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Hyperchloremic acidosis develops at the stage G4 and shifts to high anion gap acidosis at the stage G5 in chronic kidney disease

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Abstract

Background

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.

Methods

The degree of Cl-Ac, which is indicated as the bicarbonate concentration decrease with serum chloride concentration increase (∆[HCO3–]Cl), was compared with the estimated glomerular filtration rate (eGFR) by using CKD patient records.

Results

In 307 records with metabolic acidosis, a spline curve obtained from the plot comparing ∆[HCO3–]Cl with eGFR showed that ∆[HCO3–]Cl did not change, increased, and decreased during eGFR decrease until 27, from 27 to 17.5, and from 17.5 mL/min/1.73 m2, respectively.

Conclusion

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.

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Authors and Affiliations

  1. 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

    Masayuki Tanemoto, Takahide Kimura, Seiki Yamada & Takeshi Yokoyama

  2. Dialysis Unit, Shin-Kuki General Hospital, Saitama, Japan

    Masayuki Tanemoto, Ryohei Kamachi & Yukio Okazaki

Authors
  1. Masayuki Tanemoto
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  2. Ryohei Kamachi
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  3. Takahide Kimura
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  4. Seiki Yamada
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  5. Takeshi Yokoyama
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  6. Yukio Okazaki
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Corresponding author

Correspondence to Masayuki Tanemoto.

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The authors have no conflicts of interest to declare.

Ethical standards

The study was conducted in accordance with the guidelines written in the Declaration of Helsinki. The study was approved by the ethics committee of Shin-Kuki General Hospital (Approved number 0002) and written informed consent from individual patients was waived.

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Tanemoto, M., Kamachi, R., Kimura, T. et al. Hyperchloremic acidosis develops at the stage G4 and shifts to high anion gap acidosis at the stage G5 in chronic kidney disease. Clin Exp Nephrol 24, 1140–1143 (2020). https://doi.org/10.1007/s10157-020-01949-x

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  • DOI: https://doi.org/10.1007/s10157-020-01949-x

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