Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap

Kaimori Jun-Ya; Sakaguchi Yusuke; Kajimoto Sachio; Asahina Yuta; Oka Tatsufumi; Hattori Koki; Doi Yohei; Isaka Yoshitaka

doi:10.23876/j.krcp.21.200

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자료유형: 학술저널

저자정보: Kaimori Jun-Ya (Osaka University Graduate School of Medicine Osaka Japan) Sakaguchi Yusuke (Osaka University Graduate School of Medicine Osaka Japan) Kajimoto Sachio (Osaka University Graduate School of Medicine Osaka Japan) Asahina Yuta (Osaka University Graduate School of Medicine Osaka Japan) Oka Tatsufumi (Osaka University Graduate School of Medicine Osaka Japan) Hattori Koki (Osaka University Graduate School of Medicine Osaka Japan) Doi Yohei (Osaka University Graduate School of Medicine Osaka Japan) Isaka Yoshitaka (Osaka University Graduate School of Medicine Osaka Japan)

저널정보: 대한신장학회 Kidney Research and Clinical Practice Kidney Research and Clinical Practice Vol.41 No.3

발행연도: 2022.6

수록면: 288 - 297 (10page)

DOI: 10.23876/j.krcp.21.200

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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.

#Anion gap #Hydrogen-ion concentration #Metabolic acidosis

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