Correction of metabolic acidosis improves insulin resistance in chronic kidney disease

BMC Nephrology

Research Article

Domenico Santoro¹  Mario Cozzolino²  Antonio Bellasi³  Luca Di Lullo⁴  Biagio Di Iorio⁵  Emanuele De Simone⁵  Lucia Di Micco⁵  Stefania Marzocco⁶  Pasquale Guastaferro⁷ 

[1] Department of Clinical and Experimental Medicine, Unit of Nephrology, University of Messina, Messina, Italy;Department of Health Sciences, University of Milan, Milan, Italy;Department of Nephrology and Dialysis, ASST-Lariana, Ospedale Sant’ Anna, Como, (CO), Italy;Department of Nephrology and Dialysis, Ospedale Parodi, Delfino, Colleferro, (Rome), Italy;Department of Nephrology and Dialysis, UOC Nefrologia, PO “A Landolfi”, Via Melito, snc, I-83029, Solofra, (AV), Italy;Department of Pharmacy, School of Pharmacy, University of Salerno, Fisciano, (SA), Italy;Dialysis, Sant’Angelo dei Lombardi, Avellino, Italy;

关键词: CKD;    Diabetes;    Metabolic acidosis;    Homa-test;    Sodium bicarbonate;   

DOI  :  10.1186/s12882-016-0372-x

 received in 2016-05-15, accepted in 2016-10-12,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundCorrection of metabolic acidosis (MA) with nutritional therapy or bicarbonate administration is widely used in chronic kidney disease (CKD) patients. However, it is unknown whether these interventions reduce insulin resistance (IR) in diabetic patients with CKD. We sought to evaluate the effect of MA correction on endogenous insulin action in diabetic type 2 (DM2) CKD patients.MethodsA total of 145 CKD subjects (83 men e 62 women) with DM2 treated with oral antidiabetic drugs were included in the study and followed up to 1 year. All patients were randomly assigned 1:1 to either open-label (A) oral bicarbonate to achieve serum bicarbonate levels of 24–28 mmol/L (treatment group) or (B) no treatment (control group). The Homeostatic model assessment (HOMA) index was used to evaluate IR at study inception and conclusion. Parametric and non-parametric tests as well as linear regression were used.ResultsAt baseline no differences in demographic and clinical characteristics between the two groups was observed. Average dose of bicarbonate in the treatment group was 0.7 ± 0.2 mmol/kg. Treated patients showed a better metabolic control as confirmed by lower insulin levels (13.4 ± 5.2 vs 19.9 ± 6.3; for treated and control subjects respectively; p < 0.001), Homa-IR (5.9[5.0-7.0] vs 6.3[5.3–8.2]; p = 0.01) and need for oral antidiabetic drugs. The serum bicarbonate and HOMA-IR relationship was non-linear and the largest HOMA-IR reduction was noted for serum bicarbonate levels between 24 and 28 mmol/l. Adjustment for confounders, suggests that serum bicarbonate rather than treatment drives the effect on HOMA-IR.ConclusionsSerum bicarbonate is related to IR and the largest HOMA-IR reduction is noted for serum bicarbonate between 24 and 28 mmol/l. Treatment with bicarbonate influences IR. However, changes in serum bicarbonate explains the effect of treatment on HOMA index. Future efforts are required to validate these results in diabetic and non-diabetic CKD patients.Trial registrationThe trial was registered at www.clinicaltrial.gov (Use of Bicarbonate in Chronic Renal Insufficiency (UBI) study - NCT01640119)

【 授权许可】

CC BY   
© The Author(s). 2016