Equilibrio ácido base en el adulto mayor

Contenido principal del artículo

Jesús Salvador Sánchez-Díaz
Enrique Antonio Martínez-Rodríguez
Karla Gabriela Peniche-Moguel
Enrique Monares-Zepeda
Luis Del Carpio-Orantes
Orlando Rubén Nieto-Pérez
Eder Iván Zamarrón-López
María Verónica Calyeca-Sánchez

Resumen

El envejecimiento es un proceso fisiológico caracterizado por el deterioro progresivo de las funciones orgánicas, en el que la capacidad de adaptación y la respuesta a una situación de estrés se encuentra reducida. Las alteraciones en el equilibrio ácido-base representan un hito poco comprendido en el adulto mayor, los efectos per se a edad avanzada en órganos como el hígado, pulmón y riñón, asociados al consumo de polifarmacia, representan la causa de estas alteraciones. Se realizó una revisión no sistemática de la literatura por medio de las bases de datos PubMed y los portales SciELO y SpringerLink. Para integrar la presente revisión y análisis, se identificaron aquellos estudios científicos que proponían explicar los cambios renales y pulmonares asociados a la edad, y con efecto en la homeostasis ácido-base.

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1.
Sánchez-Díaz JS, Martínez-Rodríguez EA, Peniche-Moguel KG, Monares-Zepeda E, Del Carpio-Orantes L, Nieto-Pérez OR, Zamarrón-López EI, Calyeca-Sánchez MV. Equilibrio ácido base en el adulto mayor. Rev Nefrol Dial Traspl. [Internet]. 20 de septiembre de 2019 [citado 20 de octubre de 2021];39(3):213-2. Disponible en: https://www.revistarenal.org.ar/index.php/rndt/article/view/469
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1) Schmucker DL. Age-related changes in liver structure and function: Implications for disease? Exp Gerontol. 2005;40(8):650-9.

2) Sánchez-Díaz JS, Monares-Zepeda E, Meneses-Olguín C, Rodríguez-Martínez EA, García-Méndez RC, Peniche-Moguel KG, et al. Soluciones balanceadas: cloro el “nuevo villano”. Med Crit. 2017;31(3):152-8.

3) Epstein M. Aging and the kidney. J Am Soc Nephrol. 1996;7(8):1106-22.

4) Andreucci VE, Russo D, Cianciaruso B, Andreucci M. Some sodium, potassium and water changes is the elderly and their treatment. Nephrol Dial Transplant. 1996;11(Suppl 9):9-17.

5) Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis. Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412-23.

6) Martin JE, Sheaff MT. Renal ageing. J Pathol. 2007;211(2):198-205.

7) Tian Y, Riazi S, Khan O, Klein JD, Sugimura Y, Verbalis JG, et al. Renal ENaC subunit, Na-K-2Cl and Na-Cl cotransporter abundances in aged, water-restricted F344 x Brown Norway rats. Kidney Int. 2006;69(2):304-12.

8) Eiam-Ong S, Eiam-Ong S, Sabatini S. Effects of aging and potassium depletion on renal collecting tubule K+‐controlling ATPases. Nephrology (Carlton). 2002;7(2):87-91.

9) Frassetto LA, Morris RC Jr, Sebastian A. Effect of age on blood acid-base composition in adult humans: role of age-related renal functional decline. Am J Physiol. 1996;271(6 Pt 2):F1114-22.

10) Britton A, Shipley M, Singh-Manoux A, Marmot MG. Successful aging: the contribution of early-life and midlife risk factors. J Am Geriatr Soc. 2008;56(6):1098-105.

11) Havlín J, Schück O, Charvat J, Slaby K, Horackova M, Klaboch J, et al. Acid-base disorders associated with serum electrolyte patterns in patients on hemodiafiltration. Nephrol Ther. 2015;11(7):551-7.

12) Sánchez-Díaz JS, Meneses-Olguín C, Monares-Zepeda E, Torres-Gómez A, Aguirre-Sánchez J, Franco-Granillo J. La diferencia de iones fuertes (DIF) calculada por el método de Fencl-Stewart simplificado es un predictor de mortalidad en pacientes con choque séptico. Arch Med Urgenc Méx. 2014;6(1):5-11.

