Hyperchloremic acidosis develops at the stage G4 and shifts to high anion gap acidosis at the stage G5 in chronic kidney
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ORIGINAL ARTICLE
Hyperchloremic acidosis develops at the stage G4 and shifts to high anion gap acidosis at the stage G5 in chronic kidney disease Masayuki Tanemoto1,2 · Ryohei Kamachi2 · Takahide Kimura1 · Seiki Yamada1 · Takeshi Yokoyama1 · Yukio Okazaki2 Received: 31 March 2020 / Accepted: 30 July 2020 © Japanese Society of Nephrology 2020
Abstract Background Amelioration of hyperchloremic acidosis (Cl-Ac), a common complication in chronic kidney disease (CKD), could preserve renal function in chronic kidney disease (CKD). However, the development of Cl-Ac in CKD has not been clarified yet. Methods The degree of Cl-Ac, which is indicated as the bicarbonate concentration decrease with serum chloride concentration increase (∆[HCO3–]Cl), was compared with the estimated glomerular filtration rate (eGFR) by using CKD patient records. Results In 307 records with metabolic acidosis, a spline curve obtained from the plot comparing ∆[HCO3–]Cl with eGFR showed that ∆[HCO3–]Cl did not change, increased, and decreased during eGFR decrease until 27, from 27 to 17.5, and from 17.5 mL/min/1.73 m2, respectively. Conclusion By CKD progression, Cl-Ac progressed and regressed at the CKD stages G4 and G5, respectively. The regression would have reflected the shift of Cl-Ac to high anion gap acidosis. Keywords Acid–base · Chronic kidney disease · Hyperchloremic acidosis · Metabolic acidosis
Introduction Hyperchloremic acidosis (Cl-Ac) is a type of metabolic acidosis (Met-Ac), where blood bicarbonate concentration ([HCO3–]) decreases with an increase of serum chloride concentration ([Cl–]) [1]. It is a common complication in chronic kidney disease (CKD) since the kidney plays the predominant role in its development [2, 3]. Meanwhile, its amelioration could preserve renal function in CKD [4, 5]. Although Cl-Ac is considered to develop from the early stages of CKD [2, 3], there were few studies that examined Cl-Ac development in CKD, and they only estimated the development based on the association of anion gap (AG) and serum total carbon dioxide (CO2) concentration (instead of [HCO3–]) with serum creatinine concentration ([Cr]) [6–8]. In the present study, the development was examined * Masayuki Tanemoto mtanemoto‑[email protected] 1
Division of Nephrology, Department of Internal Medicine, International University of Health and Welfare School of Medicine, 13‑1 Higashi‑Kaigan‑Cho, Atami, Shizuoka 413‑8790, Japan
Dialysis Unit, Shin-Kuki General Hospital, Saitama, Japan
2
in association with the estimated glomerular filtration rate (eGFR), a universal indicator of the CKD stage [9].
Methods Participants This study was a retrospective analysis of clinical records. The records of consecutive patients managed in the department of nephrology at a general hospital from April 2015 to September 2017 were reviewed. The data of venous blood gas analysis performed simultaneously with serum chemistry measurement were collected from the records. The records that lacked either serum albumin concentration ([Alb]), serum sodium conce
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