Evaluation of Metabolic Acidosis in Patients With a Kidney Graft: Comparison of the Bicarbonate-Based and Strong Ion–Based Methods

Menesi, Fadya; Verzola, Daniela; Villaggio, Barbara; Russo, Rodolfo; Asioli, Sofia; Fontana, I.; Gallina, A.; Mannucci, Irene; Mussap, Michele; Garibotto, Giacomo

doi:10.1016/j.transproceed.2011.01.120

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…To date, the literature regarding the association of acid‐base status with transplantation outcome and/or mineral disorder is notably scarce and partly inconsistent . In this context, our study—which is the second in terms of population size and the largest taking into account blood gas parameters—brings significant novel insights.…”

Section: Discussionmentioning

confidence: 90%

Association of blood bicarbonate and pH with mineral metabolism disturbance and outcome after kidney transplantation

Brazier

Jouffroy

Martinez

et al. 2020

American Journal of Transplantation

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In kidney transplant recipients (KTRs), scarce evidence has associated low blood bicarbonate levels with mineral metabolic disturbance and reduced allograft survival. However, the contribution of the blood pH to these observations remains unassessed. Equally, little is known about the influence of the blood provenance (arteriovenous fistula vs peripheral vein) on bicarbonate values. We analyzed blood gas parameters in a single‐center cohort of 1260 stable KTRs, 3 months after transplantation. Inspection of pO2 distribution allowed the unambiguous identification of the arterial (N = 914) or venous (N = 346) origin of the samples. In patients with arterial blood samples, 435 (46%) had bicarbonate levels below 22 mmol/L. Among them, 196 (40%) were acidemic (blood pH <7.38). In multivariate analysis, low arterial blood pH was associated with increased blood ionized calcium and phosphate and reduced fibroblast growth factor 23 and calcitriol, but not with outcome. In contrast, low bicarbonate concentration predicted allograft loss independently of measured glomerular filtration rate and other potential confounders (hazard ratio [HR] 1.70; 95% confidence interval [CI] 1.04‐2.80). In KTRs, reduced arterial blood bicarbonate levels predict outcome while acidemia is associated with altered mineral metabolism.

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Section: Discussionmentioning

confidence: 90%

Association of blood bicarbonate and pH with mineral metabolism disturbance and outcome after kidney transplantation

Brazier

Jouffroy

Martinez

et al. 2020

American Journal of Transplantation

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“…The dependency on site recommends reference value should be determined in each institution. 46 However, our review showed that while only five studies collected healthy controls for the reference, 33 , 40 , 46 , 49 , 50 other studies used pre-determined numbers, 29 , 41 , 44 , 45 , 48 and the method for reference value selection in those studies was not specified. 6 , 24 , 27 , 28 , 42 , 43 These incongruences of reference value due to arbitrary choice may cause a variety of discordant results.…”

Section: Discussionmentioning

confidence: 98%

“…While 10 studies have shown the potential superiority of the Stewart approach, 6 , 27 – 29 , 40 , 44 , 46 , 48 – 50 four articles failed to show the superiority of the physicochemical approach over the traditional one, 33 , 41 – 43 and three articles even showed greater strength of the traditional method than the modern one. 24 , 45 , 47 …”

Section: Literature Searchmentioning

confidence: 96%

Traditional approach versus Stewart approach for acid–base disorders: Inconsistent evidence

