scholarly journals High serum bicarbonate level within the normal range prevents the progression of chronic kidney disease in elderly chronic kidney disease patients

2013 ◽  
Vol 14 (1) ◽  
Author(s):  
Eiichiro Kanda ◽  
Masumi Ai ◽  
Masayuki Yoshida ◽  
Renjiro Kuriyama ◽  
Tatsuo Shiigai
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
High Serum ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Normal Range ◽  
Serum Bicarbonate Level ◽  
Elderly Chronic Kidney Disease

Impact of Serum Bicarbonate Levels on Muscle Mass and Kidney Function in Pre-Dialysis Chronic Kidney Disease Patients

2019 ◽  
Vol 51 (1) ◽  
pp. 24-34 ◽  
Author(s):  
Piyawan Kittiskulnam ◽  
Somrath Srijaruneruang ◽  
Adhisabandh Chulakadabba ◽  
Nintita Sripaiboonkij Thokanit ◽  
Kearkiat Praditpornsilpa ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Muscle Strength ◽  
Sodium Bicarbonate ◽  
Muscle Mass ◽  
Control Group ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Serum Bicarbonate Level

Background: Treatment of metabolic acidosis to target the higher serum bicarbonate level than guideline recommendation may downregulate muscle protein degradation and improve renal function among chronic kidney disease (CKD) patients. We conducted a study to test the effects of increased serum bicarbonate level on muscle parameters, nutrition, and renal function in pre-dialysis CKD patients. Methods: This was a randomized, controlled study. CKD stage 3–4 patients with serum HCO3– <22 mEq/L were randomized to either receive oral sodium bicarbonate with high target bicarbonate level of 25 ± 1 or standard level of 22 ± 1 mEq/L as control group using protocol-based titration of dosage adjustment. The changes of muscle mass measured by bioelectrical impedance analysis (BIA), muscle strength by hand grip dynamometer, estimated glomerular filtration rate (eGFR) using CKD-Epidemiology Collaboration equation, nutritional markers, and muscle-related biomarkers were determined. Data at baseline and after 4 months of sodium bicarbonate supplementation were compared between groups using Student t test or chi-square test as appropriate. Results: Forty-two patients completed the study (n = 21 per group). The mean age and eGFR were 61.2 ± 9.8 years and 32.4 ± 14.1 mL/min respectively. Serum bicarbonate levels at baseline were 21.0 ± 2.1 mEq/L. Baseline data including sex, diabetes, serum bicarbonate level, creatinine, and blood pressure were similar. After 4 months of treatment, the average serum bicarbonate levels in both groups were 24.0 ± 1.4 and 20.7 ± 2.3 mEq/L (p < 0.001). Both BIA-derived total-body muscle mass and appendicular lean balance were increased at 4 months in the higher bicarbonate group (26.0 ± 5.3 to 26.7 ± 5.5 kg, p = 0.04 and 19.8 ± 4.1 to 20.7 ± 4.4 kg, p = 0.06, respectively) despite comparable body weight and protein intake. Patients in the high bicarbonate group had a significant reduction of plasma myostatin levels, a surrogate of muscle degradation, at the study exit after adjusting for baseline values (–3,137.8; 95% CI –6,235.3 to –40.4 pg/mL, p= 0.04), but unaltered insulin-like growth factor-1 level, as the mediator of muscle cell growth, (141 [106–156] to 110 [87–144] ng/mL, p = 0.13) compared to the control group. Muscle strength, eGFR as well as serum prealbumin were not significantly different between 2 groups (p > 0.05). Neither worsening hypertension nor congestive heart failure was found throughout the study. Conclusion: Bicarbonate supplementation to achieve the serum level ∼24 mEq/L demonstrates better muscle mass preservation in patients with pre-dialysis CKD. The impact of alkaline therapy on renal function may require a longer period of study.

