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Kidney Week

Abstract: SA-PO1063

Is Metabolic Acidosis a Risk Factor for Worse Long-Term Prognosis in Patients After Kidney Transplantation?

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Adamczak, Marcin, Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
  • Gojowy, Damian, Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
  • Dolega, Julia, Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
  • Górecki, Michal, Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
  • Skiba, Katarzyna, Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
  • Bartmanska, Magdalena, Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
  • Kolonko, Aureliusz, Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
  • Wiecek, Andrzej, Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
Background

Metabolic acidosis (MA) frequently occurs in patients after kidney transplantation (KTx). Results of both experimental and clinical studies suggest that MA may contribute to faster progression of chronic kidney disease. Data on such relationship in KTx patients is very limited. The aim of this clinical, single center, retrospective, observational study was to examine the relationship between MA and both mortality and renal outcomes in patients after KTx.

Methods

Blood bicarbonate concentration was measured in 486 patients (290 male; 196 female) aged 48.2 ± 12.0 years at least one year after KTx and subsequently all patients were observed during 11 years. MA was defined as the blood bicarbonate concentration lower than 22 mmol/L. The endpoints in Kaplan-Meier survival curves analysis were death, initiation of dialysis therapy or retransplantation as well as cumulative endpoint of the study i.e. death or initiation of dialysis therapy. Differences in survival curves were analyzed with log-rank test and were consider as significant when p<0.05. Relative risks (RR) were presented with 95% CI.

Results

Metabolic acidosis was diagnosed in 57 (12%) patients being long-term after KTx. The Kaplan-Meier curves analysis have shown that patients with MA reach endpoints of follow-up earlier (log-rank p=0.002 for death and p<0.001 for dialysis or retransplantation and for cumulative endpoint p<0.001). In patients with MA the risks of starting dialysis therapy or retransplantation was significantly higher than in patients without MA [RR=2.00 (1.42-2.82), p<0.001]. In patients with MA the risks of death was significantly higher than in patients without MA [RR=1.61 (1.01-2.55), p=0.04]. Risk of cumulative endpoint of the study (death and initiation of dialysis therapy or retransplantation) was also higher in patients with MA [RR=1.83 (1.49-2.23), p<0.001].

Conclusion

1. Metabolic acidosis is an important risk factor for increased mortality and progression of graft failure in kidney transplant patients. 2. The prospective interventional studies with correction of MA in patients prone to allograft nephropathy progression will provide information whether treatment of MA improves the survival of both patients and transplanted kidneys.

Funding

  • Government Support – Non-U.S.