13) Adrogué HJ, Gennari FJ, Galla JH, Madias NE. Assessing acid-base disorders. Kidney Int. 2009;76(12):1239-47.

14) Sánchez-Díaz JS, Monares-Zepeda E, Meneses-Olguín C, Rodríguez-Martínez EA, García-Méndez RC, Peniche-Moguel KG, et al. Soluciones balanceadas: cloro el “nuevo villano”. Med Crit. 2017;31(3):152-8.

15) Cortés-Román JS, Sánchez-Díaz JS, García-Méndez RC, Martínez-Rodríguez EA, Peniche-Moguel KG, Díaz-Gutiérrez SP, et al. Diferencia sodio-cloro e índice cloro/sodio como predictores de mortalidad en choque séptico. Med Int Méx. 2017;33(3):335-43.

16) Klaestrup E, Trydal T, Pedersen JF, Larsen JM, Lundbye-Christensen S, Kristensen SR. Reference intervals and age and gerder dependency for arterial blood gases and electrolytes in adults. Clin Chem Lab Med. 2011;49(9):1495-500.

17) Peñasco Y, González-Castro A, Rodríguez-Borregán JC, Llorca J. Base excess, a useful marker in the prognosis of chest trauma in the geriatric population. Rev Esp Anestesiol Reanim. 2017;64(5):250-6.

18) Frassetto L, Morris RC Jr, Sellmeyer DE, Todd K, Sebastian A. Diet, evolution and aging-the pathophysiologic effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet. Eur J Nutr. 2001;40(5):200-13.

19) Hilton JG, Goodbody MF Jr, Kruesi OR. The effect of prolonged administration of ammonium chloride on the blood acid-base equilibrium of geriatric subjects. J Am Geriatr Soc. 1955;3(9):697-703.

20) Frassetto L, Sebastian A. Age and Systemic Acid-Base Equilibrium: Analysis of Published Data. J Gerontol A Biol Sci Med Sci. 1996;51(1):B91-9.

21) Goldenstein L, Driver TH, Fried LF, Rifkin DE, Patel KV, Yenchek RH, et al. Serum bicarbonate concentrations and kidney disease progression in community-living elders: the Health, Aging, and Body Composition (Health ABC) Study. Am J Kidney Dis. 2014;64(4):542-9.

22) Manz F. History of nutrition and acid-base physiology. Eur J Nutr. 2001;40(5):189-99.

23) Goraya N, Simoni J, Jo CH, Wesson DE. A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate. Clin J Am Soc Nephrol. 2013;8(3):371-81.

24) Rylander R, Remer T, Berkemeyer S, Vormann J. Acid-Base Status Affects Renal Magnesium Losses in Healthy, Elderly Persons. J Nutr. 2006;136(9):2374-7.

25) Adeva-Andany MM, Fernández-Fernández C, Mouriño-Bayolo D, Castro-Quintela E, Domínguez-Montero A. Sodium bicarbonate therapy in patients with metabolic acidosis. ScientificWorldJournal. 2014;2014:627673.

26) Workeneb BT, Mitch WE. Review of muscle wasting associated with chronic kidney disease. Am J Clin Nutr. 2010;91(4):1128S-32S.

27) Wesson DE, Simoni J. Increased tissue acid mediates a progressive decline in the glomerular filtration rate of animals with reduced nephron mass. Kidney Int. 2009;75(9):929-35.

28) Ng HY, Chen HC, Tsai YC, Yang YK, Lee CT. Activation of intrarenal renin-angiotensin system during metabolic acidosis. Am J Nephrol. 2011;34(1):55-63.

29) Wiederkehr MR, Kalogiros J, Krapf R. Correction of metabolic acidosis improves thyroid and growth hormone axes in haemodialysis patients. Nephrol Dial Transplant. 2004;19(5):1190-7.

30) Reaich D, Graham KA, Channon SM, Hetherington C, Scrimgeour CM, Wilkinson R, et al. Insulin-mediated changes in PD and glucosa uptake after correction of acidosis in humans with CRF. Am J Physiol. 1995;268(1 Pt 1):E121-6.

