Adjusted Anion Gap Is Associated with Glomerular Filtration Rate Decline in Chronic Kidney Disease

Togawa, Akashi; Uyama, Satoko; Takanohashi, Seiko; Shimasaki, Megumi; Miyaji, Toru; Endo, Hiroyuki; Fujigaki, Yoshihide

doi:10.1159/000356461

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…In contrast, we adopted an equation for albumin-adjustment with a range similar to the usual reference [ 16 ], and hence more easily applicable. Togawa et al also analyzed 42 patients with advance CKD (eGFR 7.1–52.0 mL/min/1.73vm 2 ) for the association between A-SAG and CKD progression [ 13 ]. Although they suggested that A-SAG was significantly associated with delta eGFR/6 months in multiple linear regression (beta 0.45, P < 0.01), they did not evaluate the association with mortality.…”

Section: Discussionmentioning

confidence: 99%

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Serum Anion Gap Predicts All-Cause Mortality in Patients with Advanced Chronic Kidney Disease: A Retrospective Analysis of a Randomized Controlled Study

Lee

Kim

et al. 2016

PLoS ONE

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Background and ObjectivesCardiovascular outcomes and mortality rates are poor in advanced chronic kidney disease (CKD) patients. Novel risk factors related to clinical outcomes should be identified.MethodsA retrospective analysis of data from a randomized controlled study was performed in 440 CKD patients aged > 18 years, with estimated glomerular filtration rate 15–60 mL/min/1.73m2. Clinical data were available, and the albumin-adjusted serum anion gap (A-SAG) could be calculated. The outcome analyzed was all-cause mortality.ResultsOf 440 participants, the median (interquartile range, IQR) follow-up duration was 5.1 (3.0–5.5) years. During the follow-up duration, 29 participants died (all-cause mortality 6.6%). The area under the receiver operating characteristic curve of A-SAG for all-cause mortality was 0.616 (95% CI 0.520–0.712, P = 0.037). The best threshold of A-SAG for all-cause mortality was 9.48 mmol/L, with sensitivity 0.793 and specificity 0.431. After adjusting for confounders, A-SAG above 9.48 mmol/L was independently associated with increased risk of all-cause mortality, with hazard ratio 2.968 (95% CI 1.143–7.708, P = 0.025). In our study, serum levels of beta-2 microglobulin and blood urea nitrogen (BUN) were positively associated with A-SAG.ConclusionsA-SAG is an independent risk factor for all-cause mortality in advanced CKD patients. The positive correlation between A-SAG and serum beta-2 microglobulin or BUN might be a potential reason. Future study is needed.Trial RegistrationClinicaltrials.gov NCT 00860431

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Section: Discussionmentioning

confidence: 99%

“…SAG is elevated and related to mortality even in early kidney disease [ 12 ], and high SAG is associated with CKD progression [ 13 ]. Therefore, we hypothesized that SAG might predict mortality in advanced CKD patients.…”

Section: Introductionmentioning

confidence: 99%

Serum Anion Gap Predicts All-Cause Mortality in Patients with Advanced Chronic Kidney Disease: A Retrospective Analysis of a Randomized Controlled Study

Lee

Kim

et al. 2016

PLoS ONE

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“…Deteriorated kidney functions, decreased GFR, and increased SAG levels were observed, and it has been suggested that increased ACAG may be an independent predictor of CKD [ 24 ]. Patients with CKD and high SAG have worse cardiovascular outcomes, which may result from cardiovascular damage caused by accumulated uremic anions.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Albumin-Corrected Anion Gap and Mortality in Hospitalized Heart Failure Patients

Aydın,

Aksakal

2023

Cureus

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Background: Heart failure (HF) is a disease with high morbidity and mortality. Despite the efforts to reduce mortality rates through medical progress, it is necessary to develop markers to identify critically ill patients. In our study, we aimed to investigate the relationship between albumin-corrected anion gap (ACAG) and mortality in hospitalized patients with HF. Methodology: We performed a retrospective study that included patients with HF hospitalized in the Erzurum City Hospital between 2015 and 2022. The basal clinical, hematological, and biochemical findings of the patients were obtained from the electronic medical records. ACAG was calculated. The date and causes of death of the patients were searched and recorded through the Republic of Türkiye Ministry of Health Death Notification System (ÖBYS) and Central Population Administration System (MERNIS). Thus, the relationship between ACAG and mortality in hospitalized patients with HF was evaluated. Results: A total of 205 patients hospitalized for HF were included in the study. The mean age of all people in this study was 71.8 ± 10.7 years. A total of 104 (50.7%) of the patients included in the study were women. The mean left ventricular ejection fraction was 47.2 ± 13.6%. The mean follow-up period of the entire population was 76.5 ± 18.9 months. The mortality rate was 11.7% (24 patients). Serum anion gap (SAG) and ACAG were significantly higher in the group with death outcomes (p = 0.043 and p = 0.012, respectively). Cox regression analysis showed that ACAG was an independent predictor of HF mortality (p = 0.003). ACAG area under the curve was 0.773 (95% CI 0.634 - 0.914), the cut-off was 13, sensitivity was 75%, and specificity was 75.9% (p = 0.002). Conclusion: Statistical analysis showed a meaningful connection between an increase in ACAG and mortality in hospitalized patients with HF. Consequently, ACAG can be used as an independent predictor of mortality in patients with HF.

