Division of Nephrology, Department of Internal Medicine, International University of Health and Welfare School of Medicine, 13-1 Higashi-Kaigan-Cho, Atami, Shizuoka, 413-8790, Japan.
Dialysis Unit, Shin-Kuki General Hospital, Saitama, Japan.
Clin Exp Nephrol. 2020 Dec;24(12):1140-1143. doi: 10.1007/s10157-020-01949-x. Epub 2020 Aug 9.
Amelioration of hyperchloremic acidosis (Cl-Ac), a common complication in chronic kidney disease (CKD), could preserve renal function in chronic kidney disease (CKD). However, the development of Cl-Ac in CKD has not been clarified yet.
The degree of Cl-Ac, which is indicated as the bicarbonate concentration decrease with serum chloride concentration increase (∆[HCO]), was compared with the estimated glomerular filtration rate (eGFR) by using CKD patient records.
In 307 records with metabolic acidosis, a spline curve obtained from the plot comparing ∆[HCO] with eGFR showed that ∆[HCO] did not change, increased, and decreased during eGFR decrease until 27, from 27 to 17.5, and from 17.5 mL/min/1.73 m, respectively.
By CKD progression, Cl-Ac progressed and regressed at the CKD stages G4 and G5, respectively. The regression would have reflected the shift of Cl-Ac to high anion gap acidosis.
高氯性酸中毒（Cl-Ac）是慢性肾脏病（CKD）的常见并发症，改善 Cl-Ac 可保护 CKD 患者的肾功能。然而，CKD 中 Cl-Ac 的发展尚未阐明。
通过比较 CKD 患者记录中的碳酸氢盐浓度下降与血清氯浓度增加（∆[HCO]）的程度，与估算肾小球滤过率（eGFR）进行比较。
在 307 份代谢性酸中毒的记录中，从比较 ∆[HCO]与 eGFR 的图中得出的样条曲线显示，在 eGFR 下降至 27、27 至 17.5 和 17.5 mL/min/1.73 m 时，∆[HCO] 分别没有变化、增加和减少。
随着 CKD 的进展，Cl-Ac 在 CKD 阶段 G4 和 G5 分别进展和消退。这种消退可能反映了 Cl-Ac 向高阴离子间隙酸中毒的转变。
