Spot urinary citrate-to-creatinine ratio is a marker for acid-base status in chronic kidney disease

Gianella, Fabiola; Prado, Víctor; Poindexter, John R.; Adams‐Huet, Beverley; Li, Xilong; Miller, R. Tyler; Sakhaee, Khashayar; Maalouf, Naim M.; Moe, Orson W.

doi:10.1016/j.kint.2020.07.006

Cited by 37 publications

(28 citation statements)

References 65 publications

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“…endothelin or the renin–angiotensin–aldosterone system), while blood pH, HCO 3 − and partial pressure of arterial CO 2 remain within normal limits. This concept is based mostly on observations in rat CKD models and lower urinary citrate excretion in patients with CKD [ 16 , 17 ]. Unfortunately, no methods exist that allow measurement of local tissue pH with sufficient spatial and chemical resolution in vivo in humans to corroborate this model.…”

Section: Introductionmentioning

confidence: 99%

Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Silva

Unwin

Hoorn

et al. 2021

Nephrology Dialysis Transplantation

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Metabolic acidosis, defined as a plasma or serum bicarbonate concentration <22 mmol/L, is a frequent consequence of chronic kidney disease (CKD) and occurs in ~10-30% of patients with advanced stages of CKD. Likewise, in patients with a kidney transplant, prevalence rates of metabolic acidosis range from 20% to 50%. CKD has recently been associated with cognitive dysfunction, including mild cognitive impairment with memory and attention deficits, reduced executive functions and morphological damage detectable with imaging. Also, impaired motor functions and loss of muscle strength are often found in patients with advanced CKD, which in part may be attributed to altered central nervous system (CNS) functions. While the exact mechanisms of how CKD may cause cognitive dysfunction and reduced motor functions are still debated, recent data point towards the possibility that acidosis is one modifiable contributor to cognitive dysfunction. This review summarizes recent evidence for an association between acidosis and cognitive dysfunction in patients with CKD and discusses potential mechanisms by which acidosis may impact CNS functions. The review also identifies important open questions to be answered to improve prevention and therapy of cognitive dysfunction in the setting of metabolic acidosis in patients with CKD.

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Section: Introductionmentioning

confidence: 99%

Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Silva

Unwin

Hoorn

et al. 2021

Nephrology Dialysis Transplantation

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“…In the present series, the group with a high BF consisted of 55 out of 65 (84.7%) subjects with a BMI ≥ 25 kg/m 2 . Furthermore, metabolic acidosis is a common complication of moderate to severe CKD and has been shown to increase the risk of CKD progression; as eGFR decreases, there is less excretion of ammonia and alkalis [48,49]. Interestingly, Blijdorp et al [50] reported an inverse association between serum bicarbonate and risk of eGFR decline or renal failure in a cohort of ADPKD patients.…”

Section: Discussionmentioning

confidence: 99%

Increased Body Fat and Organic Acid Anions Production Are Associated with Larger Kidney Size in ADPKD

et al. 2022

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Background and Objectives: A high body mass index (BMI) is associated with the progression of autosomal dominant polycystic kidney disease (ADPKD). However, body fat (BF), which is another adiposity marker, has not yet been studied. Excessive weight may promote elevation in the endogenous synthesis of organic acid (OA) anions. Accordingly, we aimed to investigate the possible association of the aforementioned markers with kidney volume and renal function in patients with ADPKD. Materials and Methods: We conducted a retrospective cohort study of adult ADPKD outpatients involving clinical, serum, and urinary laboratorial data and body composition assessments retrieved from their medical records. BF was estimated by skinfold thickness (mm) on the non-dominant arm and was considered as normal or high for each sex. Total kidney volume (TKV) and height-adjusted volume (htTKV) were measured by magnetic resonance imaging. The annual estimated glomerular filtration rate (eGFR) slope was analyzed during a median follow-up time of 6 (5.0–7.0) years to calculate rapid progression (decline in renal function ≥2.5 mL/min/year over 5 years). Results: A total of 104 patients were included (41.9 ± 11.9 years old, 38.5% men), with 62.5% of the patients classified as high BF. The High BF group presented higher levels of OA, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), 24 h urinary sodium (UNa), and htTKV, and lower eGFR than those with a normal BF. In the multivariate linear regression, the associated variables with TKV were high BF, OA and BMI (std. β 0.47, p < 0.05; std. β 0.36, p = 0.001; std. β 0.25, p = 0.01, respectively). In the binary logistic regression, when adjusted for potential confounders, UNa was the only parameter associated with an increased risk of eGFR decline ≥2.5 mL/min/year (OR 1.02, 95% CI 1.01–1.03, p = 0.02). Conclusions: Increased body fat and endogenous production of organic acid anions are associated with larger kidney size in ADPKD but not with a decline in renal function.

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“…The reduction of urinary citrate excretion and, by inference, the proximal tubule luminal citrate concentration, is a very early event in CKD. Importantly, reducing urinary citrate excretion increases the risk of calcium phosphate precipitation and luminal crystallopathy (15). The proximal reclamation of filtered citrate leaves its luminal concentration in the end of the proximal tubule sufficiently low, such that when luminal phosphate concentrations increase, as occurs in CKD, there is a marked risk for calcium phosphate precipitation.…”

Section: Discussionmentioning

confidence: 99%

A generic crystallopathic model for chronic kidney disease progression

Moe¹

2021

Journal of Clinical Investigation

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Chronic kidney disease progression is universalChronic kidney disease (CKD) has reached epidemic proportions globally, imparting dire health and economic burdens on humankind. The progression of CKD appears to be nearly universal, regardless of the underlying etiology, strongly indicating that there are common underlying pathogenic mechanisms that drive the downward spiral of CKD from diverse causes. The prevalence of patients with stage 3 CKD far exceeds that of patients with more advanced stage 4 and 5 CKD (1). One would prefer to believe that a substantial fraction of patients with stage 3 CKD are stable without progression, but the sobering and disturbing fact is that stage 3 CKD has a high mortality rate. It is more likely that a patient with stage 3 CKD will die before reaching endstage kidney disease.

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Spot urinary citrate-to-creatinine ratio is a marker for acid-base status in chronic kidney disease

Cited by 37 publications

References 65 publications

Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Acidosis, cognitive dysfunction and motor impairments in patients with kidney disease

Increased Body Fat and Organic Acid Anions Production Are Associated with Larger Kidney Size in ADPKD

A generic crystallopathic model for chronic kidney disease progression

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