MO021GALECTIN 3 LEVEL IS REDUCED BY TREATMENT WITH SODIUM BICARBONATE IN PATIENTS WITH CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mirela Dobre ◽  
Neil Patel ◽  
Hima Sapa ◽  
Edward Horwitz ◽  
Michal Melamed ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Placebo Group ◽  
Metabolic Acidosis ◽  
Sodium Bicarbonate ◽  
Myocardial Fibrosis ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Galectin 3 ◽  
Serum Bicarbonate Level ◽  
One Year

Abstract Background and Aims Circulating cardiac biomarkers implicated in the pathogenesis of heart disease are a non-invasive platform to assess the cardiovascular disease (CVD) burden in individuals with chronic kidney disease (CKD). Galectin 3 is a 26 kDa β-galactoside-binding lectin that has a graded and positive association with CKD stages. In animal models, inhibition of galectin-3 prevents myocardial fibrosis. These pre-clinical findings have not been replicated in randomized controlled studies in humans. Metabolic acidosis of CKD has been shown to be associated with adverse CVD outcomes. We sought to examine whether correction of metabolic acidosis of CKD leads to lower circulating levels of Galectin 3, as an expression of myocardial fibrosis. Method A total of 95 participants with stages 3 and 4 CKD and a serum bicarbonate level between 21-25 mEq/L, were randomized to receive sodium bicarbonate at a dose of 0.4 mEq/kg/day once a day or placebo for two years at two clinical sites in US. Galectin 3, was measured at study baseline and after one year. Results Fifty participants were randomized to sodium bicarbonate and 45 to placebo. Mean age (SD) was 61.4 (10.2) years, 48% were women, 57% were non-Hispanic black, and 40% were non-Hispanic white, 61% had diabetes mellitus and 90% had hypertension at baseline. Mean baseline serum bicarbonate level was 23.5 (SD 1.7), mean (SD) baseline eGFR was 38.8 (11.2) ml/min/1.7m2 and mean (SD) baseline systolic BP was 130 (17) mmHg. There were no differences in baseline characteristics between treatment groups. Compared to the placebo group, participants randomized to sodium bicarbonate had statistically significant change in the levels of Galectin 3 after one year of treatment (-7.12% vs 7.76% and -1.25 vs 1.54 ng/ml, p=0.03 in the sodium bicarbonate vs. placebo group, respectively, Figure). In subgroup analyses by CKD stages, participants with stage 3A randomized to sodium bicarbonate observed the highest decrement in Galectin 3 levels (-19.2% vs 14.7%, p=0.01; -3.3% vs -4.8%, p=0.49; and -7.4% vs 29.1%, p=0.09; for CKD 3B, 3B and 4, respectively). Conclusion The level of Galectin 3 was reduced in patients with CKD 3 and 4 treated with sodium bicarbonate. This provides a framework for future therapeutic interventions aimed at reduction of myocardial fibrosis in patients with CKD and metabolic acidosis.

scholarly journals Metabolic Acidosis Is an Independent Risk Factor of Renal Progression in Korean Chronic Kidney Disease Patients: The KNOW-CKD Study Results

2021 ◽  
Vol 8 ◽  
Author(s):  
Hyo Jin Kim ◽  
Hyunjin Ryu ◽  
Eunjeong Kang ◽  
Minjung Kang ◽  
Miyeun Han ◽  
...  
Keyword(s):  
Risk Factor ◽  
Metabolic Acidosis ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Rapid Decline ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Serum Bicarbonate Level ◽  
Renal Progression

Background: We aimed to evaluate serum bicarbonate as a risk factor for renal progression, cardiovascular events, and mortality in Korean CKD patients.Methods: We analyzed 1,808 participants from a Korean CKD cohort whose serum bicarbonate levels were measured at enrollment. Serum bicarbonate levels were categorized as low, lower normal, higher normal, and high (total carbon dioxide &lt;22, 22–26, 26.1–29.9, and ≥30 mmol/L, respectively) groups. Metabolic acidosis was defined as a serum bicarbonate level &lt;22 mmol/L. The primary outcome was renal events defined as doubling of serum creatinine, 50% reduction of eGFR from the baseline values, or development of end-stage kidney disease. The secondary outcome consisted of cardiovascular events and death. In addition, patients whose eGFR values were measured more than three times during the follow-up period were analyzed for eGFR decline. The rapid decline in eGFR was defined as lower than the median value of the eGFR slope.Results: The mean serum bicarbonate level was 25.7 ± 3.7 mmol/L and 240 (13.2%) patients had metabolic acidosis. During the follow-up period of 55.2 ± 24.1 months, 545 (30.9%) patients developed renal events and 187 (10.6%) patients developed a composite of cardiovascular events and death. After adjustment, the low serum bicarbonate group experienced 1.27 times more renal events than the lower normal bicarbonate group [hazard ratio (HR): 1.27; 95% CI: 1.01–1.60, P = 0.043]. There was no significant association between the bicarbonate groups and the composite outcome of cardiovascular events and death. The low bicarbonate group showed a significantly rapid decline in eGFR [odds ratio (OR): 2.12; 95% CI: 1.39–3.22, P &lt; 0.001] compared to the lower normal bicarbonate group.Conclusions: Metabolic acidosis was significantly associated with increased renal events and a rapid decline in renal function in Korean predialysis CKD patients.

