Posttransplant Acidosis and Associated Disorders of Mineral Metabolism in Patients With a Renal Graft

Yakupoglu, Haci Yakup; Corsenca, Alf; Wahl, Patricia W.; Wüthrich, Rudolf P.; Ambühl, Patrice M.

doi:10.1097/01.tp.0000287430.19960.0e

Cited by 47 publications

(41 citation statements)

References 37 publications

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“…Therefore, it is hypothesized that dietary modifications could improve acid-base homeostasis in RTRs. Although post-transplant acidosis has been studied before (4,5), to our knowledge no studies have assessed the role of nutrition in acidosis in RTRs.…”

Section: Introductionmentioning

confidence: 99%

“…Although kidney transplantation is the preferred treatment for patients with ESRD, successful transplantation is still associated with substantially elevated morbidity and mortality (2,3). Many renal transplant recipients (RTRs) have metabolic acidosis (4,5), which may adversely affect cardiometabolic processes, including BP and insulin resistance, as well as proper functioning of multiple tissues (4,6,7). Therefore, it is important to identify modifiable determinants of metabolic acidosis that might help improve acid-base homeostasis in RTRs.…”

Section: Introductionmentioning

confidence: 99%

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Dietary Acid Load and Metabolic Acidosis in Renal Transplant Recipients

Berg

Engberink

Brink

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Acidosis is prevalent among renal transplant recipients (RTRs) and adversely affects cardiometabolic processes. Factors contributing to acidosis are graft dysfunction and immunosuppressive drugs. Little is known about the potential influence of diet on acidosis in RTRs. This study examined the association of metabolic acid load with acidosis and with cardiovascular risk factors in RTRs and aimed to identify dietary factors associated with acidosis.Design, participants, setting, & measurements 707 RTRs were included. Metabolic acid load was assessed by measuring 24-hour urinary net acid excretion (NAE; i.e., titratable acid + ammonium 2 bicarbonate). Acidosis was defined as serum [HCO 3 2 ] , 24 mmol/L. BP and insulin resistance, reflected by hemoglobin A1c, were among cardiovascular risk factors. Diet was assessed with food-frequency questionnaires. Linear regression analysis was applied to investigate association between NAE and acidosis and between dietary factors and acidosis.Results Mean age 6 SD was 53613 years; 57% of patients were male. Acidosis was present in 31% of RTRs. NAE was associated with acidosis (serum HCO 3 2 : b=20.61; serum pH: b=20.010; both P,0.001). Patients with high intake of animal protein (i.e., from meat, cheese, and fish) and low intake of fruits and vegetables had significantly lower serum HCO 3 2 and serum pH. No associations were observed between NAE and cardiovascular risk factors, such as hypertension and insulin resistance.Conclusions In addition to conventional factors contributing to acidosis, diet might influence acid-base homeostasis in RTRs. Higher intake of fruits and vegetables and lower animal protein intake is associated with less acidosis in RTRs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dietary Acid Load and Metabolic Acidosis in Renal Transplant Recipients

Berg

Engberink

Brink

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…24,25 Encontramos, no TxR tardio, hipercalcemia em 25% dos pacientes e HPS persistente em 24%-75% dos pacientes, de acordo com a função renal residual. 22,23,26 A hipovitaminose D correlaciona-se com maiores níveis de PTH, independentemente do grau de função renal. 22,25 Outra alteração importante é a acidose metabólica, associada com HPS e disfunção do enxerto.…”

Section: Racionalunclassified

“…22,25 Outra alteração importante é a acidose metabólica, associada com HPS e disfunção do enxerto. 26 Os corticosteroides são uma droga deletéria ao tecido ósseo, estando associados à perda de massa óssea e inciência de fraturas. Os corticosteroides diminuem a formação óssea, promovendo menor diferenciação e função dos osteoblastos e maior apoptose de osteoblastos e osteócitos.…”

Section: Racionalunclassified

Distúrbio mineral e ósseo após o transplante renal

Gueiros¹,

Neves²,

Sampaio³

et al. 2011

J. Bras. Nefrol.

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“…Metabolic acidosis may be an important contributor because it has been shown to be highly prevalent in renal transplant patients and to be associated with disturbances in mineral metabolism (8). The resorptive activity of osteoclasts in vitro is inversely related with systemic pH (9,10).…”

Section: Introductionmentioning

confidence: 99%

Correction of Metabolic Acidosis with Potassium Citrate in Renal Transplant Patients and its Effect on Bone Quality

Starke

Corsenca

Köhler

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground Acidosis and transplantation are associated with increased risk of bone disturbances. This study aimed to assess bone morphology and metabolism in acidotic patients with a renal graft, and to ameliorate bone characteristics by restoration of acid/base homeostasis with potassium citrate.Methods This was a 12-month controlled, randomized, interventional trial that included 30 renal transplant patients with metabolic acidosis (S- [HCO 3 2 ] ,24 mmol/L) undergoing treatment with either potassium citrate to maintain S- [HCO 3 2 ] .24 mmol/L, or potassium chloride (control group). Iliac crest bone biopsies and dual-energy X-ray absorptiometry were performed at baseline and after 12 months of treatment. Bone biopsies were analyzed by in vitro micro-computed tomography and histomorphometry, including tetracycline double labeling. Serum biomarkers of bone turnover were measured at baseline and study end. Twenty-three healthy participants with normal kidney function comprised the reference group. Results Administration of potassium citrate resulted in persisting normalization of S-[HCO 32 ] versus potassium chloride. At 12 months, bone surface, connectivity density, cortical thickness, and cortical porosity were better preserved with potassium citrate than with potassium chloride, respectively. Serological biomarkers and bone tetracycline labeling indicate higher bone turnover with potassium citrate versus potassium chloride. In contrast, no relevant changes in bone mineral density were detected by dual-energy X-ray absorptiometry.Conclusions Treatment with potassium citrate in renal transplant patients is efficient and well tolerated for correction of metabolic acidosis and may be associated with improvement in bone quality. This study is limited by the heterogeneity of the investigated population with regard to age, sex, and transplant vintage.

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Posttransplant Acidosis and Associated Disorders of Mineral Metabolism in Patients With a Renal Graft

Cited by 47 publications

References 37 publications

Dietary Acid Load and Metabolic Acidosis in Renal Transplant Recipients

Dietary Acid Load and Metabolic Acidosis in Renal Transplant Recipients

Distúrbio mineral e ósseo após o transplante renal

Correction of Metabolic Acidosis with Potassium Citrate in Renal Transplant Patients and its Effect on Bone Quality

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