Metabolic Acidosis in CKD: A Review of Recent Findings

Melamed, Michal L.; Raphael, Kalani L.

doi:10.1016/j.xkme.2020.12.006

Cited by 25 publications

(18 citation statements)

References 61 publications

(77 reference statements)

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“…Oral hypoglycemics were associated with 0.5 times higher risk for advanced CKD, similar to other studies (38,39). The prevalence of metabolic acidosis was 62.4 % in advanced CKD and 46.6 % in early CKD; this prevalence is higher than the 33% -40% among patients with CKD stage 3 -4 from other continents (14,40,41). The possible explanation could be firstly, the more rapid CKD progression which has been shown to occur in black patients even early in their CKD stages (16,28) and secondly, diet where replacement of traditional diets with contemporary/ western foods which contain mainly animal proteins, less vegetables and low intake of fruits might increase CKD patients' dietary acid load (29,(42)(43)(44)(45).…”

Section: Discussionsupporting

confidence: 86%

“…The possible explanation could be firstly, the more rapid CKD progression which has been shown to occur in black patients even early in their CKD stages (16, 28) and secondly, diet where replacement of traditional diets with contemporary/ western foods which contain mainly animal proteins, less vegetables and low intake of fruits might increase CKD patients’ dietary acid load (29, 42-45). Patients with low serum bicarbonate levels were 2-fold more likely to have advanced CKD, as reported also in other studies (14, 15). The prevalence of anaemia was 46.4 % in advanced CKD, including 16.6 % who had low transferrin levels, while 25.9 % of the patients with early CKD had anemia.…”

Section: Discussionsupporting

confidence: 85%

“…In addition to the known risk factors for advanced CKD, which are age, male sex, black race, arterial hypertension and proteinuria, other modifiable factors including medications (traditional and herbal), hyperuricemia, hyperlipidemia, elevated phosphate levels, heart failure and anemia are common in CKD at later stages (11)(12)(13). Metabolic acidosis increases with worsening eGFR, with prevalence of around 40% among patients with CKD stage 4 and it is associated with rapid CKD progression (14)(15)(16). Anemia is common in CKD and is frequently associated with poor outcomes, including increased cardiovascular risks, hospitalization, decreased quality of life and increased risk of mortality (17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

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Demographic and clinical profile of black patients with chronic kidney disease attending Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa

Meremo

Paget

Duarte

et al. 2022

Preprint

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Background The prevalence of chronic kidney disease (CKD) is increasing worldwide; black patients have an increased risk of developing CKD and end stage kidney disease (ESKD) at significantly higher rates than other races. Methods A cross sectional study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2020. Demographic and clinical data were extracted from the ongoing kidney outpatient clinic records and interviews, and were filled in a questionnaire. Patients provided blood and urine for laboratory investigations as standard of care, data were descriptively and inferentially analysed using STATA version 17. Multivariable logistic regression analysis was used to identify demographic and clinical data associated with advanced CKD. Results A total of 312 black patients with CKD were enrolled during the study period; 58% patients had advanced CKD, of whom 31.5% had grossly increased proteinuria, 96.7% had hypertension, 38.7% had diabetes mellitus and 38.1% had both hypertension and diabetes mellitus. For patients with advanced CKD, the median age was 61 (IQR 51-69) years, eGFR 33 (30 -39) mL/min/1.73 m2, serum bicarbonate 22 (IQR 20 – 24), hemoglobin 12.9 (IQR 11.5 – 14.0) g/dl, serum transferrin 2.44 (IQR 2.23 – 2.73) g/L, serum uric acid 0.43 (IQR 0.37 – 0.53) and serum potassium 4.4 (IQR 3.9 – 4.8) mmol/L. The prevalence of metabolic acidosis was 62.4%, anemia 46.4%, gout 30.9%, low transferrin levels 16.6% and hyperkalemia 8.8% among those with advanced CKD, while the prevalence of metabolic acidosis and anemia was 46.6% and 25.9% respectively in those with early CKD. Variables with higher odds for advanced CKD after multivariable logistic regression analysis were hypertension (OR 3.3, 95% CI 1.2 - 9.2, P = 0.020), diabetes mellitus (OR 1.8, 95% CI 1.1 - 3.3, P = 0.024), severe proteinuria (OR 3.5, 95% CI 1.9 - 6.5, P = 0.001), angina (OR 2.5, 95% CI 1.2 - 5.1, P = 0.008), anaemia (OR 2.9, 95% CI 1.7 - 4.9, P= 0.001), hyperuricemia (OR 2.4, 95% CI 1.4 - 4.1, P = 0.001), and metabolic acidosis (OR 2.0, 95% CI 1.2 - 3.1, P= 0.005). Other associations with advanced CKD were widow/widower (OR 3.2, 95% CI 1.4 - 7.4, P = 0.006), low transferrin (OR 2.4, 95% CI 1.1 - 5.1, P= 0.028), hyperkalemia (OR 5.4, 95% CI 1.2 - 24.1, P= 0.029), allopurinol (OR 2.4, 95% CI 1.4 - 4.3, P = 0.005) and doxazosin (OR 1.9, 95% CI 1.2 - 3.1, P = 0.006). Conclusion Hypertension and diabetes mellitus were strongly associated with advanced CKD, suggesting a need for primary and secondary population-based prevention measures. Metabolic acidosis, anaemia with low transferrin levels, hyperuricemia and hyperkalemia were highly prevalent in our patients, including those with early CKD, and they were strongly associated with advanced CKD, calling for the proactive role of clinicians and dietitians in supporting the needs of CKD patients in meeting their daily dietary requirements towards preventing and slowing the progression of CKD.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Demographic and clinical profile of black patients with chronic kidney disease attending Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa

Meremo

Paget

Duarte

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Metabolic acidosis is a common complication of patients with CKD and increases in prevalence with the progression of kidney disease [7]. Between 10% and 20% of patients with Stage G4 CKD have overt metabolic acidosis, which increases to 30-40% of patients with Stage G5 CKD (Figure 1) [1,[9][10][11]. Acidosis is defined here as a process causing a positive hydrogen (H þ ) balance in (extracellular) fluid compartments and encompasses overt acidosis when serum or plasma bicarbonate (HCO 3 À ) [or total carbon dioxide (CO 2 )] falls to <22 mmol/L and/or a blood pH <7.36 as well as eubicarbonataemic acidosis when systemic HCO 3…”

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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“…Clinically, it can be defined as a glomerular filtration rate (GFR) <60 mL/min/1.73 m 2 and/or albuminuria ≥30 mg/g of creatinine, present for more than 3 months [ 2 ]. If left unchecked, CKD can evolve into end-stage renal disease (ESRD), or the need for renal replacement therapy (RRT) [ 3 ]. Additionally, CKD leads to the development of a plethora of cardiovascular, gastro-enteric, nervous, metabolic, and hormonal alterations.…”

Section: Introductionmentioning

confidence: 99%

Nutritional Approaches for the Management of Metabolic Acidosis in Chronic Kidney Disease

et al. 2021

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Metabolic acidosis is a severe complication of chronic kidney disease (CKD) which is associated with nefarious impairments such as bone demineralization, muscle wasting, and hormonal alterations, for example, insulin resistance. Whilst it is possible to control this condition with alkali treatment, consisting in the oral administration of sodium citrate or sodium bicarbonate, this type of intervention is not free from side effects. On the contrary, opting for the implementation of a targeted dietetic-nutritional treatment for the control of CKD metabolic acidosis also comes with a range of additional benefits such as lipid profile control, increased vitamins, and antioxidants intake. In our review, we evaluated the main dietary-nutritional regimens useful to counteract metabolic acidosis, such as the Mediterranean diet, the alkaline diet, the low-protein diet, and the vegan low-protein diet, analyzing the potentialities and limits of every dietary-nutritional treatment. Literature data suggest that the Mediterranean and alkaline diets represent a valid nutritional approach in the prevention and correction of metabolic acidosis in CKD early stages, while the low-protein diet and the vegan low-protein diet are more effective in CKD advanced stages. In conclusion, we propose that tailored nutritional approaches should represent a valid therapeutic alternative to counteract metabolic acidosis.

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Metabolic Acidosis in CKD: A Review of Recent Findings

Cited by 25 publications

References 61 publications

Demographic and clinical profile of black patients with chronic kidney disease attending Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa

Demographic and clinical profile of black patients with chronic kidney disease attending Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa

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

Nutritional Approaches for the Management of Metabolic Acidosis in Chronic Kidney Disease

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