维持型血液透析患者中代谢性酸中毒的临床研究进展

Advances in clinical researches of metabolic acidosis in maintenance hemodialysis

代谢性酸中毒是慢性肾病的常见并发症之一。病人一旦发展为终末期肾病,血清碳酸氢盐浓度会显著降低,从而加重病情。代谢性酸中毒纠正对血透患者的临床治疗和预后具有重要意义。血清碳酸氢盐浓度过低会显著加快肾脏疾病病程,浓度过高则会增加心血管疾病风险。现阶段关于血清碳酸氢盐浓度的最优临床参考值尚无定论。针对代谢性酸中毒与血透预后的研究多集中于代谢性酸中毒发展的不良后果,对于血清碳酸氢盐水平的临床纠正过程中需要考虑的影响因素少有讨论。本文主要针对维持性血液透析中代谢性酸中毒发生的影响因素、不良后果以及临床治疗需要考虑的因素展开论述,旨在通过汇总分析临床流行病学和实验室研究结论,探讨纠正血清碳酸氢盐水平的行之有效的临床方案。

Metabolic acidosis(MA)is a kind of common complication of chronic kidney disease.Serum bicarbonate(HCO3−)concentration would significantly decrease once the end-stage renal disease was diagnosed.It would worsen the condition.MA correction would contribute to the clinical therapy and the prognosis of maintenance hemodialysis(MHD)patients.Low concentration of HCO3−would accelerate the progression of kidney disease,and high concentration of HCO3−would pose the risk of cardiovascular disease.Nevertheless,the optimal clinical reference value of serum bicarbonate concentration is still unknown.The factors that should be considered in dialysis treatment are also complicated.This paper mainly reviews the factors of MA occurrence and adverse effects in MHD patients,and further discusses the relevant practical considerations in the clinical therapy of MA in MHD.We aim to provide theoretical references for MA treatment by analyzing the results of large cohort study around the world and that from wet-lab.