Abstract:
BACKGROUND:Treatment of metabolic acidosis to target the higher serum bicarbonate level than guideline recommendation may downregulate muscle protein degradation and improve renal function among chronic kidney disease (CKD) patients. We conducted a study to test the effects of increased serum bicarbonate level on muscle parameters, nutrition, and renal function in pre-dialysis CKD patients. METHODS:This was a randomized, controlled study. CKD stage 3-4 patients with serum HCO3- <22 mEq/L were randomized to either receive oral sodium bicarbonate with high target bicarbonate level of 25 ± 1 or standard level of 22 ± 1 mEq/L as control group using protocol-based titration of dosage adjustment. The changes of muscle mass measured by bioelectrical impedance analysis (BIA), muscle strength by hand grip dynamometer, estimated glomerular filtration rate (eGFR) using CKD-Epidemiology Collaboration equation, nutritional markers, and muscle-related biomarkers were determined. Data at baseline and after 4 months of sodium bicarbonate supplementation were compared between groups using Student t test or chi-square test as appropriate. RESULTS:Forty-two patients completed the study (n = 21 per group). The mean age and eGFR were 61.2 ± 9.8 years and 32.4 ± 14.1 mL/min respectively. Serum bicarbonate levels at baseline were 21.0 ± 2.1 mEq/L. Baseline data including sex, diabetes, serum bicarbonate level, creatinine, and blood pressure were similar. After 4 months of treatment, the average serum bicarbonate levels in both groups were 24.0 ± 1.4 and 20.7 ± 2.3 mEq/L (p < 0.001). Both BIA-derived total-body muscle mass and appendicular lean balance were increased at 4 months in the higher bicarbonate group (26.0 ± 5.3 to 26.7 ± 5.5 kg, p = 0.04 and 19.8 ± 4.1 to 20.7 ± 4.4 kg, p = 0.06, respectively) despite comparable body weight and protein intake. Patients in the high bicarbonate group had a significant reduction of plasma myostatin levels, a surrogate of muscle degradation, at the study exit after adjusting for baseline values (-3,137.8; 95% CI -6,235.3 to -40.4 pg/mL, p= 0.04), but unaltered insulin-like growth factor-1 level, as the mediator of muscle cell growth, (141 [106-156] to 110 [87-144] ng/mL, p = 0.13) compared to the control group. Muscle strength, eGFR as well as serum prealbumin were not significantly different between 2 groups (p > 0.05). Neither worsening hypertension nor congestive heart failure was found throughout the study. CONCLUSION:Bicarbonate supplementation to achieve the serum level ∼24 mEq/L demonstrates better muscle mass preservation in patients with pre-dialysis CKD. The impact of alkaline therapy on renal function may require a longer period of study.
journal_name
Am J Nephroljournal_title
American journal of nephrologyauthors
Kittiskulnam P,Srijaruneruang S,Chulakadabba A,Thokanit NS,Praditpornsilpa K,Tungsanga K,Eiam-Ong Sdoi
10.1159/000504557subject
Has Abstractpub_date
2020-01-01 00:00:00pages
24-34issue
1eissn
0250-8095issn
1421-9670pii
000504557journal_volume
51pub_type
杂志文章abstract:BACKGROUND:Chronic kidney disease (CKD) impairs intestinal barrier function which by allowing influx of noxious products causes systemic inflammation. We have recently shown that intestinal barrier dysfunction in CKD is due to degradation of epithelial tight junction (TJ) which is, in part, mediated by influx of urea a...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000351171
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND/AIMS:Post-renal transplant recurrent glomerulonephritis (GN) contributes to allograft loss. Rituximab treatment has been used in a multidose strategy with variable efficacy and toxicity. We investigated a novel single-dose approach. METHODS:A single center, retrospective, cohort study was conducted between ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000371587
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:Persons with chronic kidney disease (CKD) represent a population prone to cardiovascular disease (CVD) but vulnerable to adverse medication effects. We assessed the impact of intensive antihypertensive therapy on the cerebrovascular and other CVD outcomes in high-risk patients with type 2 diabetes and baseli...
