Metabolic Acidosis Is Associated With an Accelerated Decline of Allograft Function in Pediatric Kidney Transplantation

Metabolic Acidosis Is Associated With an Accelerated Decline of Allograft Function in Pediatric Kidney Transplantation

Introduction: We investigated the relationship between metabolic acidosis over time and allograft outcome in pediatric kidney transplantation (KTx). Methods: This registry study collected data up to 10 years posttransplant. Survival analysis for a composite end point of graft loss or estimated glome...

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Main Authors: Agnieszka Prytula, Rukshana Shroff, Ineke van Gremberghe, Kai Krupka, Justine Bacchetta, Elisa Benetti, Ryszard Grenda, Isabella Guzzo, Nele Kanzelmeyer, Bahar Büyükkaragöz, Birgitta Kranz, Hülya Nalçacıoğlu, Jun Oh, Lars Pape, Mohan Shenoy, Anne-Laure Sellier-Leclerc, Burkhard Tönshoff, Gema Ariceta, Atif Awan, Sevcan Bakkaloğlu, Marjolein Bonthuis, Charlotte Bootsma Robroeks, Antonia Bouts, Martin Christian, Marlies Cornelissen, Ali Duzova, Nasrin Esfandiar, Luciana Ghio, Maria Herrero Goni, Julien Hogan, Nattaphorn Hongsawong, Aysun Karabay Bayazit, Gülşah Kaya Aksoy, Noel Knops, Linda Koster Kamphuis, Daniella Levy Erez, Victor Lopez-Baez, Alvaro Madrid, Stephen Marks, Anette Melk, Luisa Murer, Licia Peruzzi, Edita Petrosyan, Evgenia Preka, Nikoleta Printza, Andreea Liana Rachisan, Ann Raes, Oguz Soylemezoglu, Luca Dello Strologo, Ana Teixeira, Rezan Topaloglu, Markus Weitz, Jakub Zieg, Galia Zlatanova, Christian Patry, Jerome Harambat, Ayşe Ağbaş, Varvara Askiti, Marina Avramescu, Sevcan Bakkaloglu, Marjolein Bontuis, Caroline Booth, Laurene Dehoux, Giacomo Dizazzo, Dorota Drozdz, Ismail Dursun, Michaela Gessner, Jaap Groothoff, Giuliana Guido, Guenter Klaus, Linda Koster-Kamphuis, Alexander Lalayiannis, Maren Leifheit-Nestler, Sinha Manish, Chiara Matteucci, Ozan Ozkaya, Christine Pietrement, George Reusz, Franz Schaefer, Claus Peter Schmitt, Anne Schön, Fatma Lale Sever, Stella Stabouli, Serra Sürmeli Döven, Camilla Tondel, Enrico Verrina, Enrico Vidal, Dean Wallace, Zainab Arslan, M. Bald, H. Fehrenbach, D. Haffner, M. Hansen, C. Hempel, U. John, G. Klaus, J. König, B. Lange-Sperandio, D. Müller, J. Oh, L. Pape, M. Pohl, K. Sauerstein, G. Schalk, H. Staude, P. Strotmann, L.T. Weber, M. Weitz, L. Berta, K. Heindl-Rusai
Format: Article
Language:English
Published: Elsevier 2024-06-01
Series:Kidney International Reports
Subjects:
acidosis
pediatric
transplantation
Online Access:http://www.sciencedirect.com/science/article/pii/S2468024924016279
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Summary:Introduction: We investigated the relationship between metabolic acidosis over time and allograft outcome in pediatric kidney transplantation (KTx). Methods: This registry study collected data up to 10 years posttransplant. Survival analysis for a composite end point of graft loss or estimated glomerular filtration rate (eGFR) ≤ 30 ml/min per 1.73 m2 or ≥50% decline from eGFR at month 3 posttransplant was performed. The association of serum bicarbonate concentration (HCO3−) < 22 mmol/l (metabolic acidosis) and HCO3− < 18 mmol/l (severe metabolic acidosis) with allograft outcome was investigated using stratified Cox models and marginal structural models. Secondary analyses included the identification of risk factors for metabolic acidosis and the relationship between alkali supplementation and allograft outcome. Results: We report on 1911 patients, of whom 347 reached the composite end point. The prevalence of metabolic acidosis over time ranged from 20.4% to 38.9%. In the adjusted Cox models, metabolic acidosis (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.54–2.60) and severe metabolic acidosis (HR, 2.49; 95% CI, 1.56–3.99) were associated with allograft dysfunction. Marginal structural models showed similar results (HR, 1.75; 95% CI, 1.32–2.31 and HR, 2.09; 95% CI, 1.23–3.55, respectively). Older age was associated with a lower risk of metabolic acidosis (odds ratio [OR] 0.93/yr older; 95% CI, 0.91–0.96) and severe metabolic acidosis (OR, 0.89; 95% CI, 0.84–0.95). Patients with uncontrolled metabolic acidosis had the worst outcome compared to those without metabolic acidosis and without alkali (HR, 3.70; 95% CI, 2.54–5.40) Conclusion: The degree of metabolic acidosis is associated with allograft dysfunction.
ISSN:2468-0249

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