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...

Descripción completa

Detalles Bibliográficos
Autores principales: Kaimori, Jun-Ya, Sakaguchi, Yusuke, Kajimoto, Sachio, Asahina, Yuta, Oka, Tatsufumi, Hattori, Koki, Doi, Yohei, Isaka, Yoshitaka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Nephrology 2022
Materias:
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
_version_ 1784724616619491328
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
work_keys_str_mv AT kaimorijunya diagnosingmetabolicacidosisinchronickidneydiseaseimportanceofbloodphandserumaniongap
AT sakaguchiyusuke diagnosingmetabolicacidosisinchronickidneydiseaseimportanceofbloodphandserumaniongap
AT kajimotosachio diagnosingmetabolicacidosisinchronickidneydiseaseimportanceofbloodphandserumaniongap
AT asahinayuta diagnosingmetabolicacidosisinchronickidneydiseaseimportanceofbloodphandserumaniongap
AT okatatsufumi diagnosingmetabolicacidosisinchronickidneydiseaseimportanceofbloodphandserumaniongap
AT hattorikoki diagnosingmetabolicacidosisinchronickidneydiseaseimportanceofbloodphandserumaniongap
AT doiyohei diagnosingmetabolicacidosisinchronickidneydiseaseimportanceofbloodphandserumaniongap
AT isakayoshitaka diagnosingmetabolicacidosisinchronickidneydiseaseimportanceofbloodphandserumaniongap