Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap
Metabolic acidosis is one of the most common complications of chronic kidney disease (CKD). It is associated with the progression of CKD, and many other functional impairments. Until recently, only serum bicarbonate levels have been used to evaluate acid-base changes in patients with reduced kidney...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The Korean Society of Nephrology
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9184836/ https://www.ncbi.nlm.nih.gov/pubmed/35172536 http://dx.doi.org/10.23876/j.krcp.21.200 |
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author | Kaimori, Jun-Ya Sakaguchi, Yusuke Kajimoto, Sachio Asahina, Yuta Oka, Tatsufumi Hattori, Koki Doi, Yohei Isaka, Yoshitaka |
author_facet | Kaimori, Jun-Ya Sakaguchi, Yusuke Kajimoto, Sachio Asahina, Yuta Oka, Tatsufumi Hattori, Koki Doi, Yohei Isaka, Yoshitaka |
author_sort | Kaimori, Jun-Ya |
collection | PubMed |
description | Metabolic acidosis is one of the most common complications of chronic kidney disease (CKD). It is associated with the progression of CKD, and many other functional impairments. Until recently, only serum bicarbonate levels have been used to evaluate acid-base changes in patients with reduced kidney function. However, recent emerging evidence suggests that nephrologists should reevaluate the clinical approach for diagnosing metabolic acidosis in patients with CKD based on two perspectives; pH and anion gap. Biochemistry and physiology textbooks clearly indicate that blood pH is the most important acid-base parameter for cellular function. Therefore, it is important to determine if the prognostic impact of hypobicarbonatemia varies according to pH level. A recent cohort study of CKD patients showed that venous pH modified the association between a low bicarbonate level and the progression of CKD. Furthermore, acidosis with a high anion gap has recently been recognized as an important prognostic factor, because veverimer, a nonabsorbable hydrochloride-binding polymer, has been shown to improve kidney function and decrease the anion gap. Acidosis with high anion gap frequently develops in later stages of CKD. Therefore, the anion gap is a time-varying factor and renal function (estimated glomerular filtration rate) is a time-dependent confounder for the anion gap and renal outcomes. Recent analyses using marginal structural models showed that acidosis with a high anion gap was associated with a high risk of CKD. Based on these observations, reconsideration of the clinical approach to diagnosing and treating metabolic acidosis in CKD may be warranted. |
format | Online Article Text |
id | pubmed-9184836 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | The Korean Society of Nephrology |
record_format | MEDLINE/PubMed |
spelling | pubmed-91848362022-06-14 Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap Kaimori, Jun-Ya Sakaguchi, Yusuke Kajimoto, Sachio Asahina, Yuta Oka, Tatsufumi Hattori, Koki Doi, Yohei Isaka, Yoshitaka Kidney Res Clin Pract Review Article Metabolic acidosis is one of the most common complications of chronic kidney disease (CKD). It is associated with the progression of CKD, and many other functional impairments. Until recently, only serum bicarbonate levels have been used to evaluate acid-base changes in patients with reduced kidney function. However, recent emerging evidence suggests that nephrologists should reevaluate the clinical approach for diagnosing metabolic acidosis in patients with CKD based on two perspectives; pH and anion gap. Biochemistry and physiology textbooks clearly indicate that blood pH is the most important acid-base parameter for cellular function. Therefore, it is important to determine if the prognostic impact of hypobicarbonatemia varies according to pH level. A recent cohort study of CKD patients showed that venous pH modified the association between a low bicarbonate level and the progression of CKD. Furthermore, acidosis with a high anion gap has recently been recognized as an important prognostic factor, because veverimer, a nonabsorbable hydrochloride-binding polymer, has been shown to improve kidney function and decrease the anion gap. Acidosis with high anion gap frequently develops in later stages of CKD. Therefore, the anion gap is a time-varying factor and renal function (estimated glomerular filtration rate) is a time-dependent confounder for the anion gap and renal outcomes. Recent analyses using marginal structural models showed that acidosis with a high anion gap was associated with a high risk of CKD. Based on these observations, reconsideration of the clinical approach to diagnosing and treating metabolic acidosis in CKD may be warranted. The Korean Society of Nephrology 2022-05 2022-01-10 /pmc/articles/PMC9184836/ /pubmed/35172536 http://dx.doi.org/10.23876/j.krcp.21.200 Text en Copyright © 2022 The Korean Society of Nephrology https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial and No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) which permits unrestricted non-commercial use, distribution of the material without any modifications, and reproduction in any medium, provided the original works properly cited. |
spellingShingle | Review Article Kaimori, Jun-Ya Sakaguchi, Yusuke Kajimoto, Sachio Asahina, Yuta Oka, Tatsufumi Hattori, Koki Doi, Yohei Isaka, Yoshitaka Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap |
title | Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap |
title_full | Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap |
title_fullStr | Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap |
title_full_unstemmed | Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap |
title_short | Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap |
title_sort | diagnosing metabolic acidosis in chronic kidney disease: importance of blood ph and serum anion gap |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9184836/ https://www.ncbi.nlm.nih.gov/pubmed/35172536 http://dx.doi.org/10.23876/j.krcp.21.200 |
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