Zusammenfassung
Eine chronische metabolische Azidose ist eine häufige Komplikation bei niereninsuffizienten Patienten, die klinisch im Stadium IV oder V der chronischen Niereninsuffizienz („chronic kidney disease“, CKD) auffällt, jedoch bereits bei Patienten ab einem CKD 2 feststellbar ist. Die multiplen systemischen Auswirkungen einer metabolischen Azidose manifestieren sich in Störungen des Protein-, Muskel- und Knochenstoffwechsels. Zudem kann sie zur Beeinträchtigung der kardialen Funktion und der respiratorischen Belastbarkeit führen. Eine chronische metabolische Azidose ist mit einer erhöhten Mortalität der betroffenen Patienten assoziiert. Die Progression einer Nierenerkrankung ist bei Patienten mit chronischer metabolischer Azidose beschleunigt. In Therapiestudien konnte der progressionsmindernde Effekt einer Azidosekorrektur mittels Bikarbonatsubstitution nachgewiesen werden. Zur Korrektur einer Azidose sollten Anpassungen der Ernährungsweise mit einer Bikarbonatsubstitution kombiniert werden. Die Ernährung sollte auf einen erhöhten Anteil an Obst und Gemüse und eine moderate Eiweißzufuhr umgestellt werden. Die Bikarbonatsubstitution kann oral in Tablettenform erfolgen, jedoch müssen die damit verbundene Natriumzufuhr und die konsekutive Volumenbelastung beachtet werden, welche eine vorbestehende Hypertonie oder Herzinsuffizienz aggravieren können. Bei Dialysepatienten erfolgt der wesentliche Teil der Bikarbonatzufuhr über das Dialysat. Während dadurch die Azidose bei der Mehrzahl der Peritonealdialyspatienten ausgeglichen wird, bedürfen Hämodialysepatienten häufig einer zusätzlichen oralen Bikarbonatsubstitution.
Abstract
Chronic metabolic acidosis is a common complication in patients with renal failure. Clinically it is usually recognized by severe renal failure; however, lowered pH and bicarbonate concentrations are already detectable in patients with moderate chronic kidney disease (CKD). Many systemic functions are negatively affected by metabolic acidosis, such as protein catabolism, impairment of muscle and bone metabolism, impairment of cardiac function and lower respiratory performance. Chronic metabolic acidosis is associated with an increased mortality and progression of the underlying renal disease is enhanced. Studies in patients with moderate or severe CKD demonstrate that bicarbonate substitution slows the progression of CKD. For correction of acidosis patient diet should be enriched in fruit and vegetables and contain only moderate amounts of protein. Furthermore, oral bicarbonate substitution is often needed to control acidosis; however, this treatment is associated with a significant ingestion of sodium und consecutive volume overload which may aggravate hypertension and congestive heart failure. In patients on peritoneal dialysis acidosis is generally effectively corrected via a bicarbonate containing dialysate. In contrast patients on hemodialysis often need additional oral bicarbonate substitution.
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Hoyer, J. Chronische metabolische Azidose bei Niereninsuffizienz. Nephrologe 7, 472–480 (2012). https://doi.org/10.1007/s11560-012-0670-7
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DOI: https://doi.org/10.1007/s11560-012-0670-7