Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
MathurConsulting, Woodside, California, USA.
Am J Nephrol. 2022;53(8-9):603-613. doi: 10.1159/000527036. Epub 2022 Nov 8.
Metabolic acidosis is associated with chronic kidney disease (CKD) progression and mortality, but the association of race/ethnicity with incident metabolic acidosis and/or its adverse outcomes in patients with CKD is unknown.
We used deidentified medical records data (2007-2019) to generate a cohort of 136,067 patients with nondialysis-dependent CKD stages 3-5 and ≥2 years' postindex data or death within 2 years. We grouped participants into those with and without metabolic acidosis (serum bicarbonate 12 to <22 mEq/L vs. 22 to <30 mEq/L) as Asian, Black, Hispanic, non-Hispanic White individuals, or unknown. Cox proportional hazards models examined factors associated with (1) incident metabolic acidosis; and (2) time to the composite outcome of death, dialysis, transplant, or ≥40% decline from baseline eGFR (DD40) within each race/ethnic group.
Metabolic acidosis incidence was higher for Asian, Black, and Hispanic versus non-Hispanic White individuals (p values for adjusted hazard ratios [HR] all <0.001), but this higher hazard was mitigated in all groups with increasing community education. During the median follow-up of 4.2 years, 47,032 of 136,607 (34.6%) experienced a DD40 event. There was an independent association of metabolic acidosis with DD40 within each race/ethnic group. Adjusted HRs (95% confidence interval) for DD40 were 1.806 (1.312, 2.486), 1.420 (1.313, 1.536), 1.409 (1.211, 1.641), and 1.561 (1.498, 1.626) in Asian, Black, Hispanic, and non-Hispanic White groups, respectively (all p < 0.0001), for metabolic acidosis versus normal serum bicarbonate.
DISCUSSION/CONCLUSION: The higher incidence of metabolic acidosis observed in Asian, Black, and Hispanic individuals was mitigated by residing in higher education zip codes. Once established, metabolic acidosis was independently associated with DD40 in patients with CKD in all racial/ethnic groups examined.
代谢性酸中毒与慢性肾脏病（CKD）的进展和死亡率相关，但种族/民族与 CKD 患者代谢性酸中毒的发生及其不良结局的关系尚不清楚。
我们使用匿名医疗记录数据（2007-2019 年）生成了一个由 136067 例非透析依赖性 CKD 3-5 期且指数后至少 2 年或 2 年内死亡或发生透析、移植或基线 eGFR 下降≥40%（DD40）的患者组成的队列。我们将参与者分为有代谢性酸中毒（血清碳酸氢盐 12-<22mEq/L 与 22-<30mEq/L）和无代谢性酸中毒的组，按照亚洲人、黑人、西班牙裔、非西班牙裔白人或未知的种族/民族分组。Cox 比例风险模型检查了（1）代谢性酸中毒的发生相关因素；（2）每个种族/民族组内从基线 eGFR 下降≥40%（DD40）的死亡、透析、移植或死亡复合结局的时间。
与非西班牙裔白人相比，亚洲人、黑人和西班牙裔人的代谢性酸中毒发生率更高（调整后危险比[HR]的 p 值均<0.001），但在所有组中，随着社区教育程度的提高，这种较高的风险都有所降低。在中位数为 4.2 年的随访期间，136607 例患者中有 47032 例（34.6%）发生了 DD40 事件。在每个种族/民族组中，代谢性酸中毒与 DD40 独立相关。DD40 的调整后 HR（95%置信区间）分别为亚洲人组 1.806（1.312，2.486）、黑人组 1.420（1.313，1.536）、西班牙裔组 1.409（1.211，1.641）和非西班牙裔白人组 1.561（1.498，1.626）（均 p<0.0001），代谢性酸中毒与正常血清碳酸氢盐相比。
讨论/结论：在亚洲人、黑人和西班牙裔人中观察到的代谢性酸中毒发生率较高，这一情况因居住在教育程度较高的邮政编码地区而得到缓解。在所有检查的种族/民族组中，一旦发生代谢性酸中毒，与 CKD 患者的 DD40 独立相关。