2018

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Purpose:The traditional approach and the Stewart approach have been developed for evaluating acid–base phenomena. While some experts have suggested that the two approaches are essentially identical, clinical researches have still been conducted on the superiority of one approach over the other one. In this review, we summarize the concepts of each approach and investigate the reasons of the discrepancy, based on current evidence from the literature search.Methods:In the literature search, we completed a database search and reviewed articles comparing the Stewart approach with the traditional, bicarbonate-centered approach to November 2016.Results:Our literature review included 17 relevant articles, 5 of which compared their diagnostic abilities, 9 articles compared their prognostic performances, and 3 articles compared both diagnostic abilities and prognostic performances. These articles show a discrepancy over the abilities to detect acid–base disturbances and to predict patients’ outcomes. There are many limitations that could yield this discrepancy, including differences in calculation of the variables, technological differences or errors in measuring variables, incongruences of reference value, normal range of the variables, differences in studied populations, and confounders of prognostic strength such as lactate.Conclusion:In conclusion, despite the proposed equivalence between the traditional approach and the Stewart approach, our literature search shows inconsistent results on the comparison between the two approaches for diagnostic and prognostic performance. We found crucial limitations in those studies, which could lead to the reasons of the discrepancy.

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“…Finally, Abdulraof Menesi et al have shown that both the traditional and the physicochemical approaches are similar, even in specific populations, such as patients with kidney graft. (10) Abdulraof Menesi et al also suggested that the correlation between AG and SIG could be reduced when AG levels were low. (10) In our analysis, we also found a lower slope for the relationship between AGCAPL and SIG in patients with low AGCAPL (<10) compared to those with high AGCAPL (>10) (r=0.97 and r=1.07, respectively - data not shown).…”

Section: Discussionmentioning

confidence: 99%

“…(10) Abdulraof Menesi et al also suggested that the correlation between AG and SIG could be reduced when AG levels were low. (10) In our analysis, we also found a lower slope for the relationship between AGCAPL and SIG in patients with low AGCAPL (<10) compared to those with high AGCAPL (>10) (r=0.97 and r=1.07, respectively - data not shown). This finding was not the primary endpoint of our study and deservers further evaluation in larger samples.…”

Section: Discussionmentioning

confidence: 99%

Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study

Zampieri¹,

Park²,

Ranzani³

et al. 2013

Revista Brasileira De Terapia Intensiva

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ObjectiveCorrected anion gap and strong ion gap are commonly used to estimate unmeasured anions. We evaluated the performance of the anion gap corrected for albumin, phosphate and lactate in predicting strong ion gap in a mixed population of critically ill patients. We hypothesized that anion gap corrected for albumin, phosphate and lactate would be a good predictor of strong ion gap, independent of the presence of metabolic acidosis. In addition, we evaluated the impact of strong ion gap at admission on hospital mortality. MethodsWe included 84 critically ill patients. Correlation and agreement between the anion gap corrected for albumin, phosphate and lactate and strong ion gap was evaluated by the Pearson correlation test, linear regression, a Bland-Altman plot and calculating interclass correlation coefficient. Two subgroup analyses were performed: one in patients with base-excess <-2mEq/L (low BE group - lBE) and the other in patients with base-excess >-2mEq/L (high BE group - hBE). A logistic regression was performed to evaluate the association between admission strong ion gap levels and hospital mortality. ResultsThere was a very strong correlation and a good agreement between anion gap corrected for albumin, phosphate and lactate and strong ion gap in the general population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57). Correlation was also high in the lBE group (r2=0.94) and in the hBE group (r2=0.92). High levels of strong ion gap were present in 66% of the whole population and 42% of the cases in the hBE group. Strong ion gap was not associated with hospital mortality by logistic regression. ConclusionAnion gap corrected for albumin, phosphate and lactate and strong ion gap have an excellent correlation. Unmeasured anions are frequently elevated in critically ill patients with normal base-excess. However, there was no association between unmeasured anions and hospital mortality.

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Evaluation of Metabolic Acidosis in Patients With a Kidney Graft: Comparison of the Bicarbonate-Based and Strong Ion–Based Methods

Cited by 6 publications

References 23 publications

Association of blood bicarbonate and pH with mineral metabolism disturbance and outcome after kidney transplantation

Association of blood bicarbonate and pH with mineral metabolism disturbance and outcome after kidney transplantation

Traditional approach versus Stewart approach for acid–base disorders: Inconsistent evidence

Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study

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