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Kaneko S, Usui J, Takahashi K, Oda T, Yamagata K. Increased intrarenal post-glomerular blood flow is a key condition for the development of calcineurin inhibitor-induced renal tubular acidosis in kidney transplant recipients. Clin Transplant 2022; 36:e14648. [PMID: 35293652 DOI: 10.1111/ctr.14648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hyperchloremic metabolic acidosis (HCMA) from renal tubular acidosis (RTA) is common in kidney transplant (KT) recipients. Calcineurin inhibitors (CNIs) are a potential cause of RTA, and whether HCMA is a determinant of poor graft prognosis is controversial. METHODS The subjects were living-donor KT recipients (LDKTRs, n = 47) and matched donors (n = 43). All cases of rejection, extrarenal causes, and respiratory disorders were excluded. HCMA was defined as having a [Na+] - [Cl-] value of ≤ 34 or starting alkalization. We determined the potential causes of HCMA in LDKTRs at 3 months (m) and 1 year (y) post-KT. We examined renal hemodynamic parameters in 26 LDKTRs at 1 y post-KT: namely, glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF; GFR/RPF) and pre-/post-glomerular vascular resistance (pre-/postVR). RESULTS The HCMA incidence in the 3-m post-KT LDKTR group was higher than that of the donors (51.0% vs. 6.9%, p<0.001, adjusted odds ratio: 6.7-15.7). Among adjusted factors, the most dominant HCMA contributor was low hemoglobin concentration (Hb ≤12 g/dL). Compared to non-HCMA cases, HCMA patients had low FF and low post-VR (p = 0.008, 0.003, respectively) suggesting increased intrarenal post-glomerular blood flow. The high pathological score of alternative arteriolar hyalinosis (aah) ≥2 was a significant HCMA risk. The tacrolimus trough level was not high in HCMA but was significantly high in HCMA in the low post-VR setting (p = 0.002). CONCLUSION Among LDKTRs, low hemoglobin level is an important contributor to the manifestation of HCMA in the induction period, and increased intrarenal post-glomerular blood flow is a key condition for the development of CNI-induced RTA. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shuzo Kaneko
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,Department of Nephrology, Itabashi Chuo Medical Center, Itabashi, Tokyo, Japan
| | - Joichi Usui
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazuhiro Takahashi
- Department of Gastroenterological and Hepatobiliary Surgery and Organ Transplantation, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tatsuya Oda
- Department of Gastroenterological and Hepatobiliary Surgery and Organ Transplantation, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Eren N, Gungor O, Sarisik FN, Sokmen F, Tutuncu D, Cetin GY, Yazici A, Gökçay Bek S, Altun E, Altunoren O, Cefle A. Renal Tubular Acidosis in Patients with Systemic Lupus Erythematosus. Kidney Blood Press Res 2021; 45:883-889. [PMID: 33108786 DOI: 10.1159/000509841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Renal tubular acidosis (RTA) is a clinical manifestation that occurs with insufficiency in restoring bicarbonate or disruption in hydrogen ion elimination as a result of a disruption in tubulus functions, causing normal anion gap-opening metabolic acidosis. In the present study, we aimed to investigate the prevalence of RTA in the largest systemic lupus erythematosus (SLE) patient population to date. MATERIALS AND METHODS SLE patients, who were followed up in 2 different healthcare centers, were included. Patients with metabolic acidosis (pH <7.35 and HCO3 <22 mEq/L) in venous blood gas analysis were determined. The serum and urine anion GAP of these patients were estimated, and the urine pH was assessed. RTA presence was evaluated as metabolic acidosis with a normal serum anion gap and a positive urine anion GAP. RESULTS A total of 108 patients were included in the present study. The mean age of the patients was 41.5 ± 1.2 and 87% were female. The SLE diagnosis duration was 75 ± 5 months. The mean creatinine value was 0.6 ± 0.1 mg/dL and the mean eGFR was 111 ± 2 mL/min. According to the blood gas analysis, 18 patients (16.7% of the total) had RTA. Sixteen of these patients had type 1 RTA and 2 had type 2 RTA; type 4 RTA was not determined in any of the patients. CONCLUSION RTA should be considered in SLE patients even if they have normal eGFR values. This is the largest study to examine the prevalence of RTA in SLE patients in the literature.
