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Metabolic Alkalosis Associated with Malnutrition in Hemodialyzed Patients
並列摘要
Background: The association between metabolic alkalosis and nutritional status has not been well-studied in hemodialysis (HD) patients. The aim of this study was to evaluate this association and how correction of alkalosis affects nutrition in HD patients. Methods: Fourteen with HD patients with persistent metabolic alkalosis for at least 3 months were enrolled. A control group consisted of 14 age, sex and BMI matched HD patients without metabolic alkalosis. To correct the metabolic alkalosis, alkalotic HD patients were randomly divided into 2 groups. One (n=7) was treated with altering the dialysate bicarbonate (HCO3^-) concentration and the other (n=7) with intradialysis amino acid supplementation for 3 months. Nutritional parameters including anthropometry, normalized protein catabolic rate (nPCR), dietary protein intake (DPI), and biochemical markers were evaluated. Results: The mean starting plasma HCO3^- concentration (PHCO3) was 28.4±0.5 mmol/L in the alkalotic group. Compared to the non-alkalotic group, alkalotic patients had significantly lower midarm muscle circumference (MAMC), DPI, nPCR as well as serum creatinine BUN, albumin, phosphate, and intact-parathyroid hormone (I-PTH). There were no significant differences in plasma inflammatory markers such as C-reactive protein (CRP) and interleukin 6 (IL-6). Over a period of 3 months, correction of metabolic alkalosis with amino acid supplementation improved nutritional status more than reduction of the dialysate HCO3^- concentration. Conclusions: Metabolic alkalosis as a result of low protein intake is associated with malnutrition and correction of the metabolic alkalosis by adjusting dialysate HCO3^- concentration does not improve nutritional status in these well-dialyzed HD patients.
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