「代謝性アシドーシスを伴うCKD患者への 重曹投与は

1 jhospitalist network CKD . CKD . Bicarbonate Supplementation Slows Progression of CKD. and Improves Nutritional Status 2016 5 2 .. 80 . 10 . K ) . ARB eGFR .. 2 . CKD). 5mg 15mg 1mg . 155cm 58kg 150/86mmHg 60bpm . III IV . fine crackles wheeze .. WBC 6500/ l Hb Plt 24 / l BUN 28mg/dl Cr eGFR 25. Na139mmol/l K Cl 111mmol/l HCO3- 18mmol/l glucose 180mg/dl HbA1C Xp .. CKD .. EBM 5 steps Step1 PICO . Step2 . Step3 . Step4 . Step5 Step1-4 . EBM 5 steps Step1 PICO . Step2 . Step3 . Step4 . Step5 Step1-4 . Step1 PICO. Patient .. CKD . Intervention NaHCO3) . Comparison . Outcome .. EBM 5 steps Step1 PICO . Step2 . Step3 . Step4 . Step5 Step1-4 . Step2 . UpToDate CKD .. Pathogenesis, consequences, and treatment of metabolic acidosis in chronic kidney disease . TREATMENT OF METABOLIC ACIDOSIS IN CKD . Evidence supporting bicarbonate therapy - Slowing of CKD progression . J Am Soc Nephrol. 2009 Sep;20(9):2075-84. PMID: 19608703.. EBM 5 steps Step1 PICO.

2 Step2 . Step3 . Step4 . Step5 Step1-4 .. Calcium citrate ameliorates the progression of chronic renal injury. Kidney international (2004): 1224-1230.. Oral Sodium Bicarbonate Reduces Proximal Renal Tubular Peptide Catabolism, Ammoniogenesis, and Tubular Damage in Renal Patients Renal Failure Volume 20, Issue 2, 1998.. "The effect of metabolic acidosis on the rate of decline of glomerular filtration rate in patients with stage 4 CKD.". Abstract presented at the World Congress nephrology. 2005.. CKD .. PICO. P : . Stage4-5 CKD . I : . C : . O : . CKD . ESRD . ESRD : end stage renal disease . PICO . Inclusion criteria 18 . Stage4-5 CKD . (CrCl<29ml/ ). HCO3- 16~20mmol/L.. Exclusion criteria .. chronic sepsis . 4 150/90mmHg ).. Intervention 1 600mg 1 3 . 2 HCO3- . HCO3- 23mmol/L .. Comparison . J Am Soc Nephrol. 2009 Sep;20(9):2075-84. Outcome . CKD . ESRD . CKD : CrCl 3ml/ . ESRD : CrCl <10ml/min . CrCl<10ml/ K .. CrCl>10 . Secondary outcome.

3 Informed consent . Step3 .. Step3 .. (concealment) . =base line .. ( ).. Intention to treat .. (concealment) . concealment .. =base line similar ). J Am Soc Nephrol. 2009 Sep;20(9):2075-84.. 5 .. 93 . 100 . J Am Soc Nephrol. 2009 Sep;20(9):2075-84.. Intention to treat . Intention to treat .. 2 . Step3 .. RRR ARR NNT .. 95%CI .. RRR ARR NNT . RR.. CrCl (95%CI (95%CI CrCl ) ) . CKD 9 45 95% CI . ). P< ESRD 4 22 33 95% CI . ). P< . RRR ARR NNT . ESRD . RRR =100-13. 87% (95%CI 60~96%). ARR = (95%CI 5~33%). ARR 95%CI . calculator .. culators/statscalc NNT = 100 ( ~20). Kaplan-Meier 2 . J Am Soc Nephrol. 2009 Sep;20(9):2075-84. 1 .. RRR ARR NNT . 2 100 . 60 . 96 . RRR. 5 . 33 . ARR. 3 . 2 1 . 20 . 2 1 NNT. EBM 5 steps Step1 PICO . Step2 . Step3 . Step4 . Step5 Step1-4 .. 150 exclusion criteria .. Bicarbonate . Black/Asian 50 Asian . J Am Soc Nephrol. 2009 Sep;20(9):2075-84.. 1/3 .. CKD . ESRD . CrCl .. 61 48 P= 0 .. 39 30 P= .. Na .. 500mg 1 . 600mg 3 500mg 1 4.

4 4 / 1 6352 /2 .. EBM 5 steps Step1 PICO . Step2 . Step3 . Step4 . Step5 Step1-4 . Step5 1-4 .. CKD .. 500mg 2 / .. 4-6.