Format

Send to

Choose Destination
Kidney Int. 2015 Jul;88(1):137-45. doi: 10.1038/ki.2015.52. Epub 2015 Mar 11.

Urinary ammonia and long-term outcomes in chronic kidney disease.

Author information

1
1] Université Paris-Descartes, Paris, France [2] Departments of Physiology and Nephrology, Hopital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France.
2
1] INSERM U1018, Centre for Research in Epidemiology and Population Health (CESP), Diabetes, Obesity, and Chronic Kidney Disease Epidemiology Team, Villejuif, France [2] Université Paris-Sud, UMRS 1018, Villejuif, France.
3
1] Departments of Physiology and Nephrology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France [2] Université Pierre et Marie Curie, Paris, France [3] INSERM UMR 1155, Paris, France.
4
1] Departments of Physiology and Nephrology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France [2] Université Paris Diderot, Paris, France [3] INSERM UMR S 1149, Paris, France.
5
1] Departments of Physiology and Nephrology, Hopital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France [2] INSERM U1018, Centre for Research in Epidemiology and Population Health (CESP), Diabetes, Obesity, and Chronic Kidney Disease Epidemiology Team, Villejuif, France.
6
1] Departments of Physiology and Nephrology, Hopital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France [2] INSERM UMR S 970, Paris, France.
7
1] Université Pierre et Marie Curie, Paris, France [2] INSERM UMR 1155, Paris, France.
8
INSERM U1018, Centre for Research in Epidemiology and Population Health (CESP), Diabetes, Obesity, and Chronic Kidney Disease Epidemiology Team, Villejuif, France.
9
1] Departments of Physiology and Nephrology, Hopital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France [2] Sorbonne Universités, UPMC Univ Paris 06, INSERM, Université Paris Descartes, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, CNRS ERL_8228, Paris, France.

Abstract

Recent studies suggest that alkalinizing treatments improve the course of chronic kidney disease (CKD), even in patients without overt metabolic acidosis. Here, we tested whether a decreased ability in excreting urinary acid rather than overt metabolic acidosis may be deleterious to the course of CKD. We studied the associations between baseline venous total CO2 concentration or urinary ammonia excretion and long-term CKD outcomes in 1065 patients of the NephroTest cohort with CKD stages 1-4. All patients had measured glomerular filtration rate (mGFR) by (51)Cr-EDTA renal clearance. Median mGFR at baseline was 37.6 ml/min per 1.73 m(2). Urinary ammonia excretion decreased with GFR, whereas net endogenous acid production did not. After a median follow-up of 4.3 years, 201 patients reached end-stage renal disease (ESRD) and 114 died before ESRD. Twenty-six percent of the patients had mGFR decline rate greater than 10% per year. Compared with patients in the highest tertile of urinary ammonia excretion, those in the lowest tertile had a significantly increased hazard ratio for ESRD, 1.82 (95% CI, 1.06-3.13), and a higher odds ratio of fast mGFR decline, 1.84 (0.98-3.48), independent of mGFR and other confounders. Patients in the lowest tertile of venous total CO2 had significantly increased risk of fast mGFR decline but not of ESRD. None of these biomarkers was associated with mortality. Thus, these results suggest that the inability to excrete the daily acid load is deleterious to renal outcomes.

PMID:
25760321
DOI:
10.1038/ki.2015.52
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center