Schulte Kevin, Püchel Jodok, Schüssel Katrin, Borzikowsky Christoph, Kunzendorf Ulrich, Feldkamp Thorsten
Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Germany, Christian-Albrechts University, Kiel, Germany.
Scientific Institute of the AOK (WIdO), Berlin, Germany.
Transplant Direct. 2019 Jun 27;5(7):e464. doi: 10.1097/TXD.0000000000000910. eCollection 2019 Jul.
Metabolic acidosis (MA) is a common complication after kidney transplantation and regarded to increase mortality, graft failure, and bone fractures. Here, we conducted a retrospective cohort study to analyze the effect of sodium bicarbonate on those events.
All kidney transplant recipients of the German health insurance Allgemeine Ortskrankenkasse (AOK) were selected, who received their transplantation between 2007 and 2015. Three groups were formed: (1) control group (no acidosis, n = 3602), (2) acidosis group (encoded acidosis, n = 370), and (3) treatment group (encoded therapy, n = 769). The study endpoints were mortality, death-censored graft failure, and bone fractures.
The prevalence of MA in the first year after transplantation was 46.2%. The 5-year patient and graft survival were 89.8% and 89.3% in the control group, 90% and 90.8% in the acidosis group, and 87.5% and 81.6% in the treatment group, respectively. The rate of bone fractures did not differ between the groups. Neither log-rank tests nor multivariable Cox regression analyses could detect a negative impact of MA on mortality (hazard ratio [HR] 0.94; confidence interval [CI] 0.67-1.30), graft failure (HR1.18; CI 0.82-1.72), or the incidence of bone fractures (HR1.19; CI 0.92-1.55). Treatment with sodium bicarbonate was associated with an increased risk of graft failure (HR1.52; CI 1.03-2.25), whereas mortality (HR0.86; CI 0.59-1.26) and the incidence of bone fractures (HR1.16; CI 0.86-1.56) were not altered.
MA is common after kidney transplantation but not associated with an increased frequency of death, graft failure, or bone fractures. Conversely, sodium bicarbonate therapy increased the incidence of graft failure.
代谢性酸中毒（MA）是肾移植后常见的并发症，被认为会增加死亡率、移植失败率和骨折发生率。在此，我们进行了一项回顾性队列研究，以分析碳酸氢钠对这些事件的影响。
选取德国健康保险公司Allgemeine Ortskrankenkasse（AOK）在2007年至2015年期间接受肾移植的所有受者。分为三组：（1）对照组（无酸中毒，n = 3602），（2）酸中毒组（编码为酸中毒，n = 370），（3）治疗组（编码为治疗，n = 769）。研究终点为死亡率、死亡删失的移植失败率和骨折发生率。
移植后第一年MA的患病率为46.2%。对照组5年患者生存率和移植肾生存率分别为89.8%和89.3%，酸中毒组为90%和90.8%，治疗组为87.5%和81.6%。各组间骨折发生率无差异。对数秩检验和多变量Cox回归分析均未检测到MA对死亡率（风险比[HR]0.94；置信区间[CI]0.67 - 1.30）、移植失败率（HR1.18；CI 0.82 - 1.72）或骨折发生率（HR1.19；CI 0.92 - 1.55）有负面影响。碳酸氢钠治疗与移植失败风险增加相关（HR1.52；CI 1.03 - 2.25），而死亡率（HR0.86；CI 0.59 - 1.26）和骨折发生率（HR1.16；CI 0.86 - 1.56）未改变。
MA在肾移植后很常见，但与死亡、移植失败或骨折发生率增加无关。相反，碳酸氢钠治疗增加了移植失败的发生率。