Roxadustat Improves Erythropoietin Antibody-Mediated Pure Red Cell Aplasia in a Patient with Hemodialysis

2021 ◽  
pp. 1-4
Author(s):  
Sijia Li ◽  
Xueqin Chen ◽  
Penghua Hu ◽  
Suijing Wu ◽  
Jianchao Ma ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Immunosuppressive Therapy ◽  
Recombinant Human Erythropoietin ◽  
Pure Red Cell Aplasia ◽  
Red Cell ◽  
Common Complication ◽  
Normal Range ◽  
Red Cell Aplasia ◽  
Human Erythropoietin

Anemia is a common complication of chronic kidney disease (CKD). Recombinant human erythropoietin (rHu-EPO) is used extensively in patients with CKD. However, anti-erythropoietin (anti-EPO) antibody has been reported during rHu-EPO treatment, which causes pure red cell aplasia (PRCA). We presented a case of 75-year-old man, who underwent hemodialysis for 2 years. He developed PRCA during rHu-EPO treatment. The rHu-EPO was immediately discontinued, and the patient was given roxadustat treatment. After 6 months of roxadustat treatment, the anti-EPO antibody was disappeared, and hemoglobin recovered normal range. The results suggest that roxadustat can be used to treat patients with anti-EPO antibody-mediated PRCA without immunosuppressive therapy.

Is Serum Bicarbonate Level Associated With Negative Outcomes in Pediatric Patients?

2017 ◽  
Vol 33 (11) ◽  
pp. e108-e113
Author(s):  
Naveen Poonai ◽  
David Mainprize ◽  
Carolyn Travers ◽  
Lilian Lee Yan Vivas ◽  
Peter Tryphonopoulos ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Negative Outcomes ◽  
Serum Bicarbonate Level

Effect of parameters of renal replacement therapy on platelet aggregation activity

2020 ◽  
Author(s):  
Т.В. Марченко ◽  
А.В. Гончарова ◽  
И.Н. Соловьева ◽  
Е.О. Марченко ◽  
А.М. Исаева
Keyword(s):  
Chronic Kidney Disease ◽  
Platelet Aggregation ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Normal Range ◽  
Dialysis Therapy ◽  
Before And After ◽  
Aggregation Activity

Цель исследования: оценить влияние параметров заместительной почечной терапии (ЗПТ) на агрегационную активность тромбоцитов у пациентов с хронической болезнью почек (ХБН). Материалы и методы. Было выполнено 25 процедур гемодиализа (ГД) и 10 процедур гемодиафильтрации (ГДФ) 35 больным с ХБП. Изучали динамику агрегационной активности тромбоцитов до и после экстракорпоральных процедур. Результаты. После процедуры ГД агрегация тромбоцитов снижалась, а после процедуры ГДФ нарастала, не выходя за пределы нормальных значений. Параметры процедур ЗПТ на агрегацию тромбоцитов значимого влияния не оказывали. Заключение. Разовая процедура ЗПТ протяженностью не более 4 ч, проводимая с учетом всех современных требований к диализной терапии, не оказывает негативного влияния на функциональную активность тромбоцитов. Процедура ГДФ приводит к непринципиальному росту агрегационной активности тромбоцитов. Aim: to assess the effect of renal replacement therapy (RRT) parameters on platelet aggregation activity in patients with chronic kidney disease (CKD). Materials and methods. For 35 patients with CKD 25 hemodialysis (HD) procedures and 10 hemodiafiltration (HDF) procedures were performed. We studied the dynamics of platelet aggregation activity before and after extracorporeal procedures. Results. After the HD procedure, platelet aggregation decreased, and after the HDF procedure it increased, without going outside the normal range. Parameters of RRT procedures did not have a significant effect on platelet aggregation. Conclusion. A single RRT procedure not more than 4 hours with all nowadays requirements for dialysis therapy does not adversely affect the functional platelets activity. The HDF procedure leads to an unprincipled increasing of platelet aggregation activity.

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