2013年5月8日

[摘要] 口服小蘇打片與慢性腎病


Effects of Oral Sodium Bicarbonate in Patients with CKD


這期的CJASN(腎臟科的Top1 期刊) 發表了有關小蘇打片治療慢性腎病的效果研究!

簡單摘要一下:

這個單盲的研究,搜集了2009/3 至2010/8月 CKD stage 3b-4 合併血液重碳酸根20-24mEq/L的病人,使用兩週的鹼片治療(小蘇打片),使用的劑量分別為 0.3, 0.6與1.0 mEq/kg per day。

最後研究的結果顯示,每0.1mEq/kg/day 的小蘇打片,可以升高約0.33mEq/L的重碳酸根。結論是在輕度酸中毒的慢性腎病病人,在短期使用鹼片,可以增加下肢肌肉的強壯,並不影響血壓與水腫的情況。

原文摘要如下,有興趣的在上去看看吧!
Background and objectives Metabolic acidosis contributes to muscle breakdown in patients with CKD, but whether its treatment improves functional outcomes is unknown. The choice of dose and tolerability of high doses remain unclear. In CKD patients with mild acidosis, this study evaluated the dose–response relationship of alkali with serum bicarbonate, its side effect profile, and its effect on muscle strength.
Design, setting, participants, & measurements In this single-blinded pilot study from March of 2009 to August of 2010, 20 adults with estimated GFR 15–45 ml/min per 1.73 m2 and serum bicarbonate 20–24 mEq/L were treated during successive 2-week periods with placebo followed by escalating oral NaHCO3doses (0.3, 0.6, and 1.0 mEq/kg per day). At each visit, handgrip strength and time required to complete 5 and 10 repetitions of a sit-to-stand test were measured.
Results Each 0.1 mEq/kg per day increase in dose produced a 0.33 mEq/L (95% confidence interval=0.23–0.43 mEq/L) higher serum bicarbonate. Sit-to-stand time improved after 6 weeks of oral NaHCO3 (23.8±1.4 versus 22.2±1.6 seconds for 10 repetitions, P=0.002), and urinary nitrogen excretion decreased (−0.70 g/g creatinine [95% confidence interval=−1.11 to −0.30] per 0.1 mEq/kg per day higher dose). No statistically significant change was seen in handgrip strength (29.5±9.6 versus 28.4±9.4 kg, P=0.12). Higher NaHCO3 doses were not associated with increased BP or greater edema.
Conclusions NaHCO3 supplementation produces a dose-dependent increase in serum bicarbonate and improves lower extremity muscle strength after a short-term intervention in CKD patients with mild acidosis. Long-term studies are needed to determine if this finding translates into improved functional status.

雨果之前就常在慢性腎病合併酸中毒的病人使用鹼片,臨床上矯正酸中毒對於病人的生活品質改善,的確有很大的幫助,但是目前也的確沒有確實的證據顯示可以減緩慢性腎病的進展。這篇文章重要的地方在將使用小蘇打片治療的適應症,拉倒輕度酸中毒(20-24mEq/L)而非傳統上<20mEq/L的病人。或許之後,可以考慮在這類的病人身上試試。

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