The ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in CKD stages G4 and G5
Abstract Metabolic acidosis is a common disorder in patients with chronic kidney disease (CKD). As eGFR decreases, a reciprocal decrease in bicarbonate (HCO3 −) and an increase in chloride (Cl−) concentration is observed. The aim of this study is to determine whether the Cl−/HCO3 − ratio can be used...
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Nature Portfolio
2025-06-01
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| Series: | Scientific Reports |
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| Online Access: | https://doi.org/10.1038/s41598-025-05633-6 |
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| author | Justyna Korus Maciej Gołębiowski Jakub Stojanowski Maciej Szymczak Marcelina Żabińska Dorota Bartoszek Katarzyna Kościelska-Kasprzak Mirosław Banasik Milena Ściskalska Mariusz Kusztal Tomasz Gołębiowski |
| author_facet | Justyna Korus Maciej Gołębiowski Jakub Stojanowski Maciej Szymczak Marcelina Żabińska Dorota Bartoszek Katarzyna Kościelska-Kasprzak Mirosław Banasik Milena Ściskalska Mariusz Kusztal Tomasz Gołębiowski |
| author_sort | Justyna Korus |
| collection | DOAJ |
| description | Abstract Metabolic acidosis is a common disorder in patients with chronic kidney disease (CKD). As eGFR decreases, a reciprocal decrease in bicarbonate (HCO3 −) and an increase in chloride (Cl−) concentration is observed. The aim of this study is to determine whether the Cl−/HCO3 − ratio can be used to predict metabolic acidosis with pH decline. A total of 115 patients (age 63 ± 17 years), with CKD stage G4 or G5 were enrolled in this cross-sectional study. The arterial (A) and venous (V) blood samples were taken during AV fistula creation and evaluated in a point of care testing analyzer. The ratio of arterial Cl− and HCO3 − concentration were calculated. According to mean arterial pH (pH-A) the group was divided into group with pH-A ≤ 7.33 and with pH-A > 7.33. The group with pH-A ≤ 7.33 showed significantly lower HCO3 −, and higher Cl−, Cl−/HCO3 −-ratio than group with pH-A > 7.33. Cl−/HCO3 −-A ratio negatively correlated with pH (r=-0.77,p < 0.01). The discriminative power of Cl−/HCO3 −-A ratio for predicting pH-A ≤ 7.33 was 0.917 ([CI] = 0.87–0.97,p < 0.01) which provided 87% sensitivity and 84% specificity. The best cut-off was 6.22(mmol/l)/(mmol/l). In conclusion, a Cl−/HCO3 − ratio higher than 6.22(mmol/l)/(mmol/l) may be used as predictor of advanced metabolic acidosis in CKD stages G4 and G5. |
| format | Article |
| id | doaj-art-2a89ba1bfc604f92b2aa98cfca1b314e |
| institution | OA Journals |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Nature Portfolio |
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| spelling | doaj-art-2a89ba1bfc604f92b2aa98cfca1b314e2025-08-20T02:30:45ZengNature PortfolioScientific Reports2045-23222025-06-0115111310.1038/s41598-025-05633-6The ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in CKD stages G4 and G5Justyna Korus0Maciej Gołębiowski1Jakub Stojanowski2Maciej Szymczak3Marcelina Żabińska4Dorota Bartoszek5Katarzyna Kościelska-Kasprzak6Mirosław Banasik7Milena Ściskalska8Mariusz Kusztal9Tomasz Gołębiowski10Faculty of Medicine, Wroclaw Medical UniversityFaculty of Medicine, Wroclaw Medical UniversityDepartment and Clinic of Nephrology, Transplant Medicine and Internal Medicine, Wroclaw Medical UniversityDepartment and Clinic of Nephrology, Transplant Medicine and Internal Medicine, Wroclaw Medical UniversityDepartment of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and TechnologyDepartment of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and TechnologyDepartment of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and TechnologyDepartment and Clinic of Nephrology, Transplant Medicine and Internal Medicine, Wroclaw Medical UniversityDepartment of Pharmaceutical Biochemistry, Faculty of Pharmacy, Wroclaw Medical UniversityDepartment and Clinic of Nephrology, Transplant Medicine and Internal Medicine, Wroclaw Medical UniversityDepartment and Clinic of Nephrology, Transplant Medicine and Internal Medicine, Wroclaw Medical UniversityAbstract Metabolic acidosis is a common disorder in patients with chronic kidney disease (CKD). As eGFR decreases, a reciprocal decrease in bicarbonate (HCO3 −) and an increase in chloride (Cl−) concentration is observed. The aim of this study is to determine whether the Cl−/HCO3 − ratio can be used to predict metabolic acidosis with pH decline. A total of 115 patients (age 63 ± 17 years), with CKD stage G4 or G5 were enrolled in this cross-sectional study. The arterial (A) and venous (V) blood samples were taken during AV fistula creation and evaluated in a point of care testing analyzer. The ratio of arterial Cl− and HCO3 − concentration were calculated. According to mean arterial pH (pH-A) the group was divided into group with pH-A ≤ 7.33 and with pH-A > 7.33. The group with pH-A ≤ 7.33 showed significantly lower HCO3 −, and higher Cl−, Cl−/HCO3 −-ratio than group with pH-A > 7.33. Cl−/HCO3 −-A ratio negatively correlated with pH (r=-0.77,p < 0.01). The discriminative power of Cl−/HCO3 −-A ratio for predicting pH-A ≤ 7.33 was 0.917 ([CI] = 0.87–0.97,p < 0.01) which provided 87% sensitivity and 84% specificity. The best cut-off was 6.22(mmol/l)/(mmol/l). In conclusion, a Cl−/HCO3 − ratio higher than 6.22(mmol/l)/(mmol/l) may be used as predictor of advanced metabolic acidosis in CKD stages G4 and G5.https://doi.org/10.1038/s41598-025-05633-6Metabolic acidosisBicarbonate, chloride, anion gapCKD |
| spellingShingle | Justyna Korus Maciej Gołębiowski Jakub Stojanowski Maciej Szymczak Marcelina Żabińska Dorota Bartoszek Katarzyna Kościelska-Kasprzak Mirosław Banasik Milena Ściskalska Mariusz Kusztal Tomasz Gołębiowski The ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in CKD stages G4 and G5 Scientific Reports Metabolic acidosis Bicarbonate, chloride, anion gap CKD |
| title | The ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in CKD stages G4 and G5 |
| title_full | The ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in CKD stages G4 and G5 |
| title_fullStr | The ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in CKD stages G4 and G5 |
| title_full_unstemmed | The ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in CKD stages G4 and G5 |
| title_short | The ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in CKD stages G4 and G5 |
| title_sort | ratio of chloride to bicarbonate is a predictor of advanced metabolic acidosis in ckd stages g4 and g5 |
| topic | Metabolic acidosis Bicarbonate, chloride, anion gap CKD |
| url | https://doi.org/10.1038/s41598-025-05633-6 |
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