Amelioration of metabolic acidosis in patients with low GFR reduced kidney endothelin production and kidney injury, and better preserved GFR.
Metabolic acidosis often accompanies low glomerular filtration rate and induces secretion of endothelin, which in turn might mediate kidney injury. Here we tested whether treatment of metabolic acidosis in patients with low glomerular filtration rate reduced the progression of kidney disease. Fifty-nine patients with hypertensive nephropathy and metabolic acidosis had their blood pressure reduced with regimens that included angiotensin-converting enzyme inhibition. Thirty patients were then prescribed sodium citrate, and the remaining 29, unable or unwilling to take sodium citrate, served as controls. All were followed for 24 months with maintenance of their blood pressure reduction. Urine endothelin-1 excretion, a surrogate of kidney endothelin production, and N-acetyl-beta-D-glucosaminidase, a marker of kidney tubulointerstitial injury, were each significantly lower, while the rate of estimated glomerular filtration rate decline was significantly slower. The estimated glomerular filtration rate was statistically higher after 24 months of sodium citrate treatment compared to the control group. Hence it appears that sodium citrate is an effective kidney-protective adjunct to blood pressure reduction and angiotensin-converting enzyme inhibition.
Phisitkul
Sorot
S
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Khanna
Apurv
A
Simoni
Jan
J
Broglio
Kristine
K
Sheather
Simon
S
Rajab
M Hasan
MH
Wesson
Donald E
DE
D000118:Acetylglucosaminidase / Q000652:urine; D000138:Acidosis / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D015415:Biomarkers / Q000652:urine; D002021:Buffers; D002951:Citrates / Q000494:pharmacology / Q000627:therapeutic use*; D019332:Endothelin-1 / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000652:urine; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D000077559:Sodium Citrate
D015415:Biomarkers; D002021:Buffers; D002951:Citrates; D019332:Endothelin-1; D000077559:Sodium Citrate; D000118:Acetylglucosaminidase