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“…Une étude japonaise a montré l'intérêt du TAPc pour prédire un retour à une activité cardiaque spontanée dans la réanimation de l'arrêt cardiocirculatoire, avec une meilleure valeur prédictive pour le TAPc (AUC à 0,871 ; Se = 86 % ; Spé = 75 %) que pour le TAP (AUC à 0,850 ; Se = 82 % ; Spé = 69 %), et une valeur de TAPc élevée (> 30 mEq/l) était en défaveur d'une récupération de l'arrêt cardiaque [34]. Enfin, dans la population des patients insuffisants rénaux chroniques, il existerait un intérêt pronostique du TAPc [35], pouvant être considéré comme un marqueur du déclin du débit de filtration glomérulaire et de la progression de la maladie rénale chronique [36], avec une bonne corréla-tion à l'accumulation de toxines urémiques.…”

Section: Tap Corrigé à L'albumineunclassified

Les utilisations du trou anionique plasmatique corrigé pour le diagnostic de l’acidose métabolique

et al. 2015

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La compréhension des troubles acidobasiques se fonde sur une démarche diagnostique simple et hiérarchisée se reposant sur l'équation d'Henderson-Hasselbalch. Après avoir déterminé la composante métabolique, le calcul du trou anionique plasmatique (TAP) permet de quantifier les anions indosés. Physiologiquement, il est de 12 ± 2 mEq/l. Néan-moins, dans le cadre de troubles acidobasiques complexes, son calcul peut être pris en défaut, et il est nécessaire de corriger certains paramètres. L'albumine en est le principal à prendre en compte afin de déterminer le TAP corrigé (TAPc), l'hypoalbuminémie étant alcalinisante. Le TAPc peut également être diminué par une grande hyperphosphorémie ou l'augmentation de certains cations (Ca 2+ , Mg 2+ , hypergammaglobulinémie). Toute variation de la natrémie sans variation proportionnelle de la chlorémie peut égale-ment modifier le TAPc. L'utilisation du rapport ΔTAPc/ ΔHCO 3 -et du rapport Cl/Na constitue une approche complémentaire au calcul du TAPc, utile dans les désordres acidobasiques mixtes.Mots clés Équilibre acide-base · Trou anionique corrigé · Albuminémie · Rapport Na/Cl · Strong ion gap Abstract Understanding the acid-base disorders relies on a structured diagnostic approach, based on HendersonHasselbalch's equation. After the diagnosis of metabolic acidosis, the calculation of the plasmatic anion gap (AG) evaluates the excess of unmeasured anions, the reference range being 12 ± 2 mEq/l. However, in case of complex disorders, we need to correct the calculation with some parameters that constitute the true AG. Albumin is most clinically relevant to adjust the calculation of the albumin-corrected anion gap (ACAG), because hypoalbuminemia has an alkalizing effect. ACAG can reduce because of hyperphosphotemia or the increase of some cations (e.g., Ca 2+ , Mg 2+ , and hypergammaglobulinemia). Variations of sodium have to be the same as that of chloride to induce no change in the ACAG. The ratios ΔTAPc/ΔHCO 3 -and Cl/Na are accurate tools to add to the ACAG, which reveal the mechanism of complex acidosis.

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Adjusted Anion Gap Is Associated with Glomerular Filtration Rate Decline in Chronic Kidney Disease

Cited by 5 publications

References 20 publications

Serum Anion Gap Predicts All-Cause Mortality in Patients with Advanced Chronic Kidney Disease: A Retrospective Analysis of a Randomized Controlled Study

Serum Anion Gap Predicts All-Cause Mortality in Patients with Advanced Chronic Kidney Disease: A Retrospective Analysis of a Randomized Controlled Study

Relationship Between Albumin-Corrected Anion Gap and Mortality in Hospitalized Heart Failure Patients

Les utilisations du trou anionique plasmatique corrigé pour le diagnostic de l’acidose métabolique

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