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Kidney Int. 2017 Dec;92(6):1507-1514. doi: 10.1016/j.kint.2017.05.006. Epub 2017 Jul 18.

Metabolic acidosis is common and associates with disease progression in children with chronic kidney disease.

Author information

1
Pediatric Nephrology Unit, Department of Pediatrics, Bordeaux University Hospital, and Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, Bordeaux, France.
2
Institute for Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany.
3
Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany; Pediatric Center, Vilnius University, Vilnius, Lithuania.
4
Division of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey.
5
Department of Pediatric Nephrology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey.
6
Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany.
7
Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
8
Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland.
9
Division of Pediatric Nephrology, Ege University Faculty of Medicine, Izmir, Turkey.
10
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany; Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
11
Department of Pediatrics, University Hospital Estaing, Clermont Ferrand, France.
12
Division of Pediatric Nephrology, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey.
13
Department of Nephrology, University Children's Hospital, Faculty of Medicine, Belgrade, Serbia.
14
Department of Pediatric Nephrology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
15
Inselspital, University of Berne, Berne, Switzerland.
16
Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Osp Maggiore Policlinico, Milano, Italy.
17
Pediatric Center, Vilnius University, Vilnius, Lithuania.
18
Bursa Yuksek Ihtisas Teaching and Researching Hospital, Bursa, Turkey.
19
University Children's Hospital, Innsbruck Medical University, Innsbruck, Austria.
20
Department of Pediatric Nephrology, Marmara University Faculty of Medicine, Istanbul, Turkey.
21
Division of Nephrology, Dialysis, Transplantation, University of Genoa, G. Gaslini Institute, Genoa, Italy.
22
Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
23
Pediatric Nephrology Unit, Department of Pediatrics, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
24
Division of Pediatric Nephrology, Department of Pediatrics, Bakirkoy Children's Hospital, Istanbul, Turkey.
25
Division of Pediatric Nephrology, Uludağ University Faculty of Medicine, Bursa, Turkey.
26
Department of Pediatric Nephrology, Jagiellonian University Medical College, Krakow, Poland.
27
Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
28
Department of Pediatric Nephrology, Charité University, Berlin, Germany.
29
Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: franz.schaefer@med.uniheidelberg.de.

Abstract

Recent studies in adult chronic kidney disease (CKD) suggest that metabolic acidosis is associated with faster decline in estimated glomerular filtration rate (eGFR). Alkali therapies improve the course of kidney disease. Here we investigated the prevalence and determinants of abnormal serum bicarbonate values and whether metabolic acidosis may be deleterious to children with CKD. Associations between follow-up serum bicarbonate levels categorized as under 18, 18 to under 22, and 22 or more mmol/l and CKD outcomes in 704 children in the Cardiovascular Comorbidity in Children with CKD Study, a prospective cohort of pediatric patients with CKD stages 3-5, were studied. The eGFR and serum bicarbonate were measured every six months. At baseline, the median eGFR was 27 ml/min/1.73m2 and median serum bicarbonate level 21 mmol/l. During a median follow-up of 3.3 years, the prevalence of metabolic acidosis (serum bicarbonate under 22 mmol/l) was 43%, 60%, and 45% in CKD stages 3, 4, and 5, respectively. In multivariable analysis, the presence of metabolic acidosis as a time-varying covariate was significantly associated with log serum parathyroid hormone through the entire follow-up, but no association with longitudinal growth was found. A total of 211 patients reached the composite endpoint (ESRD or 50% decline in eGFR). In a multivariable Cox model, children with time-varying serum bicarbonate under 18 mmol/l had a significantly higher risk of CKD progression compared to those with a serum bicarbonate of 22 or more mmol/l (adjusted hazard ratio 2.44; 95% confidence interval 1.43-4.15). Thus, metabolic acidosis is a common complication in pediatric patients with CKD and may be a risk factor for secondary hyperparathyroidism and kidney disease progression.

KEYWORDS:

children; chronic kidney disease; metabolic acidosis; outcome; progression

PMID:
28729033
DOI:
10.1016/j.kint.2017.05.006
[Indexed for MEDLINE]

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