Prevalence of Metabolic Acidosis Among Patients with Chronic Kidney Disease and Hyperkalemia

Cook, Erin; Davis, Jill; Israni, Rubeen; Mu, Fan; Betts, Keith A.; Anzalone, Deborah; Yin, Lei; Szerlip, Harold M.; Uwaifo, Gabriel I.; Fonseca, Vivian; Wu, Eric Q.

doi:10.1007/s12325-021-01886-5

Cited by 6 publications

(6 citation statements)

References 33 publications

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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: 85%

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: 85%

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

“…Oral hypoglycemics were associated with 0.5 times higher risk for advanced CKD, similar to other studies [40,41]. Metabolic acidosis is common in CKD and it can lead to dysfunction of many organs and systems including the kidney resulting in CKD progression [42,43], 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 [43][44][45]. 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 [15,19] and secondly, diet where…”

Section: Discussionsupporting

confidence: 78%

“…Metabolic acidosis is common in CKD and it can lead to dysfunction of many organs and systems including the kidney resulting in CKD progression [ 42 , 43 ], 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 [ 43 – 45 ]. 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 [ 15 , 19 ] 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 [ 46 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

et al. 2022

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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, and data were descriptively and inferentially entered into REDcap and analysed using STATA version 17. Multivariable logistic regression analysis was used to identify demographic and clinical variables associated with advanced CKD. Results A total of 312 black patients with CKD were enrolled in the study with a median age of 58 (IQR 46–67) years; 58% patients had advanced CKD, 31.5% of whom had grossly increased proteinuria, 96.7% had hypertension, 38.7% had diabetes mellitus and 38.1% had both hypertension and diabetes mellitus. In 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), haemoglobin 12.9 (IQR 11.5–14.0) g/dl and serum uric acid 0.43 (IQR 0.37–0.53). The prevalence of metabolic acidosis was 62.4%, anemia 46.4% and gout 30.9% among those with advanced CKD, while the prevalence of metabolic acidosis and anaemia 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 loss of spouse (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), use of 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, anemia 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, requiring clinicians and dietitians to be proactive 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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“…Metabolic acidosis causes hyperkalemia through potassium and hydrogen ion exchange. In turn, hyperkalemia can lead to metabolic acidosis through impacts on renal ammonia levels [ 67 ]. This cycle leads to deleterious effects which may be treated with therapies such as sodium bicarbonate or sodium citrate [ 67 ].…”

Section: Hyperkalemia Managementmentioning

confidence: 99%

“…In turn, hyperkalemia can lead to metabolic acidosis through impacts on renal ammonia levels [ 67 ]. This cycle leads to deleterious effects which may be treated with therapies such as sodium bicarbonate or sodium citrate [ 67 ]. While beneficial in kidney disease for slowing the loss of kidney function, correction of acidosis with oral bicarbonate may require high pill burden and requires careful candidate selection [ 68 ].…”

Section: Hyperkalemia Managementmentioning

confidence: 99%

Hyperkalemia: Prevalence, Predictors and Emerging Treatments

Larivée

Michaud

et al. 2022

Cardiol Ther

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It is well established that an elevated potassium level (hyperkalemia) is associated with a risk of adverse events including morbidity, mortality and healthcare system cost. Hyperkalemia is commonly encountered in many chronic conditions including kidney disease, diabetes and heart failure. Furthermore, hyperkalemia may result from the use of renin-angiotensin-aldosterone system inhibitors (RAASi), which are disease-modifying treatments for these conditions. Therefore, balancing the benefits of optimizing treatment with RAASi while mitigating hyperkalemia is crucial to ensure patients are optimally treated. In this review, we will briefly discuss the definition, causes, epidemiology and consequences of hyperkalemia. The majority of the review will be focused on management of hyperkalemia in the acute and chronic setting, emphasizing contemporary approaches and evolving data on the relevance of dietary restriction and the use of novel potassium binders.

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Prevalence of Metabolic Acidosis Among Patients with Chronic Kidney Disease and Hyperkalemia

Cited by 6 publications

References 33 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

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

Hyperkalemia: Prevalence, Predictors and Emerging Treatments

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