Gołębiowski Tomasz, Zmonarski Sławomir, Rożek Wiktoria, Powązka Mateusz, Jerzak Patryk, Gołębiowski Maciej, Kusztal Mariusz, Olczyk Piotr, Stojanowski Jakub, Letachowicz Krzysztof, Banasik Mirosław, Konieczny Andrzej, Krajewska Magdalena
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
Diagnostics (Basel). 2023 Nov 2;13(21):3367. doi: 10.3390/diagnostics13213367.
Normal-anion-gap metabolic acidosis (AGMA) and high-anion-gap metabolic acidosis (HAGMA) are two forms of metabolic acidosis, which is a common complication in patients with chronic kidney disease (CKD). The aim of this study is to identify the prevalence of various acid-base disorders in patients with advanced CKD using point-of-care testing (POCT) and to determine the relationship between POCT parameters.
In a group of 116 patients with CKD in stages G4 and G5, with a mean age of 62.5 ± 17 years, a sample of arterial blood was taken during the arteriovenous fistula procedure for POCT, which enables an assessment of the most important parameters of acid-base balance, including: pH, base excess (BE), bicarbonate (HCO), chloride(Cl), anion gap (AG), creatinine and urea concentration. Based on this test, patients were categorized according to the type of acidosis-base disorder.
Decompensate acidosis with a pH < 7.35 was found in 68 (59%) patients. Metabolic acidosis (MA), defined as the concentration of HCO ≤ 22 mmol/L, was found in 92 (79%) patients. In this group, significantly lower pH, BE, HCO and Cl concentrations were found. In group of MA patients, AGMA and HAGMA was observed in 48 (52%) and 44 (48%) of patients, respectively. The mean creatinine was significantly lower in the AGMA group compared to the HAGMA group (4.91 vs. 5.87 mg/dL, < 0.05). The AG correlated positively with creatinine (r = 0.44, < 0.01) and urea (r = 0.53, < 0.01), but there was no correlation between HCO and both creatinine (r = -0.015, > 0.05) and urea (r = -0.07, > 0.05). The Cl concentrations correlated negatively with HCO (r = -0.8, < 0.01).
The most common type of acid-base disturbance in CKD patients in stages 4 and 5 is AGMA, which is observed in patients with better kidney function and is associated with compensatory hyperchloremia. The initiation of renal replacement therapy was significantly earlier for patients diagnosed with HAGMA compared to those diagnosed with AGMA. The more advanced the CKD, the higher the AG.
正常阴离子间隙代谢性酸中毒（AGMA）和高阴离子间隙代谢性酸中毒（HAGMA）是代谢性酸中毒的两种形式，代谢性酸中毒是慢性肾脏病（CKD）患者的常见并发症。本研究的目的是使用即时检验（POCT）确定晚期CKD患者各种酸碱紊乱的患病率，并确定POCT参数之间的关系。
在116例G4和G5期CKD患者中，平均年龄为62.5±17岁，在动静脉内瘘手术期间采集动脉血样本进行POCT，该检验能够评估酸碱平衡的最重要参数，包括：pH值、碱剩余（BE）、碳酸氢盐（HCO）、氯离子（Cl）、阴离子间隙（AG）、肌酐和尿素浓度。基于此检验，根据酸碱紊乱类型对患者进行分类。
68例（59%）患者发现pH<7.35的失代偿性酸中毒。92例（79%）患者发现代谢性酸中毒（MA），定义为HCO浓度≤22 mmol/L。在该组中，发现pH值、BE、HCO和Cl浓度显著降低。在MA患者组中，分别有48例（52%）和44例（48%）患者观察到AGMA和HAGMA。与HAGMA组相比，AGMA组的平均肌酐显著更低（4.91对5.87 mg/dL，P<0.05）。AG与肌酐（r = 0.44，P<0.01）和尿素（r = 0.53，P<0.01）呈正相关，但HCO与肌酐（r = -0.015，P>0.05）和尿素（r = -0.07，P>你提供的原文此处有误，应该是P>0.05）均无相关性。Cl浓度与HCO呈负相关（r = -0.8，P<0.01）。
4期和5期CKD患者中最常见的酸碱紊乱类型是AGMA，其在肾功能较好的患者中观察到，并与代偿性高氯血症相关。与诊断为AGMA的患者相比，诊断为HAGMA的患者开始肾脏替代治疗的时间显著更早。CKD越严重，AG越高。
