Successful correction of metabolic acidosis is difficult to achieve inchronic kidney disease

Caravaca-Fontán, Fernando; Díaz-Campillejo, Rosa; Valladares, Julián; Arnaldo, Cristina López; Barroso, Sérgio; Luna, Enrique; Caravaca, Francisco

doi:10.1016/j.nefroe.2020.06.008

Cited by 5 publications

(6 citation statements)

References 40 publications

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“…The literature search yielded 9284 potentially relevant records, of which the full texts of 185 publications were reviewed ( Figure 1 ). After screening and eligibility assessment, 14 RCTs [ 5–7 , 20–32 ] and 4 cohort studies [ 8 , 29 , 33 , 34 ] reported in 19 publications with 3695 individuals were included in this systematic review and meta-analysis. Baseline and key characteristics of the enrolled studies are presented in Supplementary Table S1 and Table S2 .…”

Section: Resultsmentioning

confidence: 99%

“…A retrospective study from the National Health and Nutrition Examination Survey III involving 1486 CKD patients with a median 14.2 years of follow-up demonstrated that a higher dietary acid load was independently associated with an increased risk of ESRD, and this association was more pronounced in individuals with advanced CKD than in those with mild or moderate CKD [ 39 ]. Several studies included in this meta-analysis reported that oral alkali supplementation can delay the progression of CKD in patients with MA [ 28 , 29 , 32 , 35 , 37 ]. However, Mahajan [ 21 ] found that oral alkali supplementation delayed the progression of CKD in stage 2 CKD patients without MA.…”

Section: Discussionmentioning

confidence: 99%

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Effects of oral alkali drug therapy on clinical outcomes in pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis

Shi

Yan

et al. 2022

Renal Failure

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Background Metabolic acidosis accelerates the progression of chronic kidney disease (CKD) and increases the mortality rate. Whether oral alkali drug therapy benefits pre-dialysis CKD patients is controversial. We performed a meta-analysis of the effects of oral alkali drug therapy on major clinical outcomes in pre-dialysis CKD patients. Methods We systematically searched MEDLINE using the Ovid, EMBASE, and Cochrane Library databases without language restriction. We included all eligible clinical studies that involved pre-dialysis CKD adults and compared those who received oral alkali drug therapy with controls. Results A total of 18 eligible studies, including 14 randomized controlled trials and 4 cohort studies reported in 19 publications with 3695 participants, were included. Oral alkali drug therapy led to a 55% reduction in renal failure events (relative risk [RR]: 0.45; 95% confidence interval [CI]: 0.25–0.82), a rate of decline in the estimated glomerular filtration rate (eGFR) of 2.59 mL/min/1.73 m 2 per year (95% CI, 0.88–4.31). There was no significant effect on decline in eGFR events (RR: 0.34; 95% CI: 0.09–1.23), proteinuria (standardized mean difference: −0.32; 95% CI: −1.08 to 0.43), all-cause mortality events (RR: 0.90; 95% CI: 0.40–2.02) and cardiovascular (CV) events (RR: 1.03; 95% CI: 0.32–3.37) compared with the control groups. Conclusion Based on the available and low-to-moderate certainty evidence, oral alkali drug therapy might potentially reduce the risk of kidney failure events, but no benefit in reducing all-cause mortality events, CV events, decline in eGFR and porteninuria.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of oral alkali drug therapy on clinical outcomes in pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis

Shi

Yan

et al. 2022

Renal Failure

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“…However, it was identified that there is a significant association (p = 0.040) with age, since the age group in which this complication occurs more frequently is from 46 to 55-years-old. Caravaca-Fontán Fernando, et al (2020) conducted a retrospective study of longitudinal observation in a cohort with the title "Successful correction of metabolic acidosis is difficult to achieve in chronic kidney disease" which included 969 patients with chronic kidney disease and 55% presented metabolic acidosis of which 52.3% were men and the age of greatest presentation was from 51 to 79 years [23].…”

Section: Discussionmentioning

confidence: 99%

Most Frequent Cause of Dialysis Emergency and Precipitating Factor in Patients with Chronic Kidney Disease Attending the Emergency Department of HGZ 50 in San Luis Potosí, Mexico

