Serum bicarbonate is associated with kidney outcomes in autosomal dominant polycystic kidney disease

Autor: Blijdorp, C.J., Severs, D., Musterd-Bhaggoe, U.M., Gansevoort, R.T., Drenth, J.P.H., Wetzels, J.F.M., Zietse, R., Hoorn, E.J.
Přispěvatelé: Internal Medicine, Clinical Genetics, Surgery, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC)
Jazyk: angličtina
Rok vydání: 2021
Předmět:
medicine.medical_specialty
Urinary system
030232 urology & nephrology
Autosomal dominant polycystic kidney disease
Urology
Renal function
030204 cardiovascular system & hematology
Kidney
urologic and male genital diseases
Excretion
03 medical and health sciences
0302 clinical medicine
end-stage kidney disease
medicine
Humans
total kidney volume
AcademicSubjects/MED00340
Transplantation
glomerular filtration rate
business.industry
urogenital system
Hazard ratio
Metabolic acidosis
medicine.disease
Polycystic Kidney
Autosomal Dominant
ammonium
Bicarbonates
medicine.anatomical_structure
Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11]
Nephrology
Disease Progression
Original Article
Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
business
Kidney disease
Zdroj: Nephrology Dialysis Transplantation, 36(12), 2248-2255. Oxford University Press
Nephrology, Dialysis, Transplantation, 36, 12, pp. 2248-2255
Nephrology, Dialysis, Transplantation, 36(12). Oxford University Press
Nephrology Dialysis Transplantation
Nephrology Dialysis Transplantation, 36(12), 2248-2255. OXFORD UNIV PRESS
Nephrology, Dialysis, Transplantation, 36, 2248-2255
ISSN: 0931-0509
Popis: Background Metabolic acidosis accelerates progression of chronic kidney disease, but whether this is also true for autosomal dominant polycystic kidney disease (ADPKD) is unknown. Methods Patients with ADPKD from the DIPAK (Developing Interventions to halt Progression of ADPKD) trial were included [n = 296, estimated glomerular filtration rate (eGFR) 50 ± 11 mL/min/1.73 m2, 2.5 years follow-up]. Outcomes were worsening kidney function (30% decrease in eGFR or kidney failure), annual eGFR change and height-adjusted total kidney and liver volumes (htTKV and htTLV). Cox and linear regressions were adjusted for prognostic markers for ADPKD [Mayo image class and predicting renal outcomes in ADPKD (PROPKD) scores] and acid–base parameters (urinary ammonium excretion). Results Patients in the lowest tertile of baseline serum bicarbonate (23.1 ± 1.6 mmol/L) had a significantly greater risk of worsening kidney function [hazard ratio = 2.95, 95% confidence interval (CI) 1.21–7.19] compared with patients in the highest tertile (serum bicarbonate 29.0 ± 1.3 mmol/L). Each mmol/L decrease in serum bicarbonate increased the risk of worsening kidney function by 21% in the fully adjusted model (hazard ratio = 1.21, 95% CI 1.06–1.37). Each mmol/L decrease of serum bicarbonate was also associated with further eGFR decline (−0.12 mL/min/1.73 m2/year, 95% CI −0.20 to −0.03). Serum bicarbonate was not associated with changes in htTKV or htTLV growth. Conclusions In patients with ADPKD, a lower serum bicarbonate within the normal range predicts worse kidney outcomes independent of established prognostic factors for ADPKD and independent of urine ammonium excretion. Serum bicarbonate may add to prognostic models and should be explored as a treatment target in ADPKD.
Graphical Abstract Graphical Abstract
Databáze: OpenAIRE
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