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Metabolic acidosis of chronic kidney disease and subclinical cardiovascular disease markers: Friend or foe?

Abstract The effect of chronic metabolic acidosis (MA) on cardiovascular disease (CVD) in the setting of chronic kidney disease (CKD) is largely unknown. Therefore, we aimed to study this relationship in nondialysis CKD patients.This cross-sectional, single-center study prospectively enrolled 95 clinically stable CKD patients (median age 61 (58, 65) years, 60% male, median eGFR 27 (22, 32) mL/min). Data on CKD etiology, CVD history, CVD traditional, and nontraditional risk factors were obtained. Also, markers of subclinical CVD were assessed: intima-media thickness (IMT), abdominal aortic calcifications (Kauppila score-AACs), cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), ejection fraction, and interventricular septum thickness. Using the serum bicarbonate cutoff value of 22 mEq/L, comparisons between MA (<22 mEq/L; 43 patients) and non-MA (≥22 mEq/L; 52 patients) groups were performed.Vascular (40%), tubulointerstitial (24%), and glomerular (22%) nephropathies were the main causes of CKD. Twenty-three percent of patients had diabetes mellitus, but only 5% were considered to have diabetic nephropathy. Patients with chronic MA had lower eGFR (P < .01), higher iPTH (P = .01), higher serum phosphate (P < .01), and increased serum cholesterol (P = .04) and triglycerides (P = .01).Higher ABI (P = .04), lower IMT (P = .03), CAVI (P = .05), and AACs (P = .03) were found in patients with chronic MA.Separate binomial logistic regression models were performed using ABI (cutoff 0.9), CAVI (cutoff 9), IMT (cutoff 0.1 cm), and AACs (cutoff 1) as dependent variables. MA was used as independent variable and adjustments were made for iPTH, serum phosphate, eGFR, proteinuria, cholesterol, triglycerides, CVD score. The absence of MA was retained as an independent predictor only for the presence of AACs.In conclusion, the present study shows a potential advantageous effect of MA on vascular calcifications in predialysis CKD patients. Thus, a guideline relaxation of the serum bicarbonate target might prove to be beneficial in CKD patients at high risk of vascular calcifications. However, one should always consider the negative effects of MA. Therefore, additional research is warranted before any clear clinical recommendation.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29381982
OWN - NLM
STAT- MEDLINE
DCOM- 20180208
LR  - 20180208
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 47
DP  - 2017 Nov
TI  - Metabolic acidosis of chronic kidney disease and subclinical cardiovascular
      disease markers: Friend or foe?
PG  - e8802
LID - 10.1097/MD.0000000000008802 [doi]
AB  - The effect of chronic metabolic acidosis (MA) on cardiovascular disease (CVD) in 
      the setting of chronic kidney disease (CKD) is largely unknown. Therefore, we
      aimed to study this relationship in nondialysis CKD patients.This
      cross-sectional, single-center study prospectively enrolled 95 clinically stable 
      CKD patients (median age 61 (58, 65) years, 60% male, median eGFR 27 (22, 32)
      mL/min). Data on CKD etiology, CVD history, CVD traditional, and nontraditional
      risk factors were obtained. Also, markers of subclinical CVD were assessed:
      intima-media thickness (IMT), abdominal aortic calcifications (Kauppila
      score-AACs), cardio-ankle vascular index (CAVI), ankle-brachial index (ABI),
      ejection fraction, and interventricular septum thickness. Using the serum
      bicarbonate cutoff value of 22 mEq/L, comparisons between MA (&lt;22 mEq/L; 43
      patients) and non-MA (&gt;/=22 mEq/L; 52 patients) groups were performed.Vascular
      (40%), tubulointerstitial (24%), and glomerular (22%) nephropathies were the main
      causes of CKD. Twenty-three percent of patients had diabetes mellitus, but only
      5% were considered to have diabetic nephropathy. Patients with chronic MA had
      lower eGFR (P &lt; .01), higher iPTH (P = .01), higher serum phosphate (P &lt; .01),
      and increased serum cholesterol (P = .04) and triglycerides (P = .01).Higher ABI 
      (P = .04), lower IMT (P = .03), CAVI (P = .05), and AACs (P = .03) were found in 
      patients with chronic MA.Separate binomial logistic regression models were
      performed using ABI (cutoff 0.9), CAVI (cutoff 9), IMT (cutoff 0.1 cm), and AACs 
      (cutoff 1) as dependent variables. MA was used as independent variable and
      adjustments were made for iPTH, serum phosphate, eGFR, proteinuria, cholesterol, 
      triglycerides, CVD score. The absence of MA was retained as an independent
      predictor only for the presence of AACs.In conclusion, the present study shows a 
      potential advantageous effect of MA on vascular calcifications in predialysis CKD
      patients. Thus, a guideline relaxation of the serum bicarbonate target might
      prove to be beneficial in CKD patients at high risk of vascular calcifications.
      However, one should always consider the negative effects of MA. Therefore,
      additional research is warranted before any clear clinical recommendation.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Capusa, Cristina
AU  - Capusa C
AD  - Nephrology Department, "Carol Davila" University of Medicine and Pharmacy.
AD  - "Dr Carol Davila" Teaching Hospital of Nephrology.
FAU - Stefan, Gabriel
AU  - Stefan G
AD  - Nephrology Department, "Carol Davila" University of Medicine and Pharmacy.
AD  - "Dr Carol Davila" Teaching Hospital of Nephrology.
FAU - Stancu, Simona
AU  - Stancu S
AD  - Nephrology Department, "Carol Davila" University of Medicine and Pharmacy.
AD  - "Dr Carol Davila" Teaching Hospital of Nephrology.
FAU - Lipan, Mariana
AU  - Lipan M
AD  - "Dr Carol Davila" Teaching Hospital of Nephrology.
FAU - Tsur, Lilach Daniel
AU  - Tsur LD
AD  - "Carol Davila" University of Medicine and Pharmacy.
FAU - Mircescu, Gabriel
AU  - Mircescu G
AD  - Nephrology Department, "Carol Davila" University of Medicine and Pharmacy.
AD  - "Dr Carol Davila" Teaching Hospital of Nephrology.
AD  - Romanian Renal Registry, Bucharest, Romania.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Bicarbonates)
RN  - 0 (Biomarkers)
RN  - 0 (Phosphates)
RN  - 0 (Triglycerides)
RN  - 97C5T2UQ7J (Cholesterol)
SB  - AIM
SB  - IM
MH  - Acidosis/*blood/etiology/physiopathology
MH  - Aged
MH  - Ankle Brachial Index
MH  - Bicarbonates/*blood
MH  - Biomarkers/blood
MH  - Cardiovascular Diseases/*etiology
MH  - Carotid Intima-Media Thickness
MH  - Cholesterol/blood
MH  - Cross-Sectional Studies
MH  - Female
MH  - Glomerular Filtration Rate
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Phosphates/blood
MH  - Prospective Studies
MH  - Renal Insufficiency, Chronic/*blood/complications/physiopathology
MH  - Risk Factors
MH  - Triglycerides/blood
MH  - Vascular Calcification/*etiology
PMC - PMC5708981
EDAT- 2018/02/01 06:00
MHDA- 2018/02/09 06:00
CRDT- 2018/02/01 06:00
PHST- 2018/02/01 06:00 [entrez]
PHST- 2018/02/01 06:00 [pubmed]
PHST- 2018/02/09 06:00 [medline]
AID - 10.1097/MD.0000000000008802 [doi]
AID - 00005792-201711270-00073 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Nov;96(47):e8802. doi: 10.1097/MD.0000000000008802.