[fr] L’acidose métabolique est une anomalie biologique fréquente et précoce de l’insuffisance rénale chronique (IRC). Les complications liées à cet état sont multiples et touchent notamment l’os, le muscle et le métabolisme protidique, sans parler du risque accru d’hyperkaliémie. Une causalité entre acidose métabolique et accélération du déclin rénal a été démontrée. La mesure du taux de bicarbonate sérique doit, dès lors, faire partie du suivi biologique systématique du patient en IRC dont le taux de filtration glomérulaire s’abaisse en dessous de 50 ml/min/1,73 m². Le dépistage et le traitement de l’acidose métabolique sont en effet simples et peu coûteux. La correction de l’acidose métabolique, notamment par le bicarbonate de sodium, permet de ralentir la progression de l’insuffisance rénale.
Disciplines :
Urology & nephrology
Author, co-author :
Georges, benoit
Huart, Justine ; Université de Liège - ULiège > Cardiovascular Sc.-Lab. of Translational Res. in Nephrology
KRZESINSKI, Jean-Marie ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie
JOURET, François ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie
Language :
French
Title :
Intérêt du dépistage et du traitement de l'acidose métabolique chez l'insuffisant rénal chronique
Alternative titles :
[en] Screening and management of metabolic acidosis in patients with chronic kidney disease
Publication date :
2018
Journal title :
Revue Médicale Suisse
ISSN :
1660-9379
Publisher :
Medecine et Hygiène, Switzerland
Volume :
14
Issue :
1455-1458
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Metabolic acidosis is a frequent and early biological abnormality of chronic kidney disease (CKD). Chronic metabolic acidosis affects the global homeostasis of the human body, including the metabolism of bone and muscles. Numerous studies have proved a causal relationship between metabolic acidosis and accelerated CKD progression. Hence, the measure of serum bicarbonate level should be part of the systematic follow-up of CKD patients of whom glomerular filtration rate decreases below 50 ml/min/1.73m². Both screening and treatment of metabolic acidosis are easy and cheap. Correcting metabolic acidosis, namely by the daily administration of sodium bicarbonate, helps slow down kidney decline.
Levey AS1, de Jong PE, Coresh J, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int 2011;80:17‑28.
Kraut J, Madias N. Metabolic acidosis of CKD: an update. Am J Kidney Dis 2016;67:307‑17.
Raphael KL, Zhang Y, Ying J, et al. Prevalence of risk factors for reduced serum bicarbonate in chronic kidney disease. Nephrology 2014;19:648‑54.
Shah SN, Abramowitz M, Hostetter TH, et al. Serum bicarbonate levels and the progression of kidney disease: a cohort sudy. Am J Kidney Dis 2009;54:270‑77.
Dobre M, Yang W, Pan Q, et al. Persistent high serum bicarbonate and the risk of heart failure in patients with chronic kidney disease (CKD): a report from the Chronic Renal Insufficieny Cohort (CRIC) Study. J Am Heart Assoc 2015;4:1‑10.
Kovesdy CP, Anderson JE, Kalantar‑ Zadeh K. Association of serum bicarbo‑ nate levels with mortality in patients with non‑dialysis dependent CKD. Nephrol Dial Transplant 2009;24:1232‑7.
Raphael KL, Wei G, Baird BC, et al. Higher serum bicarbonate levels within the normal rang are associated with better survival and renal outcomes in African Americans. Kidney Int 2011;79:356‑62.
Driver TH, Shlipak MG, Katz R, et al. Low serum bicarbonate and kidney function decline: the Multi‑Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis 2014;64:534‑41.
Rossier A, Bullani R, Burnier M, et al. Sodium bicarbonate to slow the progression of chronic kidney disease. Rev Med Suisse 2011;7:478‑82.
Raphael KL. Approach to the treat‑ ment of chronic metabolic acidosis in CKD. Am J Kidney Dis 2016;67:696‑702.
National Kidney Fondation. K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2000;35(Suppl. 2):S1‑140.
National Kidney Fondation. K/DOQI clinical practice guidelines for bone meta‑ bolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42(Suppl. 3):S1‑201.
May RC, Kelly RA, Mitch WE. Mecha‑ nisms for defects in muscle protein metabolism in rats with chronic uremic: the influence of metabolic acidosis. J Clin Invest 1987;79:1099‑2003.
Graham KA, Reaich D, Channon SM, et al. Correction acidosis in hemodialysis decreases whole body protein degrada‑ tion. J Am Soc Nephrol 1997;8:632‑7.
Movili E, Zani R, Carli O, et al. Correction of metabolic acidosis increases serum albumin concentrations and decrease kinetically evaluated protein intake in hemodialysis patient: a prospective study. Nephrol Dial Transpant 1998;13:1719‑22.
Eustache JA, Astor B, Munter PM, et al. Prevalence of acidosis and inflammation and their association with low serum albumin chronic kidney disease. Kidney Int 2004;65:1031‑40.
Sonikian M, Gogusev J, Zingraff J, et al. Potential effect of metabolic acidosis on beta 2microglulin generation: in vivo and in vitro studies. J Am Soc Nephrol 1996;7:350‑6.
Mandel EI, Forman JP, Curhan GC, et al. Plasma bicarbonate and odds of incident hypertension. Am J Hypertens 2013;26:1405‑12.
Menon V, Tighiouart H, Vaughn NS, et al. Serum bicarbonate and long‑term outcomes in CKD. Am J Kidney Dis 2010;56:907‑14.
Navaneethan SD, Shold JD, Arrigain S, et al. Serum bicarbonate and mortality in stage 3 and stage 4 chronic kidney disease. Clin J Am Soc Nephrol 2011;6:2395‑402.
Raphael KL, Zhang Y, Wei G, et al. Serum bicarbonate and mortality in adults in NHANES III. Nephrol Dial Transplant 2013;28:1207‑13.
Nath KA, Hostetter MK, Hostetter TH. Pathophysioloy of chonic tubulo‑intersti‑ tial disease in rats. Interactions of dietary acid load, ammonia and complement component C3. J Clin Invest 1985;76:667‑75.
Wesson DE, Simoni J, Broglio K, et al. Acid retention accompagnies reduced GFR in humans and increases plasma levels of aldosterone and endothelin. Am J Physiol Renal Physiol 2011;300:F830‑7.
de Britot‑Ashurst I, Varagunam M, Raftery MJ, et al Bicarbonate supplemen‑ tation slows progression of CKD and improves nutritonal status. J Am Soc Nephrol 2009;20:2075‑84.
Phisitkul S, Khanna A, SimoniJ, et al. Amelioration of metabolic acidosis in patients with low GFR reduced kidney endothelin production and kidney injury, and better preserved GFR. Kidney Int 2010;77:617‑23.
Navaneethan SD, Shold JD, Arrigain S, et al. Serum bicarbonate and mortality in stage 3 and stage 4 chronic kidney disease. Clin J Am Soc Nephrol 2011;6:2395‑402.
Bushinsky D.A, Hostetter Th, Klaemer G, et al. Randomized controlled trila of TRC101 to incresase serum bicarbonate in patient with CKD. Clin J Am Soc Nephrol 2018;13:26‑35.
Goraya N, Simoni J, Jo C, et al. Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patient with moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney Int 2012;81:86‑93.
Gennari FJ, Hood VL, Greene T, et al. Effect of dietary protein intake on serum total CO2 concentration in chronic kidney disease: modification of diet in renal disease study findings. Clin J Am Soc Nephrol 2006;1:52‑7.