Gołębiowski Tomasz, Kusztal Mariusz, Konieczny Andrzej, Kuriata-Kordek Magdalena, Gawryś Ada, Augustyniak-Bartosik Hanna, Letachowicz Krzysztof, Zielińska Dorota, Wiśniewska Magdalena, Krajewska Magdalena
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland.
Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-214 Szczecin, Poland.
Diagnostics (Basel). 2021 Feb 3;11(2):226. doi: 10.3390/diagnostics11020226.
Metabolic acidosis in patients with chronic kidney disease (CKD) is a common complication. A bicarbonate concentration in venous blood (V-HCO) is a key index for diagnosis and treatment initiation. The aim of our study is to evaluate usability of acid-base balance parameters of in blood taken simultaneously from peripheral artery and the vein.
A total of 49 patients (median age 66 years [interquartile range IQR 45-75]), with CKD stage G4 or G5 were enrolled in this cross-sectional study. All patients were qualified for arteriovenous fistula creation in pre-dialysis period. The samples were taken during surgery, directly after dissection, and evaluated in a point of care testing analyzer. The arteriovenous difference in bicarbonate levels (Δ-HCO) was calculated. According to glomerular filtration rate (eGFR) the group was divided into Group A eGFR ≥ 10 mL/min/1.73 m) and Group B eGFR < 10 mL/min/1.73 m).
In Group A Δ-HCO was significantly higher compared to Group B. No such differences were observed in the case of V-HCO. Δ-HCO positively correlated with eGFR. The discriminative power of Δ-HCO for predicting eGFR < 10 mL/min/1.73 m was 0.72 (95% confidence interval [CI] = 0.551-0.88; 0.01) which provided 67% sensitivity and 75% specificity. The best cut-off was 0.5 mmol/L.
The Δ-HCO lower than 0.5 mmol/L may be used as predictor of exhaust buffer capacity. The value of this tool should be tested in larger population.
慢性肾脏病（CKD）患者的代谢性酸中毒是一种常见并发症。静脉血碳酸氢盐浓度（V-HCO）是诊断和开始治疗的关键指标。我们研究的目的是评估同时从外周动脉和静脉采集的血液中酸碱平衡参数的可用性。
本横断面研究共纳入49例CKD G4或G5期患者（中位年龄66岁[四分位间距IQR 45-75]）。所有患者在透析前期均符合动静脉内瘘建立条件。样本在手术期间、解剖后直接采集，并在即时检验分析仪中进行评估。计算碳酸氢盐水平的动静脉差值（Δ-HCO）。根据肾小球滤过率（eGFR）将该组分为A组（eGFR≥10 mL/min/1.73 m²）和B组（eGFR<10 mL/min/1.73 m²）。
A组的Δ-HCO显著高于B组。在V-HCO方面未观察到此类差异。Δ-HCO与eGFR呈正相关。Δ-HCO预测eGFR<10 mL/min/1.73 m²的判别能力为0.72（95%置信区间[CI]=0.551-0.88；P=0.01），敏感性为67%，特异性为75%。最佳截断值为0.5 mmol/L。
低于0.5 mmol/L的Δ-HCO可作为缓冲能力耗尽的预测指标。该工具的价值应在更大规模人群中进行测试。
