Prospective associations between the CKD-mineral bone disorder and metabolic acidosis
Abstract
BACKGROUND: The common chronic kidney disease (CKD)-associated complications of mineral bone disorder (MBD) and metabolic acidosis share some biochemical features that physiologic studies suggest may be linked by the effects of progressive acidosis on bone and kidney. To explore this further, we examined prospective associations between key elements of the CKD-MBD and the subsequent appearance of subclinical and clinical metabolic acidosis in patients with stage 3/4 CKD.
METHODS: Post hoc analysis of 1993 CAN AIM TO PREVENT participants followed for 2.86 years per participant. Mixed-effects linear and logistic regression were used to evaluate prospective associations between phosphate, calcium, 25(OH)D, PTH, and FGF-23 with (1) declining plasma bicarbonate, (2) subclinical metabolic acidosis (bicarbonate 22-24 mmol/L), and (3) clinical metabolic acidosis (bicarbonate < 22 mmol/L).
RESULTS: Each mmol/L increase in phosphate predicted a lower bicarbonate (- 1.29 mmol/L (95% CI - 1.61, - 0.98; p < 0.001)), and increased odds for subclinical (OR 1.92 (1.32, 2.79); p = 0.001) and clinical metabolic acidosis (OR 5.03 (3.16, 7.93); p < 0.001). Each mmol/L increase in calcium predicted a higher bicarbonate (2.70 mmol/L (2.11, 3.30; p < 0.001)), and decreased odds for subclinical (OR 0.23 (0.11, 0.46); p < 0.001) and clinical metabolic acidosis (OR 0.15 (0.06, 0.37); p < 0.001). Each unit increase in log-transformed 25(OH)D predicted a higher bicarbonate (0.38 mmol/L (0.23, 0.53); p…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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