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Affiliation(s)
- Necmi Eren
- Department of Nephrology, Medical Faculty, Kocaeli University, Kocaeli, Turkey,
| | - Ozkan Gungor
- Department of Nephrology, Medical Faculty, Kahramanmaraş Sutcu Imam University, Kahramanmaras, Turkey
| | - Feyza Nur Sarisik
- Department of Nephrology, Medical Faculty, Kahramanmaraş Sutcu Imam University, Kahramanmaras, Turkey
| | - Fatih Sokmen
- Department of Nephrology, Medical Faculty, Kahramanmaraş Sutcu Imam University, Kahramanmaras, Turkey
| | - Didem Tutuncu
- Department of Nephrology, Medical Faculty, Kahramanmaraş Sutcu Imam University, Kahramanmaras, Turkey
| | - Gozde Yildirim Cetin
- Department of Nephrology, Medical Faculty, Kahramanmaraş Sutcu Imam University, Kahramanmaras, Turkey
| | - Ayten Yazici
- Department of Rheumatology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Sibel Gökçay Bek
- Department of Nephrology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Eda Altun
- Department of Nephrology, Gölcük State Hospital, Kocaeli, Turkey
| | - Orcun Altunoren
- Department of Nephrology, Medical Faculty, Kahramanmaraş Sutcu Imam University, Kahramanmaras, Turkey
| | - Ayse Cefle
- Department of Rheumatology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
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Avila-Poletti D, De Azevedo L, Iommi C, Heldal K, Musso CG. Hyperchloremic metabolic acidosis in the kidney transplant patient. Postgrad Med 2019; 131:171-175. [PMID: 30924703 DOI: 10.1080/00325481.2019.1592360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hyperchloremic metabolic acidosis of renal origin results from a defect in renal tubular acidification mechanism, and this tubular dysfunction can consist of an altered tubular proton secretion or bicarbonate reabsorption capability. Studies have documented that all forms of renal tubular acidosis (RTA), type I to IV, are documented in kidney transplant patients. Among RTA pathophysiologic mechanisms have been described the renal mass reduction, hyperkalemia, hyperparathyroidism, graft rejection, immunologic diseases, and some drugs such as renin-angiotensin-aldosterone blockers, and calcineurin inhibitors. RTA can lead to serious complications as is the case of muscle protein catabolism, muscle protein synthesis inhibition, renal osteodystrophy, renal damage progression, and anemia promotion. RTA should be treated by suppressing its etiologic factor (if it is possible), avoiding hyperkalemia, and/or supplying bicarbonate or a precursor (citrate). In conclusion: Hyperchloremic metabolic acidosis of renal origin is a relatively frequent complication in kidney transplantation patients, which can be harmful, and should be adequately treated in order to avoid its renal and systemic adverse effects.
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Affiliation(s)
- Debora Avila-Poletti
- a Human Physiology Department , Instituto Universitario del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Leticia De Azevedo
- a Human Physiology Department , Instituto Universitario del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Candela Iommi
- a Human Physiology Department , Instituto Universitario del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - Kristian Heldal
- b Clinic of Internal Medicine, Telemark Hospital Trust , Skien , Norway.,c Institute of Clinical Medicine, Faculty of Medicine of University of Oslo , Oslo , Norway
| | - Carlos G Musso
- a Human Physiology Department , Instituto Universitario del Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
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Pochineni V, Rondon-Berrios H. Electrolyte and Acid-Base Disorders in the Renal Transplant Recipient. Front Med (Lausanne) 2018; 5:261. [PMID: 30333977 PMCID: PMC6176109 DOI: 10.3389/fmed.2018.00261] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022] Open
Abstract
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.
