Metabolic acidosis and its association with nutritional status in hemodialysis

Oliveira, Cláudia Maria Costa de; Vidal, Caroline Lustosa da Costa; Cristino, Eurinice Fontenele; Pinheiro, Fábio; Kubrusly, Marcos

doi:10.5935/0101-2800.20150073

Cited by 7 publications

(6 citation statements)

References 46 publications

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“…[32] Malnutrition, another common condition defined by low serum albumin and a risk factor for poor outcome in renal disease, may be related to acidemia due to an increased protein catabolism, decreased protein synthesis, endocrine abnormalities and inflammation among patients with renal disease. [9,33] Additionally, in our data, we observed significant prevalence of serum bicarbonate lower or higher than 20 mmol/L on high 10-year risk for coronary heart disease (FRS > 20%) during our median follow up time of 60 months. Supportively, the relationship between the three groups of patients according to the serum bicarbonate concentrations and according to the 10-year risk for coronary heart disease by FRS was found statistically significant.…”

Section: Discussionsupporting

confidence: 58%

Metabolic acidosis status and mortality in patients on the end stage of renal disease

Raikou

2016

Journal of Translational Internal Medicine

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Background and Objectives: Uncorrected metabolic acidosis leads to higher death risk in dialysis patients. We observed the relationship between metabolic acidosis status and mortality rate in patients on renal replacement therapy during a median follow up time of 60 months. Methods: We studied 76 patients on an on-line hemodiafiltration. The dialysis adequacy was defined by Kt/V for urea. The Framingham risk score (FRS) points were used to determine the 10-year risk for coronary heart disease. We examined the impact of high or low serum bicarbonate concentrations on mortality rate and on 10-year risk for coronary heart disease via the Kaplan-Meier method. Cox's model was used to evaluate a combination of prognostic variables, such as dialysis adequacy defined by Kt/V for urea, age and serum bicarbonate concentrations. Results: We divided the enrolled patients in three groups according to serum bicarbonate concentrations (< 20 mmol/L, 20-22 mmol/L and > 22 mmol/L). Kaplan-Meier survival curve for the impact of serum bicarbonate concentrations on overall mortality was found significant (log-rank = 7.8, P = 0.02). The prevalence of serum bicarbonate less or more than 20 mmol/L on high FRS (> 20%) by Kaplan-Meier curve was also found significant (log-rank = 4.9, P = 0.02). Cox's model revealed the significant predictive effect of serum bicarbonate on overall mortality (P = 0.006, OR = 1.5, 95% CI = 1.12-1.98) in combination to Kt/V for urea and age. Conclusion: Uncorrected severe metabolic acidosis, defined by serum bicarbonate concentrations less than 20 mmol/L, is associated with a 10-year risk for coronary heart disease more than 20% and high overall mortality in patients on renal replacement therapy.

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Section: Discussionsupporting

confidence: 58%

Metabolic acidosis status and mortality in patients on the end stage of renal disease

Raikou

2016

Journal of Translational Internal Medicine

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“…Malnutrition and anemia have already been reported as specific cardiovascular risk factors for dialysis patients and each of the MIA syndrome components worsens the survival of these patients [ 35 , 36 ]. Malnutrition may be related to metabolic acidosis due to increased protein catabolism, decreased protein synthesis, endocrine abnormalities, and inflammation among dialysis patients [ 37 ]. Metabolic acidosis defined by low serum bicarbonate (<22 mmol/L) is a common condition in end stage renal disease patients resulting in inflammatory stimulation, lipids oxidation, and oxidative stress [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

The Association between Intradialytic Hypertension and Metabolic Disorders in End Stage Renal Disease

