Amelioration of metabolic acidosis in patients with low GFR reduced kidney endothelin production and kidney injury, and better preserved GFR

Sorot Phisitkul, Apurv Khanna, Jan Simoni, Kristine Broglio, Simon Sheather, M. Hasan Rajab, Donald E. Wesson

Research output: Contribution to journalArticlepeer-review

224 Scopus citations

Abstract

Metabolic acidosis often accompanies low glomerular filtration rate and induces secretion of endothelin, which in turn might mediate kidney injury. Here we tested whether treatment of metabolic acidosis in patients with low glomerular filtration rate reduced the progression of kidney disease. Fifty-nine patients with hypertensive nephropathy and metabolic acidosis had their blood pressure reduced with regimens that included angiotensin-converting enzyme inhibition. Thirty patients were then prescribed sodium citrate, and the remaining 29, unable or unwilling to take sodium citrate, served as controls. All were followed for 24 months with maintenance of their blood pressure reduction. Urine endothelin-1 excretion, a surrogate of kidney endothelin production, and N-acetyl-Β-D-glucosaminidase, a marker of kidney tubulointerstitial injury, were each significantly lower, while the rate of estimated glomerular filtration rate decline was significantly slower. The estimated glomerular filtration rate was statistically higher after 24 months of sodium citrate treatment compared to the control group. Hence it appears that sodium citrate is an effective kidney-protective adjunct to blood pressure reduction and angiotensin-converting enzyme inhibition.

Original languageEnglish
Pages (from-to)617-623
Number of pages7
JournalKidney International
Volume77
Issue number7
DOIs
StatePublished - Apr 2010

Bibliographical note

Funding Information:
We thank the nursing and clerical staff of the Internal Medicine Clinic of the Department of Internal Medicine at Texas Tech University Health Sciences Center for their assistance. This work was supported by funds from the Larry and Jane Woirhaye Memorial Endowment in Renal Research at the Texas Tech University Health Sciences Center.

Keywords

  • Blood pressure
  • CKD
  • GFR
  • Na citrate
  • Tubulointerstitial injury

ASJC Scopus subject areas

  • Nephrology

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