Marroquín¹,

Ruiz²

2023

Int J Crit Care Emerg Med

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Background: Chronic kidney disease (CKD) represents a worldwide public health problem, Mexico has a prevalence of 12.2%, of which 52,000 patients are in renal replacement therapy and 80% are treated at the Mexican Social Security Institute, it is associated with early mortality with a higher incidence after 40 years of age. The literature mentions severe metabolic acidosis, severe hyperkalemia and hyperphosphatemia, water overload and uremic syndrome as frequent causes of dialysis urgency. However, the most frequent dialysis emergency in our setting has not been studied.Objective: To establish the most frequent cause of dialysis emergencies and to identify the precipitating factor in patients with chronic kidney disease admitted to the emergency department of Hospital General Zone (HGZ) 50, Mexico.Methods: Analytical and retrospective study, the sample was obtained by calculating the finite sample (Murray's formula) of patients admitted to the emergency department over a period of one year, as well as descriptive statistics (measures of trend, central, ranges, frequencies, proportions, chi-square to establish associations), SPSS software was used. Results. Data were collected from 148 patients.Results: Severe metabolic acidosis was identified as the main cause of dialysis urgency (29.1%) and the main precipitating factor was the presence of infections at any level (33.8%). Conclusion:Refractory metabolic acidosis is the main dialysis emergency in our patients, it is important to perform gasometry on admission in the ED, the main precipitating factor is the presence of infection, so initiating timely treatment and immediately requesting renal replacement therapy, as well as providing sanitary and preventive measures will have a positive impact on reducing morbidity and mortality.

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“…Moreover, treatment of metabolic acidosis with sodium bicarbonate- or citrate-containing liquids is often limited by poor palatability [ 23 ]. In patients with advanced CKD, adequate correction of metabolic acidosis (i.e., serum HCO 3 − levels >22 mmol/L) with sodium bicarbonate or sodium citrate is associated with a significant increase in Na + load [ 24 ] and is often not achieved, most likely due to poor adherence [ 25 ]. Therefore, alternative therapeutic options for the management of CKD-associated metabolic acidosis with hyperkalemia would be useful.…”

Section: Discussionmentioning

confidence: 99%

Effect of Sodium Zirconium Cyclosilicate on Serum Potassium and Bicarbonate in Patients with Hyperkalemia and Metabolic Acidosis Associated with Chronic Kidney Disease: Rationale and Design of the NEUTRALIZE Study

Ash

Batlle

Kendrick

et al. 2022

Nephron

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Introduction: Sodium zirconium cyclosilicate (SZC) is a selective potassium (K+) binder for hyperkalemia management that provides rapid and sustained correction of hyperkalemia. The NEUTRALIZE study is investigating whether SZC, in addition to correcting hyperkalemia and maintaining normal serum K+, can provide sustained increases in serum bicarbonate (HCO3−) in patients with hyperkalemia and metabolic acidosis associated with chronic kidney disease (CKD). Methods: This is a prospective, randomized, double-blind, placebo-controlled phase 3b study of US adults with stage 3–5 CKD not on dialysis with hyperkalemia (K+ >5.0–≤5.9 mmol/L) and low-serum HCO3− (16–20 mmol/L). In the open-label correction phase, all eligible patients receive SZC 10 g three times daily for up to 48 h. Patients who achieve normokalemia (K+ ≥3.5–≤5.0 mmol/L) are then randomized 1:1 to once-daily SZC 10 g or placebo for a 4-week, double-blind, placebo-controlled maintenance phase. The primary endpoint is the proportion of patients with normokalemia at the end of treatment (EOT) without rescue therapy for hyperkalemia. Key secondary endpoints include mean change in serum HCO3−, the proportion of patients with an increase in serum HCO3− of ≥2 or ≥3 mmol/L without rescue therapy for metabolic acidosis, and the proportion of patients with serum HCO3− ≥22 mmol/L at EOT. Conclusions: NEUTRALIZE will establish whether SZC can provide sustained increases in serum HCO3− while lowering serum K+ in patients with hyperkalemia and CKD-associated metabolic acidosis and may provide insights on the mechanism(s) underlying the increased serum HCO3− with SZC treatment.

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Successful correction of metabolic acidosis is difficult to achieve inchronic kidney disease

Cited by 5 publications

References 40 publications

Effects of oral alkali drug therapy on clinical outcomes in pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis

Effects of oral alkali drug therapy on clinical outcomes in pre-dialysis chronic kidney disease patients: a systematic review and meta-analysis

Most Frequent Cause of Dialysis Emergency and Precipitating Factor in Patients with Chronic Kidney Disease Attending the Emergency Department of HGZ 50 in San Luis Potosí, Mexico

Effect of Sodium Zirconium Cyclosilicate on Serum Potassium and Bicarbonate in Patients with Hyperkalemia and Metabolic Acidosis Associated with Chronic Kidney Disease: Rationale and Design of the NEUTRALIZE Study

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