AKI时碳酸氢钠的应用
作者：Mark D. Uniacke, G. Venkat Raman, Jonathan Hewitt 来源：AJKD 日期：2013-02-20
导读
Sodium Bicarbonate Use in Acute Kidney Injury
Abstract
Acute acidosis is known to affect a number of organ systems adversely and therefore may be one of the factors contributing to the poor outcomes associated with acute kidney injury (AKI).1, 2 In patients with less severe AKI who do not require dialysis treatment or in situations in which renal replacement therapy is not readily available, acidosis has been treated by administering sodium bicarbonate. This treatment approach currently is recommended in many major nephrology textbooks.3 However, its use in other clinical settings, such as lactic acidosis, has failed to show clear benefits and is potentially detrimental.4
We recently have conducted a systematic review for the Cochrane database to assess the benefits and harms of using sodium bicarbonate in the setting of AKI.5 We did not include studies that investigated the use of sodium bicarbonate for AKI prevention. Our search did not identify even a single randomized controlled trial. Further literature searches also failed to identify high-quality large-scale observational studies.
Although sodium bicarbonate commonly is recommended for treating acidosis in patients with AKI, we found no randomized controlled trial evidence for its use in this setting. We believe it is important that the wider nephrology community be made aware of this situation and want to highlight the need for well-conducted large-scale studies, either observational or randomized controlled trials, in this area. In the absence of such evidence, this treatment is as likely as not to be causing harm.
http://www.ajkd.org/article/S0272-6386(12)01501-6/fulltext
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