Effect | Comment |
---|---|
Muscle wasting | Seen with even mild metabolic acidosis (important factor in causing muscle wasting in patients with CKD) |
Reduced albumin synthesis | Acidosis is one of many factors contributing to hypoalbuminemia in patients with CKD |
Bone disease | Acidosis contributes to the genesis of bone disease by diverse mechanisms; contributory rather than primary mechanism in producing bone disease |
Direct effects | |
• Physicochemical dissolution of bone• Decreased function of osteoblast | |
• Increased function of osteoclast | |
Indirect effects | |
• Increased release of parathyroid hormone | |
• Increased number of parathyroid hormone receptors | |
• Increased binding of parathyroid hormone to its receptor | |
• Decreased activity of 1-a hydroxylase | |
Impaired insulin sensitivity | Effect unclear given the impact of changes in insulin metabolism with renal failure; could induce metabolic changes similar to those seen in syndrome X* |
B2-Microglobulin accumulation | Found with studies of acetate v bicarbonate dialysis in dialysis patients; no studies of patients with CKD not on dialysis therapy |
Exacerbation of renal failure | Data for and against role of acidosis in progression of renal failure |
Impaired thyroid metabolism | May contribute to abnormalities in basal metabolic rate |
Stunted growth in children | Reversed in part by correction of acidosis |
Cardiac disease | Role in the development of cardiac disease is theoretical, not proven |
Increased inflammation | Conflicting evidence for and against the role of acidosis in dialysis patients |