Metabolic Acidosis Is an Independent Risk Factor of Renal Progression in Korean Chronic Kidney Disease Patients: The KNOW-CKD Study Results

Frontiers in Medicine

article

Hyo Jin Kim¹  Suah Sung³  Eun Young Seong¹  Curie Ahn⁴  Kook-Hwan Oh⁵  Hyunjin Ryu⁵  Eunjeong Kang⁷  Minjung Kang⁵  Miyeun Han⁸  Sang Heon Song¹  Joongyub Lee⁹  Ji Yong Jung^1,10  Kyu-Beck Lee^1,11 

[1] Department of Internal Medicine, Pusan National University Hospital;Biomedical Research Institute, Pusan National University Hospital;Department of Internal Medicine, Eulji Medical Center, Eulji University;Department of Internal Medicine, National Medical Center;Department of Internal Medicine, Seoul National University Hospital;Department of Internal Medicine, Seoul National University College of Medicine;Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine;Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital;Department of Preventive Medicine, Seoul National University College of Medicine;Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon;Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine

关键词: metabolic acidosis;    serum bicarbonate;    chronic kidney disease;    renal progression;    renal function decline;   

DOI  :  10.3389/fmed.2021.707588

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: We aimed to evaluate serum bicarbonate as a risk factor for renal progression, cardiovascular events, and mortality in Korean CKD patients. Methods: We analyzed 1,808 participants from a Korean CKD cohort whose serum bicarbonate levels were measured at enrollment. Serum bicarbonate levels were categorized as low, lower normal, higher normal, and high (total carbon dioxide <22, 22–26, 26.1–29.9, and ≥30 mmol/L, respectively) groups. Metabolic acidosis was defined as a serum bicarbonate level <22 mmol/L. The primary outcome was renal events defined as doubling of serum creatinine, 50% reduction of eGFR from the baseline values, or development of end-stage kidney disease. The secondary outcome consisted of cardiovascular events and death. In addition, patients whose eGFR values were measured more than three times during the follow-up period were analyzed for eGFR decline. The rapid decline in eGFR was defined as lower than the median value of the eGFR slope. Results: The mean serum bicarbonate level was 25.7 ± 3.7 mmol/L and 240 (13.2%) patients had metabolic acidosis. During the follow-up period of 55.2 ± 24.1 months, 545 (30.9%) patients developed renal events and 187 (10.6%) patients developed a composite of cardiovascular events and death. After adjustment, the low serum bicarbonate group experienced 1.27 times more renal events than the lower normal bicarbonate group [hazard ratio (HR): 1.27; 95% CI: 1.01–1.60, P = 0.043]. There was no significant association between the bicarbonate groups and the composite outcome of cardiovascular events and death. The low bicarbonate group showed a significantly rapid decline in eGFR [odds ratio (OR): 2.12; 95% CI: 1.39–3.22, P < 0.001] compared to the lower normal bicarbonate group. Conclusions: Metabolic acidosis was significantly associated with increased renal events and a rapid decline in renal function in Korean predialysis CKD patients.

【 授权许可】

CC BY