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Nephron Extra. 2013 Nov 14;3(1):113-117. eCollection 2013.

Adjusted Anion Gap Is Associated with Glomerular Filtration Rate Decline in Chronic Kidney Disease.

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  • 1Department of Nephrology, Shizuoka Saiseikai General Hospital, Tokyo, Japan.
  • 2Miyaji Clinic, Hamamatsu University School of Medicine, Hamamatsu, Tokyo, Japan.
  • 3Tanpopo Clinic, Shizuoka, Hamamatsu University School of Medicine, Hamamatsu, Tokyo, Japan.
  • 4Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Tokyo, Japan ; Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.



Metabolic acidosis is known to accelerate the progression of chronic kidney disease (CKD). However, whether undetermined anions as indicated by the adjusted anion gap (aAG) are associated with estimated glomerular filtration rate (eGFR) decline in patients with CKD is unclear.


Data from 42 patients with CKD (baseline eGFR, 7.1-52.0 ml/min/ 1.73 m2) without massive proteinuria (urinary protein-creatinine ratio, UPCR <3.5) were retrospectively analyzed. aAG was calculated from serum sodium, serum chloride, serum bicarbonate, serum albumin, serum potassium, serum calcium and serum phosphate. The association between the percentage of the 6-month change of eGFR (%ΔeGFR/6m) and aAG was examined.


The mean baseline eGFR was 27.5 ± 11.1 ml/min/1.73 m2 and the mean %ΔeGFR/6m was 13.8 ± 10.3. UPCR and aAG were 1.13 ± 0.93 and 9.48 ± 1.88, respectively. %ΔeGFR/6m was associated with aAG (r = 0.438, p < 0.005), but not with UPCR (r = 0.194, p = 0.218). In multivariate linear regression analyses, aAG remained significantly associated with %ΔeGFR/6m (β = 0.45, p < 0.01) after controlling for age, baseline eGFR, UPCR and HCO3- concentration.


These data suggest that aAG appears to be associated with the progression of CKD. aAG might be an independent predictor of CKD progression.


Adjusted anion gap; Chronic kidney disease; Glomerular filtration rate decline

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