Raikou

Kyriaki

2018

International Journal of Hypertension

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Background Intradialytic hypertension was associated with a high mortality risk. We examined the relationship between intradialytic hypertension and metabolic disorders in hemodialysis treatment patients. Methods We studied 76 patients in online hemodiafiltration. Dialysis adequacy was defined by Kt/V for urea. Normalized protein catabolic rate (nPCR), as a marker of protein intake, was calculated. Sodium removal was determined as percent sodium removal. Metabolic acidosis was determined by serum bicarbonate less than 22 mmol/L. Interdialytic urine volume more than 100 ml was recorded. Intradialytic hypertension was defined by an increase in systolic blood pressure equal to 10 mmHg from pre- to posthemodialysis. Arterial stiffness was assessed as carotid-femoral pulse wave velocity (c-fPWV) and carotid augmentation index (AIx). Chi-square tests and logistic regression analysis were applied for intradialytic hypertension prediction. Results Patients with intradialytic hypertension were older and had significantly lower hemoglobin, nPCR, urine output, and serum bicarbonate and significantly higher c-fPWV, though similar Kt/V for urea, than patients without intradialytic hypertension. They also had increased sodium removal and pulse pressure related to less urine output. Serum bicarbonate was inversely associated with c-fPWV (r = −0.377, p = 0.001). Chi-square test showed significant association between intradialytic hypertension and serum bicarbonate < 22 mmol/L (x2 = 5.6, p = 0.01), which was supported by an adjusted model. Conclusion The intradialytic hypertension was significantly associated with metabolic disorders including malnutrition/inflammation and uncontrolled metabolic acidosis in hemodialysis treatment patients. Severe metabolic acidosis may reflect sodium imbalance and hemodynamic instability of these patients resulting in volume overload and increased vascular resistance.

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“…Decreased CO 2 CP has been demonstrated to be an indicator of metabolic acidosis in patients without respiratory disease. 2 Previous studies have shown that metabolic acidosis is associated with insulin resistance, 3 hypertension, 4 inflammation, 5 activation of the renin-angiotensin-aldosterone system 6 and endothelial dysfunction, 7 all of which can contribute to adverse clinical outcomes after stroke. 3 8 Furthermore, acidosis is common and has been proven to be associated with poor outcomes in ischaemic stroke.…”

Section: Introductionmentioning

confidence: 99%

CO₂combining power and outcomes in patients with acute ischaemic stroke or transient ischaemic attack

Wang

Tian

et al. 2020

Stroke Vasc Neurol

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Background and purposeThe clinical significance of carbon dioxide combining power (CO2CP) in ischaemic cerebrovascular disease is not well established, and the role of CO2CP in the prognosis of acute ischaemic stroke (AIS) or transient ischaemic attack (TIA) has not been reported. The objective of the study was to investigate the associations between CO2CP and clinical outcomes in patients with AIS or TIA.MethodsData were derived from the China National Stroke Registry III. Patients were classified into five groups by quintiles of CO2CP levels and three groups according to the normal range of CO2CP (23–29 mmol/L). Multivariable Cox and logistic regressions were adopted to explore the associations of CO2CP levels with all-cause death and poor functional outcomes (modified Rankin Scale (mRS) 3–6/2–6) at 3 months and 1 year.ResultsAmong 9531 patients included in the study, the median (IQR) CO2CP was 24.9 (23.0–27.0) mmol/L. After adjustment for potential confounders, patients in the first CO2CP quintile (21.1–23.3 mmol/L) had higher risk of all-cause death and poor functional outcomes (mRS score of 3–6/2–6) (HR or OR with 95% CI 2.37 (1.32 to 4.25), 1.49 (1.20 to 1.83) and 1.21 (1.03 to 1.42), respectively) compared with those in the fourth quintile. Similar results were found for outcomes at 1 year. Furthermore, all associations were also significant when CO2CP was <23 mmol/L compared with CO2CP of 23–29 mmol/L.ConclusionsDecreased CO2CP was associated with high risk of all-cause death and poor functional outcomes in patients with AIS or TIA.

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Metabolic acidosis and its association with nutritional status in hemodialysis

Cited by 7 publications

References 46 publications

Metabolic acidosis status and mortality in patients on the end stage of renal disease

Metabolic acidosis status and mortality in patients on the end stage of renal disease

The Association between Intradialytic Hypertension and Metabolic Disorders in End Stage Renal Disease

CO₂combining power and outcomes in patients with acute ischaemic stroke or transient ischaemic attack

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Metabolic acidosis and its association with nutritional status in hemodialysis

Cited by 7 publications

References 46 publications

Metabolic acidosis status and mortality in patients on the end stage of renal disease

Metabolic acidosis status and mortality in patients on the end stage of renal disease

The Association between Intradialytic Hypertension and Metabolic Disorders in End Stage Renal Disease

CO2combining power and outcomes in patients with acute ischaemic stroke or transient ischaemic attack

Contact Info

Product

Resources

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CO₂combining power and outcomes in patients with acute ischaemic stroke or transient ischaemic attack