journal_title:American journal of nephrology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1159/000446122
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Three million people in the United States are estimated to have chronic kidney disease (CKD). Management of these CKD patients in the outpatient primary care clinic setting has not been well studied. HYPOTHESIS:Primary care management of CKD can be assessed and opportunities for improvement can be identifie...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000066296
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND/AIMS:There is evidence that hereditary predisposition contributes to the development of diabetic nephropathy and hypertension. Polymorphisms in the genes for bradykinin receptors (B(1)R and B(2)R) were found to be associated with decreased risk of the development of end-stage renal disease. This study examin...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000068035
更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:Malnutrition-inflammation score (MIS) is a comprehensive and quantitative system to assess malnutrition-inflammation complex syndrome, and a strong correlation between MIS and morbidity/mortality in maintenance hemodialysis (MHD) patients had been demonstrated. However, there is no cut-off value of MIS to ca...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000137684
更新日期:2008-01-01 00:00:00
abstract::The medical history of salt begins in ancient times and is closely related to different aspects of human history. Salt may be extracted from sea water, mineral deposits, surface encrustations, saline lakes and brine springs. In many inland areas, wood was used as a fuel source for evaporation of brine and this practic...
journal_title:American journal of nephrology
pub_type: 历史文章,杂志文章
doi:10.1159/000168759
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Estimating total body water (TBW) is crucial in determining dry weight and dialytic dose for hemodialysis patients. Several anthropometric equations have been used to predict TBW, but a more accurate method is needed. We developed an artificial neural network (ANN) to predict TBW in hemodialysis patients. M...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000088279
更新日期:2005-09-01 00:00:00
abstract::Administration of a single dose of 1,25-OH(2)D(3) can lower PTH levels for up to 4 days in chronic hemodialysis patients. Our purpose was to verify the effects of the same weekly dose of calcitriol per os given in one, two or three administrations, to patients on dialysis with secondary hyperparathyroidism. Thirty pat...
journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1159/000046197
更新日期:2000-11-01 00:00:00
abstract::Renal function and life expectancy can be improved by aggressive antihypertensive therapy in severe hypertension. However, most reports of severe hypertension and renal failure concern primary hypertensive states. 3 cases of primary renal disease, 1 glomerular, 1 obstructive and 1 of chronic pyelonephritis, are descri...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000166576
更新日期:1982-01-01 00:00:00
abstract::We describe an elderly women who died of renal failure secondary to spontaneous renal atheroembolic disease. The sole clinical clue to this diagnosis was a profound eosinophilia up to 19,100/mm3 and a relative eosinophil count of 80%. Renal atheroembolic disease should be a prominent consideration in any patient with ...
journal_title:American journal of nephrology
pub_type: 杂志文章,评审
doi:10.1159/000168476
更新日期:1992-01-01 00:00:00
abstract:BACKGROUND/AIMS:Upregulation of transforming growth factor beta (TGF-beta)/Smad signaling has been implicated in the primary pathogenesis of renal fibrosis. The ubiquitin-proteasome pathway has an important influence on TGF-beta signaling through regulating Smad degradation. As E3 ubiquitin ligases, both Arkadia and Sm...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000100518
更新日期:2007-01-01 00:00:00
abstract::Awareness that sphygmomanometry is encompassed with serious limitations has led to the development of techniques that allow blood pressure (BP) to be monitored intraarterially or noninvasively during the day or over a 24-hour period. Although intraarterial BP monitoring allows an accurate evaluation of 24-hour BP mean...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167335
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND/AIMS:Although the effect of exercise on health is well established, nephrologists seldom consider physical activity in the treatment of chronic kidney disease (CKD) or CKD in the presence of diabetes mellitus (DM/CKD). The aim of the present study was to analyze the benefits of leisure-time physical activity...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000357133
更新日期:2013-01-01 00:00:00
abstract::A patient with renal failure due to myeloma kidney and coincident digitalis intoxication due to prescribed daily digoxin administration was treated with digoxin-specific antibody fragments and plasmapheresis. Rapid response to therapy was noted, removal of digoxin-antidigoxin antibody complexes was confirmed, and prev...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168179
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND/AIMS:Evaluation of the risk factors, and phenotype-genotype correlation of familial Mediterranean fever (FMF) gene (MEFV) and serum amyloid A1 (SAA1) gene polymorphisms in renal amyloidosis. METHODS:We investigated MEFV and SAA1 genotypes (alpha, beta, and gamma isoforms) in 50 FMF patients and 50 healthy c...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000087824
更新日期:2005-09-01 00:00:00
abstract::In this paper, we analyze the collection of ancient Greek treatises ascribed to Hippocrates (460; between 371 and 350 BC), in order to determine whether or not edema can be traced. As a result of reading these works on the Greek text, we recognize some symptoms of edema in those called oidêma (swelling) and udrôps (dr...
