Metabolic acidosis is common and associates with disease progression in children with chronic kidney disease

Harambat, Jérôme; Kunzmann, Kevin; Ažukaitis, Karolis; Bayazıt, Aysun Karabay; Canpolat, Nur; Doyon, Anke; Düzova, Ali; Niemirska, Anna; Sözeri, Betül; Thurn‐Valsassina, Daniela; Anarat, Ali; Bessenay, Lucie; Candan, Cengiz; Peco-Antić, Amira; Yılmaz, Alev; Tschumi, Sibylle; Testa, Sara; Jankauskienė, Augustina; Erdoğan, Hakan; Rosales, Alejandra; Alpay, Harika; Lugani, Francesca; Arbeiter, Klaus; Mencarelli, Francesca; Kıyak, Aysel; Dönmez, Osman; Drożdż, Dorota; Melk, Anette; Querfeld, Uwe; Schaefer, Franz

doi:10.1016/j.kint.2017.05.006

Cited by 75 publications

(52 citation statements)

References 36 publications

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“…Another possible line of evidence suggesting that MA is more specific to interstitial damage than to glomerular dysfunction is the high prevalence of MA in child and adolescent patients with CKD, in whom interstitial damage is more frequent than in adults with a similar eGFR. 30 The observation that anemia due to insufficient erythropoietin synthesis by cells in the interstitium of the kidneys in KTx recipients is less frequent than in CKD patients also supports this hypothesis.…”

Section: Discussionmentioning

confidence: 84%

Metabolic acidosis in patients after kidney transplantation

Skiba¹,

Gojowy²,

Szotowska³

et al. 2018

Polish Archives of Internal Medicine

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Introduction Metabolic acidosis (MA) may accelerate the progression of chronic kidney disease (CKD) and is an important risk factor for increased mortality in CKD patients. The clinical value of MA in kidney transplant (KTx) recipients has not been extensively studied so far. Objectives The aim of this clinical single‑‑center case‑‑control study was to assess the prevalence of MA in KTx recipients in comparison with CKD patients and to identify pathogenic factors for MA in KTx recipients. Patients and methods Venous blood concentrations of bicarbonate (HCO3-) and blood hemoglobin concentrations were measured in 500 KTx recipients and 500 CKD patients matched for sex, age, and estimated glomerular filtration rate (eGFR). None of these patients received alkali treatment before the study. MA was diagnosed in KTx recipients with HCO3- levels lower than 22 mmol/l. Results The prevalence of MA was lower in KTx recipients than in CKD patients (12.0% vs 19.6%; P = 0.001). In both groups, the prevalence increased with progression of CKD stages (P <0.001 for trend) and was higher in patients with anemia. In a multivariable analysis, hemoglobin concentrations correlated independently with eGFR and HCO3- in KTx recipients (β = 0.314, P <0.001 and β = 0.274, P <0.001, respectively). Similar correlations were observed in CKD patients (β = 0.273, P <0.001 and β = 0.123, P = 0.006, respectively). Conclusions Our study revealed that the prevalence of MA is lower in KTx recipients than in CKD patients. Moreover, in KTx recipients, blood bicarbonate concentrations are related to kidney function and blood hemoglobin concentrations.

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Section: Discussionmentioning

confidence: 84%

Metabolic acidosis in patients after kidney transplantation

Skiba¹,

Gojowy²,

Szotowska³

et al. 2018

Polish Archives of Internal Medicine

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“…We used ICD‐9‐CM codes signifying preterm birth up to 2500 g (765‐765.27) to exclude premature births addressed in the guideline. We excluded subjects with Medicare listed as a health insurance payer due to the possibility of complex presentations and severe comorbidities such as end stage renal disease, a condition required for Medicare eligibility among children …”

Section: Methodsmentioning

confidence: 99%

Implementing lower‐risk brief resolved unexplained events guideline reduces admissions in a modelled population

Oglesbee

Roberts

Sapién

2019

Evaluation Clinical Practice

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Rationale: American Academy of Pediatrics released a clinical practice guideline (CPG) in 2016 recommending the term apparent life-threatening events (ALTE) be replaced by brief resolved unexplained events (BRUE). The CPG provides recommendations for the clinical evaluation and management of infants with this condition based on the risk of a serious underlying disorder or repeat event. The lower-risk CPG was applied to a modelled population, studying predictors of hospital admission, defined as length of stay (LOS) ≥ 24 hours. Methods: An algorithm was derived using a Pediatric Emergency Care AppliedResearch Network database. Propensity score weighting, based on probability of following the CPG, determined the adjusted odds ratio (aOR) and 95% confidence interval (CI) of hospital admission. Multiple imputation allowed any missing data problems be addressed and a sensitivity analysis of database robustness. Results:Applying the modelling algorithm, 3116 observations were identified, among whom 1974 (63.4%) the CPG was followed and 1142 (36.6%) not followed.The CPG was followed for 60.1% of infants staying ≥24 hours compared with 76.6% of infants staying <24 hours (P < .001). After propensity score weighting and multiple imputation, the likelihood of hospital admission was significantly lower when the CPG was followed (aOR = 0.49; 95% CI, 0.39-0.62, P < .001). Conclusions:Results suggest that use of the CPG under strict conditions would lead to fewer hospital admissions among infants with a lower-risk BRUE. Implementation of CPGs in modelled populations may help clinicians identify unanticipated factors and address these issues beforehand. We noted differences in care based on race, necessitating further investigation. KEYWORDSbrief resolved unexplained events, infantile apparent life-threatening event, medical informatics, paediatric emergency medicine, practice guideline, propensity score

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“…If left untreated, this may contribute to osteopenia and growth impairment, and increase the risk of secondary hyperparathyroidism and CKD progression. 37 Advanced acidosis may contribute to hyperkalemia. Metabolic acidosis in CKD also adversely affects protein and muscle metabolism, stimulates inflammation, and enhances insulin resistance.…”

Section: Metabolic Acidosis Of Ckdmentioning

confidence: 99%

Chronic Kidney Disease and Dietary Measures to Improve Outcomes

Akchurin

2019

Pediatric Clinics of North America

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Metabolic acidosis is common and associates with disease progression in children with chronic kidney disease

Cited by 75 publications

References 36 publications

Metabolic acidosis in patients after kidney transplantation

Metabolic acidosis in patients after kidney transplantation

Implementing lower‐risk brief resolved unexplained events guideline reduces admissions in a modelled population

Chronic Kidney Disease and Dietary Measures to Improve Outcomes

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