Metabolic acidosis in renal transplantation: neglected but of potential clinical relevance

Messa, P.; Alfieri, Carlo; Vettoretti, Simone

doi:10.1093/ndt/gfv098

Cited by 33 publications

(42 citation statements)

References 71 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, this study might have limited generalizability due to the low rate of graft failure, which could be associated with the high proportion of living donor transplants. Second, although normal AG renal tubular acidosis is common in KTRs, 1 we could not diagnose the types of MA due to the absence of other necessary data, including urinary measurements. Moreover, residual confounding factors originating from the retrospective design may have existed.…”

Section: Discussionmentioning

confidence: 98%

“…Subclinical tubular dysfunction and the presence of a single kidney to process acid loads may reduce the capacity for renal acid excretion. 1,24 Experimental studies indicate that rats with reduced nephron mass induced by subtotal nephrectomy were more susceptible to MA, which caused GFR decline mediated by endothelin. 25,26 In our study, deceased donor transplantation and tacrolimus instead of cyclosporine were also suspected to be associated with MA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Metabolic Acidosis and Long-Term Clinical Outcomes in Kidney Transplant Recipients

Park¹,

Kang²,

Park³

et al. 2016

JASN

View full text Add to dashboard Cite

Metabolic acidosis (MA), indicated by low serum total CO (TCO) concentration, is a risk factor for mortality and progressive renal dysfunction in CKD. However, the long-term effects of MA on kidney transplant recipients (KTRs) are unclear. We conducted a multicenter retrospective cohort study of 2318 adult KTRs, from January 1, 1997 to March 31, 2015, to evaluate the prevalence of MA and the relationships between TCO concentration and clinical outcomes. The prevalence of low TCO concentration (<22 mmol/L) began to increase in KTRs with eGFR<60 ml/min per 1.73 m and ranged from approximately 30% to 70% in KTRs with eGFR<30 ml/min per 1.73 m Multivariable Cox proportional hazards models revealed that low TCO concentration 3 months after transplant associated with increased risk of graft loss (hazard ratio [HR], 1.74%; 95% confidence interval [95% CI], 1.26 to 2.42) and death-censored graft failure (DCGF) (HR, 1.66; 95% CI, 1.14 to 2.42). Cox regression models using time-varying TCO concentration additionally demonstrated significant associations between low TCO concentration and graft loss (HR, 3.48; 95% CI, 2.47 to 4.90), mortality (HR, 3.16; 95% CI, 1.77 to 5.62), and DCGF (HR, 3.17; 95% CI, 2.12 to 4.73). Marginal structural Cox models adjusted for time-varying eGFR further verified significant hazards of low TCO concentration for graft loss, mortality, and DCGF. In conclusion, MA was frequent in KTRs despite relatively preserved renal function and may be a significant risk factor for graft failure and patient mortality, even after adjusting for eGFR.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Metabolic Acidosis and Long-Term Clinical Outcomes in Kidney Transplant Recipients

Park¹,

Kang²,

Park³

et al. 2016

JASN

View full text Add to dashboard Cite

show abstract

“…To date, the literature regarding the association of acid-base status with transplantation outcome and/or mineral disorder is notably scarce and partly inconsistent. 6,[14][15][16][17][18] 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: (Continues)mentioning

confidence: 99%

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

View full text Add to dashboard Cite

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.

show abstract

“…Metabolic acidosis after kidney transplantation is not an uncommon finding. It has been reported with varying prevalence from 12 to 58% ( 21 ). While in patients with chronic kidney disease, it is seen mainly at glomerular filtration rates (GFR) of less than 30 mL/min, in renal transplant recipients it is seen at higher GFR and even in patients with normal renal function.…”

Section: Metabolic Acidosismentioning

confidence: 99%

Electrolyte and Acid-Base Disorders in the Renal Transplant Recipient

Pochineni

Rondon‐Berrios

2018

Front. Med.

View full text Add to dashboard Cite

Kidney transplantation is the current treatment of choice for patients with end-stage renal disease. Innovations in transplantation and immunosuppression regimens have greatly improved the renal allograft survival. Based on recently published data from the Scientific Registry of Transplant recipients, prevalence of kidney transplants is steadily rising in the United States. Over 210,000 kidney transplant recipients were alive with a functioning graft in mid-2016, which is nearly twice as many as in 2005. While successful renal transplantation corrects most of the electrolyte and mineral abnormalities seen in advanced renal failure, the abnormalities seen in the post-transplant period are surprisingly different from those seen in chronic kidney disease. Multiple factors contribute to the high prevalence of these abnormalities that include level of allograft function, use of immunosuppressive medications and metabolic changes in the post-transplant period. Electrolyte disturbances are common in patients after renal transplantation, and several studies have tried to determine the clinical significance of these disturbances. In this manuscript we review the key aspects of the most commonly found post-transplant electrolyte abnormalities. We focus on their epidemiology, pathophysiology, clinical manifestations, and available treatment approaches.

show abstract

Metabolic acidosis in renal transplantation: neglected but of potential clinical relevance

Cited by 33 publications

References 71 publications

Metabolic Acidosis and Long-Term Clinical Outcomes in Kidney Transplant Recipients

Metabolic Acidosis and Long-Term Clinical Outcomes in Kidney Transplant Recipients

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

Electrolyte and Acid-Base Disorders in the Renal Transplant Recipient

Contact Info

Product

Resources

About