الفهرس 
METABOLIC ACIDOSIS PATHOPHYSIOLOGY AND CONSEQUENCESOnly 14 pages are availabe for public view
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Abstract
Metabolic acidosis is a common health problem among CKD patients, particularly those on dialysis. K/DOQI guidelines suggested treating acidosis when serum bicarbonate levels are below 22, but didn’t impose a specific therapy scheme for metabolic acidosis in CKD subjects.
Chronic metabolic acidosis has multiple consequences including decreased albumin synthesis, increased muscle wasting, generation and exacerbation of bone disease, growth retardation in children and many other effects.
Protein energy wasting (PEW) is a syndrome of adverse changes in nutrition and body composition, highly prevalent in patients with chronic kidney disease (CKD), especially in those undergoing dialysis, and it is associated with high morbidity and mortality. Metabolic acidosis is an important contributing factor in the pathogenesis of PEW.
Furthermore, one of the major adverse effects of metabolic acidosis is the development or exacerbation of bone disease, this may be through stimulation of the secretion of PTH. CKD-MBD is an important cause of morbidity, decreased quality of life, and vascular calcification that have been associated with increased cardiovascular mortality.
The present study was designed to study the effect of oral sodium bicarbonate therapy, in maintenance hemodialysis patients who had chronic metabolic acidosis, on nutritional status and bone disease. It included 60 prevalent hemodialysis patients, selected from Dakahlia governate hospitals, during the period from November 2014 till May 2015, all the patients had pre-dialysis serum bicarbonate <22 meq/l.
They were divided into two groups: Group I (included 30 patients) who received oral sodium bicarbonate therapy targeting serum HCO3 >22 meq/l and Group II (included 30 patients) who didn’t receive oral sodium bicarbonate therapy.
All patients were subjected to the following: full history and clinical examination, laboratory investigations, assessment of Kt/V and nPCR and anthropometric measurements in the form of triceps skin fold (TSF) and mid-arm muscle circumference (MAMC).
The results of the study showed that correction of metabolic acidosis led to improvement of secondary hyperparathyroidism and reduction of serum potassium towards normal level, however it didn’t lead to improvement of nutritional status.