2012; 5: 265–271.
 
12.
Kokot F. Gospodarka wodno-elektrolitowa i kwasowo-zasadowa w stanach fizjologii i patologii. Wydawnictwo Lekarskie PZWL. Warszawa 2005, 182–352.
 
13.
Kokot F. Zaburzenia gospodarki wodno-elektrolitowej i równowagi kwasowo-zasadowej. 2225–2254. W: Szczeklik A. Choroby wewnętrzne. Medycyna Praktyczna Kraków 2010.
 
14.
Kraut J.A., Madias N.E. Consequences and therapy of the metabolic acidosis of chronic kidney disease. Pediatr. Nephrol. 2011; 26(1): 19–28.
 
15.
Wallia R., Greenberg A., Piraino B., Mitro R., Puschett J.B. Serum electrolyte patterns in end-stage renal disease. Am. J. Kidney Dis. 1986; 8(2): 98–104.
 
16.
Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am. J. Kidney Dis. 2000; 35(6 Suppl. 2): S1–140.
 
17.
McSherry E., Morris R.C. Jr Attainment and maintenance of normal stature with alkali therapy in infants and children with classic renal tubular acidosis. J. Clin. Invest. 1978; 61(2): 509–527.
 
18.
Pickering W.P., Price S.R., Bircher G., Marinovic A.C., Mitch W.E., Walls J. Nutrition in CAPD: serum bicarbonate and the ubiquitin-proteasome system in muscle. Kidney Int. 2002; 61(4): 1286–1292.
 
19.
Eustace J.A., Astor B., Muntner P.M., Ikizler T.A., Coresh J. Prevalence of acidosis and inflammation and their association with low serum albumin in chronic kidney disease. Kidney Int. 2004; 65(3): 1031–1040.
 
20.
Ballmer P.E., McNurlan M.A., Hulter H.N., Anderson S.E., Garlick P.J., Krapf R. Chronic metabolic acidosis decreases albumin synthesis and induces negative nitrogen balance in humans. J. Clin. Invest. 1995; 95(1): 39–55.
 
21.
Mak R.H. Effect of metabolic acidosis on insulin action and secretion in uremia. Kidney Int. 1998; 54(2): 603–607.
 
22.
Bellocq A., Suberville S., Philippe C., Bertrand F., Perez J., Fouqueray B., Cherqui G., Baud L. Low environmental pH is responsible for the induction of nitric-oxide synthase in macrophages. Evidence for involvement of nuclear factor-kappaB activation. J. Biol. Chem. 1998; 273(9): 5086–5092.
 
23.
Sonikian M., Gogusev J., Zingraff J., Loric S., Quednau B., Bessou G., Siffert W., Drüeke T.B., Reusch H.P., Luft F.C. Potential effect of metabolic acidosis on beta 2-microglobulin generation: in vivo and in vitro studies. J. Am. Soc. Nephrol. 1996; 7(2): 350–356.
 
24.
Wiederkehr M.R., Kalogiros J., Krapf R. Correction of metabolic acidosis improves thyroid and growth hormone axes in haemodialysis patients. Nephrol. Dial. Transplant. 2004; 19(5): 1190–1197.
 
25.
Bommer J., Locatelli F., Satayathum S. Association of predialysis serum bicarbonate levels with risk of mortality and hospitalization in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am. J. Kidney Dis. 2004; 44(4): 661–671.
 
26.
Suchowierska E., Myśliwiec M., Hryszko T., Kalinowski M., Naumnik B. Stężenie wodorowęglanów w osoczu chorych przed zabiegiem hemodializy czynnikiem ryzyka zgonów z przyczyn sercowo-naczyniowych. Nefrol. Dializ. Pol. 2014; 18: 197–200.
 
27.
Kovesdy C.P., Anderson J.E., Kalantar-Zadeh K. Association of serum bicarbonate levels with mortality in patients with non-dialysis-dependent CKD. Nephrol. Dial. Transplant. 2009; 24(4): 1232–1237.
 
28.
Kanda E., Ai M., Yoshida M., Kuriyama R., Shiigai T. High serum bicarbonate level within the normal range prevents the progression of chronic kidney disease in elderly chronic kidney disease patients. BMC Nephrol. 2013; 14: 4.
 