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Affiliation(s)
- Vaishnavi Pochineni
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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López-Cayuqueo KI, Chavez-Canales M, Pillot A, Houillier P, Jayat M, Baraka-Vidot J, Trepiccione F, Baudrie V, Büsst C, Soukaseum C, Kumai Y, Jeunemaître X, Hadchouel J, Eladari D, Chambrey R. A mouse model of pseudohypoaldosteronism type II reveals a novel mechanism of renal tubular acidosis. Kidney Int 2018; 94:514-523. [PMID: 30146013 DOI: 10.1016/j.kint.2018.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 02/04/2023]
Abstract
Pseudohypoaldosteronism type II (PHAII) is a genetic disease characterized by association of hyperkalemia, hyperchloremic metabolic acidosis, hypertension, low renin, and high sensitivity to thiazide diuretics. It is caused by mutations in the WNK1, WNK4, KLHL3 or CUL3 gene. There is strong evidence that excessive sodium chloride reabsorption by the sodium chloride cotransporter NCC in the distal convoluted tubule is involved. WNK4 is expressed not only in distal convoluted tubule cells but also in β-intercalated cells of the cortical collecting duct. These latter cells exchange intracellular bicarbonate for external chloride through pendrin, and therefore, account for renal base excretion. However, these cells can also mediate thiazide-sensitive sodium chloride absorption when the pendrin-dependent apical chloride influx is coupled to apical sodium influx by the sodium-driven chloride/bicarbonate exchanger. Here we determine whether this system is involved in the pathogenesis of PHAII. Renal pendrin activity was markedly increased in a mouse model carrying a WNK4 missense mutation (Q562E) previously identified in patients with PHAII. The upregulation of pendrin led to an increase in thiazide-sensitive sodium chloride absorption by the cortical collecting duct, and it caused metabolic acidosis. The function of apical potassium channels was altered in this model, and hyperkalemia was fully corrected by pendrin genetic ablation. Thus, we demonstrate an important contribution of pendrin in renal regulation of sodium chloride, potassium and acid-base homeostasis and in the pathophysiology of PHAII. Furthermore, we identify renal distal bicarbonate secretion as a novel mechanism of renal tubular acidosis.
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Affiliation(s)
- Karen I López-Cayuqueo
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France; Centro de Estudios Científicos, Valdivia, Chile
| | - Maria Chavez-Canales
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France
| | - Alexia Pillot
- Centre National de la Recherche Scientifique Equipe de Recherche Labelisée 8228, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche_S1138, Centre de Recherche des Cordeliers, Paris, France
| | - Pascal Houillier
- Centre National de la Recherche Scientifique Equipe de Recherche Labelisée 8228, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche_S1138, Centre de Recherche des Cordeliers, Paris, France; Genetics, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Maximilien Jayat
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France
| | - Jennifer Baraka-Vidot
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1188, CYROI, Sainte Clotilde, La Réunion, France
| | - Francesco Trepiccione
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France
| | - Véronique Baudrie
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France; Genetics, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Cara Büsst
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France
| | - Christelle Soukaseum
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France
| | - Yusuke Kumai
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France
| | - Xavier Jeunemaître
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France; Genetics, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Juliette Hadchouel
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France
| | - Dominique Eladari
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France; Service d'Explorations Fonctionnelles Rénales, Hôpital Felix Guyon, CHU de la Réunion, Saint Denis, La Réunion, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1188, CYROI, Sainte Clotilde, La Réunion, France.
| | - Régine Chambrey
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1188, CYROI, Sainte Clotilde, La Réunion, France; Centre National de la Recherche Scientifique, Délégation Paris Michel-Ange, Paris, France.
