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

Abstract

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.

Acid base disorders in patients with COVID-19

“…Metabolic acidosis—acute or chronic—is a serious medical condition, associated with high morbidity and poor outcome in CKD [ 17 ] and non-CKD subjects [ 18 ]. This acid–base disorder causes notable adverse effects on organ homeostasis, especially on the cardiovascular system [ 14 , 15 ], where acidosis reduces cardiac contractility, cardiac output and induces arterial vasodilation [ 16 ].…”

Study of Arterial Blood Gas Analysis in Moderate-to-Severe COVID-19 Patients

“…Acute or chronic metabolic acidosis is a significant medical condition that is linked to increased morbidity and a poor prognosis in patients with and without chronic kidney disease [24,25]. This acid-base condition exerts distinct detrimental consequences on the homeostasis of organs, most notably on the cardiovascular system, because acidosis decreases cardiac contractility as well as cardiac output and promotes arterial vasodilation [26][27][28].…”

Pathway and application value of exploration of the pulmonary artery by endobronchial ultrasound

“…Considering the high sensitivity and specificity of EBUS-TBNA in the diagnosis of mediastinal and hilar tumors, and the high risk associated with these tumors for pulmonary embolism, the exploration and evaluation of the pulmonary artery to identify possible pulmonary embolism when performing EBUS-TBNA has potentially important clinical significance. In addition, EBUS pulmonary artery exploration may have value for patients who cannot undergo contrast-enhanced chest CT or ECT scan due to renal insufficiency or pregnancy (27).…”