Modulation of the Association of Hypobicarbonatemia and Incident Kidney Failure With Replacement Therapy by Venous pH: A Cohort Study

Kajimoto, Shinji; Sakaguchi, Yusuke; Asahina, Yuta; Kaimori, Jun-Ya; Isaka, Yoshitaka

doi:10.1053/j.ajkd.2020.06.019

Cited by 20 publications

(17 citation statements)

References 38 publications

(45 reference statements)

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“…Continued proton accumulation and impaired bicarbonate production eventually leads to low serum bicarbonate concentration, but low serum bicarbonate is not always accompanied by low systemic pH in patients with CKD. 1 Hence, there is a spectrum of metabolic acidosis in CKD extending from eubicarbonatemic metabolic acidosis to an acid state characterized by low bicarbonate and acidemia ( Figure 1). There is a theoretical direct association between severity of the acid state and risk of poor clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Metabolic Acidosis in CKD: A Review of Recent Findings

Melamed

Raphael

2021

Kidney Medicine

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Introductionmentioning

confidence: 99%

Metabolic Acidosis in CKD: A Review of Recent Findings

Melamed

Raphael

2021

Kidney Medicine

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“…À levels that associate with disease risks and serum pH might influence the association between serum HCO 3 À , renal failure and other disease risks [12]. As discussed below, such an analysis is also missing for the association between HCO 3 À levels and cognitive dysfunction.…”

Section: Metabolic Acidosis In Patients With Ckdmentioning

confidence: 99%

Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Silva

Unwin

Hoorn

et al. 2021

Nephrology Dialysis Transplantation

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Metabolic acidosis, defined as a plasma or serum bicarbonate concentration <22 mmol/L, is a frequent consequence of chronic kidney disease (CKD) and occurs in ~10-30% of patients with advanced stages of CKD. Likewise, in patients with a kidney transplant, prevalence rates of metabolic acidosis range from 20% to 50%. CKD has recently been associated with cognitive dysfunction, including mild cognitive impairment with memory and attention deficits, reduced executive functions and morphological damage detectable with imaging. Also, impaired motor functions and loss of muscle strength are often found in patients with advanced CKD, which in part may be attributed to altered central nervous system (CNS) functions. While the exact mechanisms of how CKD may cause cognitive dysfunction and reduced motor functions are still debated, recent data point towards the possibility that acidosis is one modifiable contributor to cognitive dysfunction. This review summarizes recent evidence for an association between acidosis and cognitive dysfunction in patients with CKD and discusses potential mechanisms by which acidosis may impact CNS functions. The review also identifies important open questions to be answered to improve prevention and therapy of cognitive dysfunction in the setting of metabolic acidosis in patients with CKD.

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“…However, a recent retrospective study of patients with CKD (n = 1,058; baseline estimated GFR [eGFR] < 60 mL/min/1.73 m 2 ) casts doubt on this assumption. 31 At baseline, only 59% of patients in the lowest serum [HCO 3ˉ] quartile (≤21.5 mEq/L) were acidemic (pH < 7.32 by venous blood gas), whereas 38% were normohydric (pH 7.32-7.42) and 3% were alkalemic (pH > 7.42). The latter 2 groups presumably reflected metabolic acidosis with increased ventilatory adaptation and respiratory alkalosis.…”

Section: Classic Concept Of the Metabolic Acidosis Of Ckdmentioning

confidence: 97%

“…The study has several limitations and confirmatory work is required. 31 , 32 Nonetheless, it introduces the plausible concept that measurement of blood pH might be needed for risk stratification of hypobicarbonatemic patients with CKD.…”

Section: Classic Concept Of the Metabolic Acidosis Of Ckdmentioning

confidence: 99%

“…Limited data suggest that of such hypobicarbonatemic patients, only a relatively small fraction is being treated with alkali (2.7%, 6%-10%, and 24.4% in 3 studies). 31 , 36 , 37 , 38 This degree of poor following of the guideline is notable given that base therapy, mainly sodium bicarbonate (NaHCO 3 ), is an effective, low-cost, and largely safe therapy. 1 , 2 , 3 , 10 The substantial variance in the normal range of serum [HCO 3 ˉ] prevailing among laboratories likely undermines adherence to the guideline.…”

Section: Classic Concept Of the Metabolic Acidosis Of Ckdmentioning

confidence: 99%

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Eubicarbonatemic Hydrogen Ion Retention and CKD Progression

Madias

2021

Kidney Medicine

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Small-scale trials in patients with chronic kidney disease (CKD) 3-5 have shown that hypobicarbonatemic metabolic acidosis promotes progression of CKD. Accordingly, the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline suggests base administration to patients with CKD when serum bicarbonate concentration ([HCO 3ˉ] ) is <22 mEq/L (~15% of non--dialysis-dependent patients with CKD). However, individuals with milder CKD largely maintain serum [HCO 3ˉ] within the normal range (eubicarbonatemia) and yet can manifest hydrogen ion (H + ) retention. Limited data in eubicarbonatemic patients with CKD 2 suggest that base administration ameliorates CKD progression. Furthermore, most patients with moderate and advanced CKD maintain a normal serum [HCO 3ˉ] , and of those, the vast majority most likely harbor masked H + retention. The present review probes this expanded concept of metabolic acidosis of CKD: the eubicarbonatemic H + retention or subclinical metabolic acidosis of CKD. It focuses on the high prevalence of the entity, its pathophysiologic features, its clinical course, and recent work on potential biomarkers of the condition. Further, it puts forward the urgent task of investigating definitively whether treatment with alkali of eubicarbonatemic H + retention delays CKD progression. If proven true, such knowledge would trigger a paradigm shift in the indication for alkali therapy in CKD.Complete author and article information provided before references.

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Modulation of the Association of Hypobicarbonatemia and Incident Kidney Failure With Replacement Therapy by Venous pH: A Cohort Study

Cited by 20 publications

References 38 publications

Metabolic Acidosis in CKD: A Review of Recent Findings

Metabolic Acidosis in CKD: A Review of Recent Findings

Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Eubicarbonatemic Hydrogen Ion Retention and CKD Progression

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