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Abstract
Distal renal tubular acidosis (DRTA) is defined as hyperchloremic, non-anion gap metabolic acidosis with impaired urinary acid excretion in the presence of a normal or moderately reduced glomerular filtration rate. Failure in urinary acid excretion results from reduced H+ secretion by intercalated cells in the distal nephron. This results in decreased excretion of NH4+ and other acids collectively referred as titratable acids while urine pH is typically above 5.5 in the face of systemic acidosis. The clinical phenotype in patients with DRTA is characterized by stunted growth with bone abnormalities in children as well as nephrocalcinosis and nephrolithiasis that develop as the consequence of hypercalciuria, hypocitraturia, and relatively alkaline urine. Hypokalemia is a striking finding that accounts for muscle weakness and requires continued treatment together with alkali-based therapies. This review will focus on the mechanisms responsible for impaired acid excretion and urinary potassium wastage, the clinical features, and diagnostic approaches of hypokalemic DRTA, both inherited and acquired.
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Yuan LP, Bo Y, Qin Z, Ran H, Li W, Li YF, Ming G. Expression of Acid-Sensing Ion Channels in Renal Tubular Epithelial Cells and Their Role in Patients with Henoch-Schönlein Purpura Nephritis. Med Sci Monit 2017; 23:1916-1922. [PMID: 28428534 PMCID: PMC5408900 DOI: 10.12659/msm.904132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Acid-sensing ion channels (ASICs) are ligand-gated cation channels activated by extracellular protons. However, the role of ASICs in kidney diseases remains uncertain. This study investigated ASICs expression in kidney tissues and their role in the development of Henoch-Schönlein purpura nephritis (HSPN). Material/Methods The expression of ASIC subunits was examined by immunochemical techniques in the kidney tissue from HSPN patients. Acid-induced ASICs expression in cultured renal tubular epithelial cells was determined by quantitative RT-PCR analysis. The expression of K7 and K18 protein in renal tubular epithelial cells was used to evaluate acid-induced cell injury. In addition, we observed the effect of blocking ASICs on acid-induced cell injury to assess the role of ASICs in renal tubular epithelial cell injury. Results The results showed that ASIC1, ASIC2, and ASIC3 proteins were obviously expressed in renal tubular cells from HSPN patients. ASIC1 expression and 24-h urine protein level were higher in the pathological grade ISKD III group than in the ISKD II group. ASIC1, ASIC2, and ASIC3 mRNA, and K7 and K18 protein expression in cultured renal tubular epithelial cells were increased when exposed to pH 6.5. K7 and K18 protein expression was closely related to ASIC1 expression, and ASICs blockers reduced K7 and K18 protein expression in tubular epithelial cells. Conclusions These findings suggest ASICs are most highly expressed in renal tubular cells of HSPN patients, which is closely related to renal tubular injury. ASICs might be involved in the development of HSPN.
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Affiliation(s)
- Li-Ping Yuan
- Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Yan Bo
- Department of Medical Technology, Anhui Medical College, Hefei, Anhui, China (mainland)
| | - Zhang Qin
- Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Hua Ran
- Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Wang Li
- Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Yu-Fei Li
- Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Gui Ming
- Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
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Garoufi A, Drapanioti S, Marmarinos A, Askiti V, Mitsioni AJ, Mila M, Grigoriadou G, Georgakopoulos D, Stefanidis CJ, Gourgiotis D. Plasma Urotensin II levels in children and adolescents with chronic kidney disease: a single-centre study. BMC Nephrol 2017; 18:113. [PMID: 28359257 PMCID: PMC5374664 DOI: 10.1186/s12882-017-0530-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/24/2017] [Indexed: 02/07/2023] Open
Abstract
Background Increased plasma Urotensin II (UII) levels have been found in adults with renal diseases. Studies in children are scarce. The objective of the study is to estimate plasma UII levels in subjects with chronic kidney disease (CKD) stages 3 to 5 and renal transplant recipients (RTR). In addition, the correlation of UII with anthropometric features and biochemical parameters was assessed. Methods Fifty-four subjects, aged 3 to 20 years old, 23 with CKD, 13 with end-stage kidney disease (ESKD) undergoing hemodialysis (HD) and 18 RTR were enrolled. A detailed clinical evaluation was performed. Biochemical parameters of renal and liver function were measured. Plasma UII levels were measured in all patients and in 117 healthy controls, using a high sensitive enzyme immunoassay (EIA) kit. All data were analyzed using STATA™ (Version 10.1). Results Median UII and mean log-transformed UII levels were significantly higher in CKD and RTR patients compared to healthy subjects (p < 0.001). HD patients had higher but not statistically significant UII and log-UII levels than controls. UII levels increased significantly at the end of the HD session and were higher than controls and in line to those of other patients. The geometric scores of UII in HD (before dialysis), CKD and RTR patients increased respectively by 42, 136 and 164% in comparison with controls. Metabolic acidosis was associated with statistical significant change in log-UII levels (p = 0.001). Patients with metabolic acidosis had an increase in UII concentration by 76% compared to those without acidosis. Conclusions Children and adolescents with CKD, particularly those who are not on HD and RTR, have significantly higher levels of UII than healthy subjects. UII levels increase significantly at the end of the HD session. The presence of metabolic acidosis affects significantly plasma UII levels.