31) Ballmer PE, McNurlan MA, Hulter HN, Anderson SE, Garlick PJ, Krapf R. Chronic metabolic acidosis decreases albumin synthesis and induces negative nitrogen balance in humans. J Clin Invest. 1995;95(1):39-45.

32) Movili E, Zani R, Carli O, Sangalli L, Pola A, Camerini C, et al. Correction of metabolic acidosis increases serum albumin concentrations and decreases kinetically evaluated protein intake in haemodialysis patients: a prospective study. Nephrol Dial Transplant. 1998;13(7):1719-22.

33) Kraut JA, Kurtz I. Metabolic acidosis of CKD: diagnosis, clinical characteristics, and treatment. Am J Kidney Dis. 2005;45(6):978-93.

34) Yenchek R, Ix JH, Rifkin DE, Shlipak MG, Sarnak MJ, García M, et al. Association of serum bicarbonate with incident functional limitation in older adults. Clin J Am Soc Nephrol. 2014;9(12):2111-6.

35) Klaboch J, Opatrná S, Matousovic K, Sefrna F, Havlín J, Schück O. Acid-base balance in peritoneal dialysis patients: a Stewart-Fencl análisis. Ren Fail. 2009;31(8):625-32.

36) Hsu CY, Chertow GM. Elevations of serum phosphorus and potassium in mild to moderate chronic renal insufficiency. Nephrol Dial Transplant. 2002;17(8):1419-25.

37) Abramowitz MK, Hostetter TH, Melamed ML. The serum anion gap is altered in early kidney disease and associates with mortality. Kidney Int. 2012;82(6):701-9.

38) Raphael KL, Murphy RA, Shlipak MG, Satterfield S, Huston HK, Sebastian A, et al. Bicarbonate Concentration, Acid-Base Status, and Mortality in the Health, Aging, and Body Composition Study. Clin J Am Soc Nephrol. 2016;11(2):308-16.

39) Jiménez JV, Carrillo-Pérez DL, Rosado-Canto R, García-Juárez I, Torre A, Kershenobich D, et al. Electrolyte and acid-base disturbances in end-stage liver disease: a physiopathological approach. Dig Dis Sci. 2017;62(8):1855-71.

40) Sotirakopoulos N, Kalogiannidou I, Tersi M, Armentzioiou K, Sivridis D, Mavromatidis K. Acid-base and electrolyte disorders in patients with diabetes mellitus. Saudi J Kidney Dis Transpl. 2012;23(1):58-62.

41) Sánchez-Díaz JS, Monares-Zepeda E, Martínez-Rodríguez EA, Cortés-Román JS, Torres-Aguilar O, Peniche-Moguel KG, et al. Metformin-related lactic acidosis: Case report. Rev Colomb Anestesiol. 2017;45(4):353-9.

42) Khow KS, Lau SY, Li JY, Yong TY. Diuretic-associated electrolyte disorders in the elderly: risk factors, impact, management and prevention. Curr Drug Saf. 2014;9(1):2-15.

43) Raphael KL, Zhang Y, Ying J, Greene T. Prevalence of and risk factors for reduced serum bicarbonate in chronic kidney disease. Nephrology (Carlton). 2014;19(10):648:54.

44) de Brito-Ashurst I, Varagunam M, Raftery MJ, Yaqoob MM. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol. 2009;20(9):2075-84.

45) Löfberg E, Gutierrez A, Anderstam B, Wernerman J, Bergström J, Price SR, et al. Effect of bicarbonate on muscle protein in patients receiving hemodialysis. Am J Kidney Dis. 2006;48(3):419-29.

46) Mathur RP, Dash SC, Gupta N, Prakash S, Saxena S, Bhowmik D. Effects of correction of metabolic acidosis on blood urea and bone metabolism in patients with mild to moderate chronic kidney disease: A prospective randomized single blind controlled trial. Ren Fail. 2006;28(1):1-5.

47) Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010;362(7):590-9.

48) Withham MD, Band MM, Littleford RC, Avenell A, Soiza RL, McMurdo ME, et al. Does oral sodium bicarbonate therapy improve function and quality of life in older patients with chronic kidney disease and low-grade acidosis (the BiCARB trial)? Study protocol for a randomized controlled trial. Trials. 2015;16:326.

