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<p>Metabolic acidosis is a common disorder in patients with chronic kidney disease (CKD). As eGFR decreases, a reciprocal decrease in bicarbonate (HCO<sub>3</sub><sup>−</sup>) and an increase in chloride (Cl<sup>−</sup>) concentration is observed. The aim of this study is to determine whether the Cl<sup>−</sup>/HCO<sub>3</sub><sup>−</sup> ratio can be used to predict metabolic acidosis with pH decline. A total of 115 patients (age 63 ± 17 years), with CKD stage G4 or G5 were enrolled in this cross-sectional study. The arterial (A) and venous (V) blood samples were taken during AV fistula creation and evaluated in a point of care testing analyzer. The ratio of arterial Cl<sup>−</sup> and HCO<sub>3</sub><sup>−</sup> concentration were calculated. According to mean arterial pH (pH-A) the group was divided into group with pH-A ≤ 7.33 and with pH-A &gt; 7.33. The group with pH-A ≤ 7.33 showed significantly lower HCO<sub>3</sub><sup>−</sup>, and higher Cl<sup>−</sup>, Cl<sup>−</sup>/HCO<sub>3</sub><sup>−</sup>-ratio than group with pH-A &gt; 7.33. Cl<sup>−</sup>/HCO<sub>3</sub><sup>−</sup>-A ratio negatively correlated with pH (<i>r</i>=-0.77,<i>p</i> &lt; 0.01). The discriminative power of Cl<sup>−</sup>/HCO<sub>3</sub><sup>−</sup>-A ratio for predicting pH-A ≤ 7.33 was 0.917 ([CI] = 0.87–0.97,<i>p</i> &lt; 0.01) which provided 87% sensitivity and 84% specificity. The best cut-off was 6.22(mmol/l)/(mmol/l). In conclusion, a Cl<sup>−</sup>/HCO<sub>3</sub><sup>−</sup> ratio higher than 6.22(mmol/l)/(mmol/l) may be used as predictor of advanced metabolic acidosis in CKD stages G4 and G5.</p>

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The ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in CKD stages G4 and G5

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月6日

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  • Justyna Korus,
  • Maciej Gołębiowski,
  • Jakub Stojanowski,
  • Maciej Szymczak,
  • Marcelina Żabińska,
  • Dorota Bartoszek,
  • Katarzyna Kościelska-Kasprzak,
  • Mirosław Banasik,
  • Milena Ściskalska,
  • Mariusz Kusztal,
  • Tomasz Gołębiowski

摘要

Metabolic acidosis is a common disorder in patients with chronic kidney disease (CKD). As eGFR decreases, a reciprocal decrease in bicarbonate (HCO3−) and an increase in chloride (Cl−) concentration is observed. The aim of this study is to determine whether the Cl−/HCO3− ratio can be used to predict metabolic acidosis with pH decline. A total of 115 patients (age 63 ± 17 years), with CKD stage G4 or G5 were enrolled in this cross-sectional study. The arterial (A) and venous (V) blood samples were taken during AV fistula creation and evaluated in a point of care testing analyzer. The ratio of arterial Cl− and HCO3− concentration were calculated. According to mean arterial pH (pH-A) the group was divided into group with pH-A ≤ 7.33 and with pH-A > 7.33. The group with pH-A ≤ 7.33 showed significantly lower HCO3−, and higher Cl−, Cl−/HCO3−-ratio than group with pH-A > 7.33. Cl−/HCO3−-A ratio negatively correlated with pH (r=-0.77,p < 0.01). The discriminative power of Cl−/HCO3−-A ratio for predicting pH-A ≤ 7.33 was 0.917 ([CI] = 0.87–0.97,p < 0.01) which provided 87% sensitivity and 84% specificity. The best cut-off was 6.22(mmol/l)/(mmol/l). In conclusion, a Cl−/HCO3− ratio higher than 6.22(mmol/l)/(mmol/l) may be used as predictor of advanced metabolic acidosis in CKD stages G4 and G5.