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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| Format: | Article |
| Language: | English |
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The Korean Society of Nephrology
2022-05-01
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| Series: | Kidney Research and Clinical Practice |
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| Online Access: | http://www.krcp-ksn.org/upload/pdf/j-krcp-21-200.pdf |
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| author | Jun-Ya Kaimori Yusuke Sakaguchi Sachio Kajimoto Yuta Asahina Tatsufumi Oka Koki Hattori Yohei Doi Yoshitaka Isaka |
| author_facet | Jun-Ya Kaimori Yusuke Sakaguchi Sachio Kajimoto Yuta Asahina Tatsufumi Oka Koki Hattori Yohei Doi Yoshitaka Isaka |
| author_sort | Jun-Ya Kaimori |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-13T10:27:14Z |
| format | Article |
| id | doaj.art-57cfbfed951c4119b3f89a44210fa489 |
| institution | Directory Open Access Journal |
| issn | 2211-9132 2211-9140 |
| language | English |
| last_indexed | 2024-04-13T10:27:14Z |
| publishDate | 2022-05-01 |
| publisher | The Korean Society of Nephrology |
| record_format | Article |
| series | Kidney Research and Clinical Practice |
| spelling | doaj.art-57cfbfed951c4119b3f89a44210fa4892022-12-22T02:50:16ZengThe Korean Society of NephrologyKidney Research and Clinical Practice2211-91322211-91402022-05-0141328829710.23876/j.krcp.21.2006108Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gapJun-Ya Kaimori0Yusuke Sakaguchi1Sachio Kajimoto2Yuta Asahina3Tatsufumi Oka4Koki Hattori5Yohei Doi6Yoshitaka Isaka7 Department of Inter-Organ Communication Research in Kidney Diseases, Osaka University Graduate School of Medicine, Osaka, Japan Department of Inter-Organ Communication Research in Kidney Diseases, Osaka University Graduate School of Medicine, Osaka, Japan Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, JapanMetabolic 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.http://www.krcp-ksn.org/upload/pdf/j-krcp-21-200.pdfanion gaphydrogen-ion concentrationmetabolic acidosis |
| spellingShingle | Jun-Ya Kaimori Yusuke Sakaguchi Sachio Kajimoto Yuta Asahina Tatsufumi Oka Koki Hattori Yohei Doi Yoshitaka Isaka Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap Kidney Research and Clinical Practice anion gap hydrogen-ion concentration metabolic acidosis |
| 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 | anion gap hydrogen-ion concentration metabolic acidosis |
| url | http://www.krcp-ksn.org/upload/pdf/j-krcp-21-200.pdf |
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