49) Amodu A, Abramowitz MK. Dietary acid, age, and serum bicarbonate levels among adults in the United States. Clin J Am Soc Nephrol. 2013;8(12):2034-42.

50) Goraya N, Simoni J, Jo C, Wesson DE. Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertenvie nephropathy. Kidney Int. 2012;81(1):86-93.

51) Doberer D, Funk GC, Kirchner K, Schneeweiss B. A critique of Stewart’s approach: the chemical mechanism of dilutional acidosis. Intensive Care Med. 2009;35(12):2173-80.

52) Peixoto AJ, Alpern RJ. Treatment of severe metabolic alkalosis in a patient with congestive heart failure. Am J Kidney Dis. 2013;61(5):822-7.

53) Shirakabe A, Hata N, Kobayashi N, Shinada T, Tomita K, Tsurumi M, et al. Clinical significance of acid-base balance in an emergency setting in patients with acute heart failure. J Cardiol. 2012;60(4):288-94.

54) Story DA, Poustie S, Bellomo R. Estimating unmeasured anions in critically ill patients: anion-gap, base-deficit, and strong-ion-gap. Anaesthesia. 2002;57(11):1109-14.

55) Tareen N, Zadshir A, Martins D, Nagami G, Levine B, Norris KC. Alterations in Acid-Base Homeostasis with Aging. J Natl Med Assoc. 2004;96(7):921-5.

56) de Solis AJ, González-Pacheco FR, Deudero JJ, Neria F, Albalate M, Petkov V, et al. Alkalinization potentiates vascular calcium deposition in an uremic milieu. J Nephrol. 2009;22(5):647-53.

57) Vaz Fragoso CA, Gill TM. Respiratory impairment and the aging: a novel paradigm for assessing pulmonary function. J Gerontol A Biol Sci Med Sci. 2012;67(3):264-75.

58) Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. 2006;1(3):253-60.

59) Sprung J, Gajic O, Warner DO. Review article: age related alterations in respiratory function - anesthesic considerations. Can J Anaesth. 2006;53(12):1244-57.

60) McQuillan BM, Picard MH, Leavitt M, Weyman AE. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation. 2001;104(23):2797-802.

61) Janssens JP. Aging of the respiratory system: impact on pulmonary function test and adaptation to exertion. Clin Chest Med. 2005;26(3):469-84.

62) Korkushko OV, Ivanov LA, Pisurak AV, Chebotarev ND. The respiratory function of blood in elderly and old age and the factors that determine it. Hum Physiol. 2009;35(2):163-9.

63) ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211-77.

64) Vázquez-García JC, Pérez-Padilla R. Valores gasométricos estimados para las principales poblaciones y sitios a mayor altitud en México. Rev Inst Nal Enf Resp Mex. 2000;13(1):6-13.

65) Bruno CM, Valenti M. Acid-base disorders in patients with chronic obstructive pulmonary disease: a pathophysiological review. J Biomed Biotechnol. 2012;2012:915150.

66) Warren PM, Flenley DC, Millar JS, Avery A. Respiratory failure revisited: acute exacerbations of chronic bronchitis between 1961-68 and 1970-76. Lancet. 1980;1(8166):467-70.

67) Incalzi RA, Corsonello A, Pedone C, Battaglia S, Paglino G, Bellia V, et al. Chronic renal failure: a neglected comorbidity of COPD. Chest. 2010;137(4):831-7.

68) Butnoriene J, Bunevicius A, Saudargiene A, Nemeroff CB, Norkus A, Ciceniene V, et al. Metabolic syndrome, major depression, generalized anxiety disorder, and ten-year all-cause and cardiovascular mortality in middle aged and elderly patients. Int J Cardiol. 2015;190:360-6.

69) Sánchez-Díaz JS, Martínez-Rodríguez EA, Peniche-Moguel KG, Díaz-Gutiérrez SP, Pin-Gutiérrez E, Cortés-Román JS, et al. Interpretación de gasometrías: solo tres pasos, solo tres fórmulas. Med Crit. 2018;32(3):156-9.