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Metabolic acidosis and long-Term clinical outcomes in kidney transplant recipients

Journal of the American Society of Nephrology, ISSN: 1533-3450, Vol: 28, Issue: 6, Page: 1886-1897
2017
  • 54
    Citations
  • 0
    Usage
  • 47
    Captures
  • 0
    Mentions
  • 25
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    54
  • Captures
    47
  • Social Media
    25
    • Shares, Likes & Comments
      25
      • Facebook
        25

Article Description

Metabolic acidosis (MA), indicated by low serum total CO2 (TCO2) concentration, is a risk factor for mortality and progressive renal dysfunction in CKD. However, the long-Term effects ofMA on kidney transplant recipients (KTRs) are unclear. We conducted a multicenter retrospective cohort study of 2318 adult KTRs, from January 1, 1997 to March 31, 2015, to evaluate the prevalence of MA and the relationships between TCO2 concentration and clinical outcomes. The prevalence of low TCO2 concentration (,22 mmol/L) began to increase in KTRs with EGFR,60 ml/min per 1.73 m2 and ranged from approximately 30% to 70% in KTRs with EGFR,30 ml/min per 1.73 m2. Multivariable Cox proportional hazards models revealed that low TCO2 concentration 3 months after transplant associated with increased risk of graft loss (hazard ratio [HR], 1.74%; 95% confidence interval [95% CI], 1.26 to 2.42) and death-censored graft failure (DCGF) (HR, 1.66; 95%CI, 1.14 to 2.42). Cox regressionmodels using time-varying TCO2 concentration additionally demonstrated significant associations between low TCO2 concentration and graft loss (HR, 3.48; 95% CI, 2.47 to 4.90),mortality (HR, 3.16; 95%CI, 1.77 to 5.62), and DCGF (HR, 3.17; 95%CI, 2.12 to 4.73).Marginal structuralCoxmodels adjusted for time-varyingEGFRfurther verified significant hazards of lowTCO2 concentration forgraft loss,mortality, andDCGF.Inconclusion,MAwasfrequent inKTRsdespite relativelypreserved renal function and may be a significant risk factor for graft failure and patient mortality, even after adjusting for EGFR.

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