Correction of metabolic acidosis improves thyroid and growth hormone axes in haemodialysis patients.
BACKGROUND
Chronic metabolic acidosis (CMA) in normal adults results in complex endocrine and metabolic alterations including growth hormone (GH) insensitivity, hypothyroidism, hyperglucocorticoidism, hypoalbuminaemia and loss of protein stores. Similar alterations occur in chronic renal failure, a prototypical state of CMA. We evaluated whether metabolic acidosis contributes to the endocrine and metabolic alterations characteristic of end-stage renal disease.


METHODS
We treated 14 chronic haemodialysis patients with daily oral Na-citrate for 4 weeks, yielding a steady-state pre-dialytic plasma bicarbonate concentration of 26.7 mmol/l, followed by 4 weeks of equimolar Na-chloride, yielding a steady-state pre-dialytic plasma bicarbonate of 20.2 mmol/l.


RESULTS
Blood pressure, body weight and dialysis adequacy were equivalent in the two protocols. Na-citrate treatment corrected CMA, improved GH insensitivity, increased and normalized plasma free T(3) concentration, and improved plasma albumin. Correction of CMA had no significant effect on measured cytokines (interleukin-1 beta and -6, tumour necrosis factor-alpha) or acute phase reactants (C-reactive protein, serum amyloid A, alpha(2)-macroglobulin).


CONCLUSIONS
CMA contributes to the derangements of the growth and thyroid hormone axes and to hypoalbuminaemia, but is not a modulator of systemic inflammation in dialysis patients. Correcting CMA may improve nutritional and metabolic parameters and thus lower morbidity and mortality.
Department of Internal Medicine, University Hospital Bruderholz, Basel, Switzerland. wiederkehrm@dneph.com
Michael R
MR
Wiederkehr
Jris
J
Kalogiros
Reto
R
Krapf
D000138:Acidosis / Q000097:blood / Q000628:therapy*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D001784:Blood Gas Analysis; D002951:Citrates / Q000008:administration & dosage / Q000627:therapeutic use*; D016207:Cytokines / Q000097:blood; D005260:Female; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D006435:Renal Dialysis; D012709:Serum Albumin / Q000378:metabolism; D012964:Sodium / Q000097:blood; D000077559:Sodium Citrate; D014284:Triiodothyronine / Q000097:blood*
D001639:Bicarbonates; D002951:Citrates; D016207:Cytokines; D012709:Serum Albumin; D014284:Triiodothyronine; D019382:Human Growth Hormone; D000077559:Sodium Citrate; D012964:Sodium