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Metabolic Acidosis Is an Independent Risk Factor of Renal Progression in Korean Chronic Kidney Disease Patients: The KNOW-CKD Study Results

Title
Metabolic Acidosis Is an Independent Risk Factor of Renal Progression in Korean Chronic Kidney Disease Patients: The KNOW-CKD Study Results
Authors
Kim, Hyo JinRyu, HyunjinKang, EunjeongKang, MinjungHan, MiyeunSong, Sang HeonLee, JoongyubJung, Ji YongLee, Kyu-BeckSung, SuahSeong, Eun YoungAhn, CurieOh, Kook-Hwan
Ewha Authors
강은정
SCOPUS Author ID
강은정scopus
Issue Date
2021
Journal Title
FRONTIERS IN MEDICINE
ISSN
2296-858XJCR Link
Citation
FRONTIERS IN MEDICINE vol. 8
Keywords
metabolic acidosisserum bicarbonatechronic kidney diseaserenal progressionrenal function decline
Publisher
FRONTIERS MEDIA SA
Indexed
SCIE; SCOPUS WOS
Document Type
Article
Abstract
Background: We aimed to evaluate serum bicarbonate as a risk factor for renal progression, cardiovascular events, and mortality in Korean CKD patients. Methods: We analyzed 1,808 participants from a Korean CKD cohort whose serum bicarbonate levels were measured at enrollment. Serum bicarbonate levels were categorized as low, lower normal, higher normal, and high (total carbon dioxide <22, 22-26, 26.1-29.9, and >= 30 mmol/L, respectively) groups. Metabolic acidosis was defined as a serum bicarbonate level <22 mmol/L. The primary outcome was renal events defined as doubling of serum creatinine, 50% reduction of eGFR from the baseline values, or development of end-stage kidney disease. The secondary outcome consisted of cardiovascular events and death. In addition, patients whose eGFR values were measured more than three times during the follow-up period were analyzed for eGFR decline. The rapid decline in eGFR was defined as lower than the median value of the eGFR slope. Results: The mean serum bicarbonate level was 25.7 +/- 3.7 mmol/L and 240 (13.2%) patients had metabolic acidosis. During the follow-up period of 55.2 +/- 24.1 months, 545 (30.9%) patients developed renal events and 187 (10.6%) patients developed a composite of cardiovascular events and death. After adjustment, the low serum bicarbonate group experienced 1.27 times more renal events than the lower normal bicarbonate group [hazard ratio (HR): 1.27; 95% CI: 1.01-1.60, P = 0.043]. There was no significant association between the bicarbonate groups and the composite outcome of cardiovascular events and death. The low bicarbonate group showed a significantly rapid decline in eGFR [odds ratio (OR): 2.12; 95% CI: 1.39-3.22, P < 0.001] compared to the lower normal bicarbonate group. Conclusions: Metabolic acidosis was significantly associated with increased renal events and a rapid decline in renal function in Korean predialysis CKD patients.
DOI
10.3389/fmed.2021.707588
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의료원 > 의료원 > Journal papers
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