29.
Shah S.N., Abramowitz M., Hostetter T.H., Melamed M.L. Serum bicarbonate levels and the progression of kidney disease: a cohort study. Am. J. Kidney Dis. 2009; 54(2): 270–277.
 
30.
Abramowitz M.K., Melamed M.L., Bauer C., Raff A.C., Hostetter T.H. Effects of oral sodium bicarbonate in patients with CKD. Clin. J. Am. Soc. Nephrol. 2013; 8(5): 714–720.
 
31.
Chen W., Abramowitz M.K. Treatment of metabolic acidosis in patients with CKD. Am. J. Kidney Dis. 2014; 63(2): 311–317.
 
32.
Mathur R.P., Dash S.C., Gupta N., Prakash S., Saxena S., Bhowmik D. Effects of correction of metabolic acidosis on blood urea and bone metabolism in patients with mild to moderate chronic kidney disease: a prospective randomized single blind controlled trial. Ren. Fail. 2006; 28(1): 1–5.
 
33.
Lu K.C., Lin S.H., Yu F.C., Chyr S.H., Shieh S.D. Influence of metabolic acidosis on serum 1,25(OH)2D3 levels in chronic renal failure. Miner. Electrolyte Matab. 1995; 21(6): 398–402.
 
34.
Lefebvre A., de Vernejoul M.C., Gueris J., Goldfarb B., Graulet A.M., Morieux C. Optimal correction of acidosis changes progression of dialysis osteodystrophy. Kidney Int. 1989; 36(6): 1112–1118.
 
35.
Disthabanchong S., Treeruttanawanich A. Oral sodium bicarbonate improves thyroid function in predialysis chronic kidney disease. Am. J. Nephrol. 2010; 36(2): 549–556.
 
36.
Carrero J.J., Qureshi A.R., Axelsson J., Yilmaz M.I., Rehnmark S., Witt M.R., Bárány P., Heimbürger O., Suliman M.E., Alvestrand A., Lindholm B., Stenvinkel P. Clinical and biochemical implications of low thyroid hormone levels (total and free forms) in euthyroid patients with chronic kidney disease. J. Intern. Med. 2007; 262(6): 690–701.
 
37.
Zoccali C., Benedetto F., Mallamaci F., Tripepi G., Cutrupi S., Pizzini P., Malatino L.S., Bonanno G., Seminara G. Low triiodothyronine and cardiomyopathy in patients with end-stage renal disease. J. Hypertens. 2006; 24(10): 2039–2046.
 
38.
Mahajan A., Simoni J., Sheather S.J., Broglio K.R., Rajab M.H., Wesson D.E. Daily oral sodium bicarbonate preserves glomerular filtration rate by slowing its decline in early hypertensive nephropathy. Kidney Int. 2010; 78(3): 303–309.
 
39.
Susantitaphong P., Sewaralthahab K., Balk E.M., Jaber B.L., Madias N.E. Short- and long-term effects of alkali therapy in chronic kidney disease: a systematic review. Am. J. Nephrol. 2012; 35(6): 540–547.
 
40.
Łoniewski I., Wesson D.E. Bicarbonate therapy for prevention of chronic kidney disease progression. Kidney Int. 2014; 85(3): 529–535.
 
41.
Goraya N., Simoni J., Jo C., Wesson D.E. Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephronpathy. Kidney Int. 2012; 81(1): 86–93.
 
42.
Shore A.C., Markandu N.D., MacGregor G.A. A randomized crossover study to compare the blood pressure response to sodium loading with and without chloride in patients with essential hypertension. J. Hypertens. 1988; 6(8): 613–617.
 
43.
Kurtz T.W., Al-Bander H.A., Morris R.C. Jr "Salt-sensitive" essential hypertension in men. Is the sodium ion alone important? N. Engl. J. Med. 1987; 317(17): 1043–1048.
 
44.
Goraya N., Simoni J., Jo C.H., Wesson D.E. A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate. Clin. J. Am. Soc. Nephrol. 2013; 8(3): 371–381.
 
45.
Uribarri J., Oh M.S. The key to halting progression of CKD might be in the produce market, not in the pharmacy. Kidney Int. 2012; 81(1): 7–9.
 
46.
Kovesdy C.P. Metabolic acidosis and kidney disease: does bicarbonate therapy slow the progression of CKD? Nephrol. Dial. Transplant. 2012; 27(8): 3056–3062.
 
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