journal_title:American journal of nephrology
pub_type: 传,历史文章,杂志文章
doi:10.1159/000013442
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:Various medications are cleared by the kidneys, therefore patients with impaired renal function, especially dialysis patients are at risk for adverse drug events (ADEs). There are limited studies on ADEs in maintenance dialysis patients. METHODS:We utilized a nationally representative database, the Nationwi...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000489703
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND/AIMS:Epithelial-to-mesenchymal cell transformation (EMT) is the trans-differentiation of tubular epithelial cells into myofibroblasts, an event underlying progressive chronic kidney disease in diabetes, resulting in fibrosis. Mainly reported in proximal regions of the kidney, EMT is now recognized as a key c...
journal_title:American journal of nephrology
pub_type: 杂志文章,评审
doi:10.1159/000256659
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Fibrillary glomerulonephritis is characterized by randomly arranged fibrils, approximately 20 nm in diameter by electron microscopy. Patients present with proteinuria, hematuria and kidney insufficiency, and about half of the reported patients progress to end-stage kidney disease within 4 years. The dependen...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000455390
更新日期:2017-01-01 00:00:00
abstract::To determine the prevalence and type of glomerulonephritis (GN) associated with hepatitis C virus (HCV) cirrhosis, we prospectively evaluated 28 consecutive Saudi patients with HCV cirrhosis for liver transplantation. Six patients (21%) underwent kidney biopsies for proteinuria, unexplained elevated serum creatinine o...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168874
更新日期:1995-01-01 00:00:00
abstract::Hyperkalemia is a commonly encountered problem in dialysis patients with end-stage renal disease. In this study we evaluated the effect of mineralocorticoid therapy (MCT; fludrocortisone 0.1-0.3 mg per os daily) on serum potassium of hyperkalemic end-stage renal disease patients. Consecutive monthly clinical and bioch...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168604
更新日期:1993-01-01 00:00:00
abstract:BACKGROUND:Uric acid has been reported to be a risk factor for the development of chronic kidney disease; however, no study has examined whether uric acid may confer a risk for acute kidney injury. METHODS:We investigated the relation between serum uric acid and the incidence of postoperative acute kidney injury in pa...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000238824
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND/AIM:While the familial nature of chronic kidney disease (CKD) has been recognized, it has primarily been defined from studies of first-degree relatives of selected sets of cases. The goal of this study is an evaluation of the familial clustering of end-stage renal disease (ESRD) and CKD mortality using a pop...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000092280
更新日期:2006-01-01 00:00:00
abstract::We analyzed routine serum potassium concentration measurements and conditions temporally associated with abnormalities in potassium concentration in outpatients on chronic hemodialysis (136 nondiabetics, 36 diabetics) and continuous ambulatory peritoneal dialysis (16 nondiabetics, 10 diabetics). The following potassiu...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167443
更新日期:1987-01-01 00:00:00
abstract:BACKGROUND:Almost 20 million people in the US have chronic kidney disease (CKD). Cardiovascular disease and arterial wall abnormalities are common in this population. Because angiotensin II may have adverse effects on the arterial wall, we hypothesized that an angiotensin receptor blocker (ARB) would improve arterial c...
journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1159/000087211
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Living donor liver transplantation (LDLT) patients run the risk of developing acute kidney injury (AKI) and subsequent chronic kidney disease, affecting morbidity and mortality. Sevoflurane has anti-inflammation properties, and renal ischemia/reperfusion under sevoflurane anesthesia resulted in drastic impro...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000319623
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND/AIM:Although clinical and immunological findings in steroid-sensitive nephrotic syndrome (SSNS) favor an immunopathogenesis, many issues remain unsolved. Comprehensive studies analyzing cellular and humoral immunity in SSNS are scarce, and few studies addressed the effect of steroids on immunological factors...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000085357
更新日期:2005-03-01 00:00:00
abstract::A 23-year-old female with acute renal failure associated with acute tubulointerstitial nephritis and uveitis is reported. Renal tubular acidosis and inflammatory reactions consisting of markedly increased erythrocyte sedimentation rate and high serum immunoglobulin levels were seen on admission. Light microscopy revea...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168020
更新日期:1989-01-01 00:00:00
abstract::Serum levels of soluble interleukin-2 receptors (IL2R) and of beta 2-microglobulin (beta 2M) were studied with the immunoenzymatic technique in 38 patients with primary glomerulonephritis (GN), in 10 patients with essential hypertension (EH) and in 30 healthy subjects. IL2R correlated with beta 2M (p < 0.05). IL2R and...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168627
更新日期:1993-01-01 00:00:00