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Affiliation(s)
- Anastasia Garoufi
- Second Department of Pediatrics, Medical School, National and Kapodistrian University of Athens,"P. & A. Kyriakou" Childrens' Hospital, Thivon & Levadias str, 11527, Athens, Greece.
| | - Styliani Drapanioti
- Second Department of Pediatrics, Medical School, National and Kapodistrian University of Athens,"P. & A. Kyriakou" Childrens' Hospital, Thivon & Levadias str, 11527, Athens, Greece
| | - Antonios Marmarinos
- Laboratory of Clinical Biochemistry - Molecular Diagnostic, Medical School, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Childrens' Hospital, Thivon & Levadias str, 11527, Athens, Greece
| | - Varvara Askiti
- Department of Nephrology, "P. & A. Kyriakou" Childrens' Hospital, Thivon & Levadias str, 11527, Athens, Greece
| | - Andromachi J Mitsioni
- Department of Nephrology, "P. & A. Kyriakou" Childrens' Hospital, Thivon & Levadias str, 11527, Athens, Greece
| | - Maria Mila
- Department of Nephrology, "P. & A. Kyriakou" Childrens' Hospital, Thivon & Levadias str, 11527, Athens, Greece
| | | | | | - Constantinos J Stefanidis
- Department of Nephrology, "P. & A. Kyriakou" Childrens' Hospital, Thivon & Levadias str, 11527, Athens, Greece
| | - Dimitrios Gourgiotis
- Laboratory of Clinical Biochemistry - Molecular Diagnostic, Medical School, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Childrens' Hospital, Thivon & Levadias str, 11527, Athens, Greece
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Park S, Kang E, Park S, Kim YC, Han SS, Ha J, Kim DK, Kim S, Park SK, Han DJ, Lim CS, Kim YS, Lee JP, Kim YH. Metabolic Acidosis and Long-Term Clinical Outcomes in Kidney Transplant Recipients. J Am Soc Nephrol 2016; 28:1886-1897. [PMID: 28031407 DOI: 10.1681/asn.2016070793] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/23/2016] [Indexed: 01/07/2023] Open
Abstract
Metabolic acidosis (MA), indicated by low serum total CO2 (TCO2) 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 TCO2 concentration and clinical outcomes. The prevalence of low TCO2 concentration (<22 mmol/L) began to increase in KTRs with eGFR<60 ml/min per 1.73 m2 and ranged from approximately 30% to 70% in KTRs with eGFR<30 ml/min per 1.73 m2 Multivariable Cox proportional hazards models revealed that low TCO2 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 TCO2 concentration additionally demonstrated significant associations between low TCO2 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 TCO2 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.
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Affiliation(s)
| | | | | | | | | | - Jongwon Ha
- Surgery, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | - Duck Jong Han
- Division of Kidney Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; and
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | | | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Hoon Kim
- Division of Kidney Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; and
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