Post-renal transplant metabolic acidosis: A neglected entity

Fernando, M Edwin; Jayanivash, J; Srinivasaprasad, ND; Suren, S; Thirumalvalavan, K

doi:10.4103/ijn.ijn_93_18

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…In addition, in this study, residual serum tacrolimus levels were not associated with the occurrence of hyperkalemic RTA. However, in an observational study of 106 kidney transplant patients, serum tacrolimus levels appeared to be an independent risk factor for RTA (all types) [38]. Even if the occurrence of hyperkalemic RTA is attributed to CNI, its discontinuation is often problematic in the immediate post-transplant period.…”

Section: Discussionmentioning

confidence: 99%

Variables Associated With Hyperkalemic Renal Tubular Acidosis in Solid Organ Transplant Recipients

Mohib,

Vanderhulst,

Catalano

et al. 2024

Cureus

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Introduction: The occurrence of hyperkalemic renal tubular acidosis (RTA) in the post-transplantation period is likely underestimated, and its identification remains important to offer adequate medical management. Transplant recipients frequently present with clinical and biological characteristics that may be associated with the occurrence of this complication.Methods: This was a single-center retrospective study that compared transplanted patients with hyperkalemic RTA and a control group to identify variables associated with the occurrence of this complication. Fisher's exact test and the Mann-Whitney test, followed by multivariate logistic regression, were applied to test whether there was a significant association between hyperkalemic RTA and different variables.Results: Kidney and heart transplant recipients were at greater risk of developing RTA than lung transplant recipients (p = 0.016). There was also a significant association between the development of RTA and kalemia (p < 0.01), chloremia (p < 0.01), and bicarbonatemia (p < 0.01). The significant impact of these last three variables was confirmed by the results of the multivariate logistic regression. Residual serum tacrolimus levels (p = 0.13) and creatinine levels (p = 0.17) of renal transplant patients were not significantly associated with hyperkalemic RTA. Conclusion:The type of transplanted organ, kalemia, chloremia, and bicarbonatemia were significantly associated with the occurrence of hyperkalemic RTA. This study calls into question certain approaches to managing this complication proposed in a number of case reports, such as reducing the target serum residual of tacrolimus or discontinuing trimethoprim-sulfamethoxazole (TMP-SMX) in favor of another antibiotic prophylactic agent, potentially exposing patients to graft rejection and opportunistic infections.

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Section: Discussionmentioning

confidence: 99%

Variables Associated With Hyperkalemic Renal Tubular Acidosis in Solid Organ Transplant Recipients

Mohib,

Vanderhulst,

Catalano

et al. 2024

Cureus

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“…Based on our statistical data, there does not appear to be a signi cant association between the residual serum tacrolimus level and the occurrence of hyperkalemic RTA. However, in an observational study of 106 kidney transplant patients, serum tacrolimus levels appeared to be an independent risk factor for RTA (all types) [39]. Even if the occurrence of hyperkalemic RTA is attributed to CNI, its discontinuation is often problematic in the immediate posttransplant period.…”

Section: Discussionmentioning

confidence: 99%

Clinical and biological factors predisposing to hyperkalemic renal tubular acidosis in solid organ transplant recipients : a retrospective monocentric study

Mohib

Vanderhulst

Catalano

et al. 2023

Preprint

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Background The occurrence of hyperkalemic renal tubular acidosis in the post-transplantation period is likely underestimate, and its identification remains important to offer adequate medical management. Transplanted recipients frequently present clinical and biological characteristics which are associated in the literature with the occurrence of this complication. Post-transplant exposure to drugs that cause hyperkalemic renal tubular acidosis may therefore appear risky. We conducted a single-center retrospective comparative study in which we compared patients with hyperkalemic renal tubular acidosis and a control group to identify clinical and biological factors significantly associated with this complication.Methods The Fisher’s exact test was applied to test whether there is a significant association between hyperkalemic renal tubular acidosis and qualitative variable. The Mann-Whitney test was applied for the quantitative variables. We performed a multivariate logistic regression excluding some variables and then selected the variables using a stepwise procedure. The best logistic model according to the Akaike Information Criterion was the final model.Results Kidney and heart transplant recipients appear to be at greater risk of developing this complication than lung transplant recipients (p = 0.016). No other qualitative variable showed a significant association with the occurrence of hyperkalemic RTA. We also found a significant difference in kalemia (p < 0.01), chloremia (p < 0.01), and bicarbonatemia (p < 0.01).Neither the residual serum tacrolimus level (p = 0.19) nor the creatinine level of renal transplant patients (p = 0.17) was significantly associated with hyperkalemic renal tubular acidosis. In multivariate logistic regression, the analysis of the final model confirms the significant impact of kalemia (p < 0.01), chloremia (p < 0.01), and bicarbonatemia (p = 0.013) in the occurrence of this complication.Conclusion In our study, the type of transplanted organ, kalemia, chloremia, and bicarbonatemia seem to be significantly associated with the occurrence of hyperkalemic renal tubular acidosis. It is essential to identify this complication and to treat hyperkalemia first before proposing additional treatments. Larger studies are needed to more accurately define transplanted patients at risk for hyperkalemic renal tubular acidosis.

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