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

Frontiers in Medicine

Curie Ahn¹  Kook-Hwan Oh²  Sang Heon Song³  Hyo Jin Kim³  Eun Young Seong³  Suah Sung⁴  Eunjeong Kang⁵  Ji Yong Jung⁶  Miyeun Han⁷  Kyu-Beck Lee⁸  Hyunjin Ryu^1,10  Minjung Kang^1,10  Joongyub Lee^1,11 

[1] 0Department of Internal Medicine, National Medical Center, Seoul, South Korea;1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea;Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea;Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, South Korea;Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea;Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea;Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, South Korea;Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;Department of Internal Medicine, Pusan National University Hospital, Busan, South Korea;Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea;Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea;

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

DOI  :  10.3389/fmed.2021.707588

来源: DOAJ

【 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】

Unknown