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S\u00e4ureretention und metabolische Azidose (MA) sind h\u00e4ufige Komplikationen bei chronischer Nierenkrankheit (\u201echronic kidney disease\u201c [CKD]) und treten auch nach Nierentransplantation auf. Neben di\u00e4tetischen Ma\u00dfnahmen kommen medikament\u00f6se Therapien zur Azidosekorrektur zum Einsatz, mit Natrium(hydrogen)karbonat als am h\u00e4ufigsten eingesetzter Substanz. Mehrere Studien konnten einen positiven Effekt einer Azidosekorrektur auf die CKD-Progression aufzeigen. Die Studienresultate sind jedoch nicht einheitlich und es ist von eher kleineren Behandlungseffekten auszugehen. Nach Nierentransplantation konnte bisher keine positive Wirkung auf die Transplantatfunktion nachgewiesen werden. Die MA ist mit einer eingeschr\u00e4nkten Knochenqualit\u00e4t assoziiert, wobei Alkaliinterventionsstudien bislang einen positiven Effekt auf Marker des Knochenstoffwechsels, nicht jedoch auf die Knochendichte gezeigt haben. Die MA ist mit einer erh\u00f6hten kardiovaskul\u00e4ren Ereignisrate assoziiert, Interventionsstudien mit harten kardiovaskul\u00e4ren Endpunkten fehlen jedoch bis dato. Eine Interventionsstudie mit jedoch wesentlichen Limitationen konnte einen positiven Effekt einer Alkalitherapie auf die Mortalit\u00e4t zeigen. Eine Azidosekorrektur scheint sich positiv auf den Protein- und Muskelkatabolismus auszuwirken, wobei eine Verbesserung der k\u00f6rperlichen Leistungsf\u00e4higkeit in einer geriatrischen Population nicht gezeigt werden konnte. Bez\u00fcglich der endokrinologischen Effekte einer Alkalitherapie existieren nur sehr wenige Studien. Hier zeigten sich ein g\u00fcnstiger Effekt auf den Glukosestoffwechsel und ein m\u00f6glicher Nutzen in Bezug auf die Schilddr\u00fcsenfunktion bei pr\u00e4dialytischen Patienten mit CKD. Aufgrund der insgesamt eher geringen bis moderaten Evidenz f\u00fcr den Nutzen einer Alkalitherapie sowie angesichts der teilweise widerspr\u00fcchlichen Studienlage wird in den aktualisierten Leitlinien von Kidney Disease: Improving Global Outcomes (KDIGO) die Empfehlung f\u00fcr Erwachsene abgeschw\u00e4cht und eine Alkalibehandlung vorgeschlagen, um ein Serumbikarbonat &lt;\u202f18\u202fmmol\/l (bislang &lt;\u202f22\u202fmmol\/l) und die damit verbundenen Komplikationen zu vermeiden.<\/jats:p>","DOI":"10.1007\/s00108-024-01806-z","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T12:17:27Z","timestamp":1731068247000},"page":"1209-1215","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Was ist gesichert in der Therapie der metabolischen Azidose bei chronischer Nierenkrankheit?","What is confirmed in the treatment of metabolic acidosis in chronic kidney disease?"],"prefix":"10.1007","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9049-0765","authenticated-orcid":false,"given":"Alexander","family":"Ritter","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1346-3429","authenticated-orcid":false,"given":"Christian","family":"Kuhn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8229-9733","authenticated-orcid":false,"given":"Nilufar","family":"Mohebbi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,11,8]]},"reference":[{"key":"1806_CR1","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1186\/s12882-016-0372-x","volume":"17","author":"A Bellasi","year":"2016","unstructured":"Bellasi\u00a0A, Di Micco\u00a0L, Santoro\u00a0D et\u00a0al (2016) Correction of metabolic acidosis improves insulin resistance in chronic kidney disease. 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