Relation between Diet and Metabolic Acidosis in Chronic Dialysis Patients

Lee, Young Ki; Kwon, Young Joo; Kim, Nan Hee; Yoon, Jong Woo; Jo, Sang Kyung; We, Kyung So; Kim, Yong Seop; Cha, Dae Ryong; Cho, Won Yong; Pyo, Hee Jung; Kim, Hyoung Kyu; Hur, In Sun

Abstract

OBJECTIVES
It has been known that the incidence of protein malnutrition is high in patients with chronic renal failure(CRF). Although the effect of uremia on protein metabolism has not been known clearly, some reports suggest that metabolic acidosis, one of the uremic manifestations, increases protein catabolism. In a steady state, acid production is mainly related to dietary protein intake. Also severe acidosis causes anorexia and may decreases protein intake. But the relationship between diet and metabolic acidosis in chronic dialysis patients has not been established. In order to investigate the relation between metabolic acidosis and diet in CRF patients, we analyzed the diet intake and the nutritional status in chronic dialysis patients with or without severe metabolic acidosis.
METHODS
We selected 10 patients as an acidosis group (total CO2 < 14.0mEq/L) and 10 patients with acid-base balance as control group (total CO2 > 17.5mEq/L) among patients who have been receiving hemodialysis.
RESULTS
The mean ages and male to female ratios were similar in both groups, but in the underlying diseases of acidosis group, non-chronic glomerular nephritis (nonCGN) was more prevalent. Weekly hemodialysis time of the acidosis and the control group were 10.20, 11.45hours per week, respectively. The concentrations of pre-dialysis BUN were 89.74 vs. 71.25mg/dL and nPCR were 1.289 vs. 1.035g/kg/ day in each group.. However, the analysis of dietary protein intake showed no significant difference between both groups. The nutritional status of both groups were similar.
CONCLUSION
In CRF patients, metabolic acidosis increases protein catabolism by stimulated amino acid oxidation and protein degradation in muscle. This study therefore suggests that patients with metabolic acidosis need to receive more adequate dialysis to correct the acidosis. And we recommend the indivisualization of protein intakes rather than the indiscriminate protein restriction in CRF patients with metabolic acidosis.