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PLoS One. 2016;11(6):e0156381.

Serum Anion Gap Predicts All-Cause Mortality in Patients with Advanced Chronic Kidney Disease: A Retrospective Analysis of a Randomized Controlled Study.

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제1저자 이성우 · 교신저자 김세중

PMID 27249416 PMC4889106 DOI 10.1371/journal.pone.0156381 IF 2.8 신장내과
소속 (14)
  1. Department of Internal Medicine, Eulji General Hospital, Seoul, 01830, Korea.
  2. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Korea.
  3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.
  4. Department of Internal Medicine, National Medical Center, Seoul, 04564, Korea.
  5. Department of Internal Medicine, Yonsei University College of Medicine 03722, Seoul, Korea.
  6. Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Korea.
  7. Department of Internal Medicine, Korea University Ansan-Hospital, Korea University, Ansan, Gyeonggi-do, 15355, Korea.
  8. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, 14068, Korea.
  9. Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Gyeonggi-do, 11765, Korea.
  10. Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Goyang, Gyeonggi-do, 10380, Korea.
  11. Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 05030, Korea.
  12. Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University of Medicine and Science, Incheon, 21565, Korea.
  13. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, 08708, Korea.
  14. Kidney Research Institute, Seoul National University, Seoul, 03080, Korea.

Abstract

BACKGROUND AND OBJECTIVES Cardiovascular outcomes and mortality rates are poor in advanced chronic kidney disease (CKD) patients. Novel risk factors related to clinical outcomes should be identified.

METHODS A retrospective analysis of data from a randomized controlled study was performed in 440 CKD patients aged > 18 years, with estimated glomerular filtration rate 15-60 mL/min/1.73m2. Clinical data were available, and the albumin-adjusted serum anion gap (A-SAG) could be calculated. The outcome analyzed was all-cause mortality.

RESULTS Of 440 participants, the median (interquartile range, IQR) follow-up duration was 5.1 (3.0-5.5) years. During the follow-up duration, 29 participants died (all-cause mortality 6.6%). The area under the receiver operating characteristic curve of A-SAG for all-cause mortality was 0.616 (95% CI 0.520-0.712, P = 0.037). The best threshold of A-SAG for all-cause mortality was 9.48 mmol/L, with sensitivity 0.793 and specificity 0.431. After adjusting for confounders, A-SAG above 9.48 mmol/L was independently associated with increased risk of all-cause mortality, with hazard ratio 2.968 (95% CI 1.143-7.708, P = 0.025). In our study, serum levels of beta-2 microglobulin and blood urea nitrogen (BUN) were positively associated with A-SAG.

CONCLUSIONS A-SAG is an independent risk factor for all-cause mortality in advanced CKD patients. The positive correlation between A-SAG and serum beta-2 microglobulin or BUN might be a potential reason. Future study is needed.

TRIAL REGISTRATION Clinicaltrials.gov NCT 00860431.

Figures

Fig 1
Fig 1 Patient selection algorithm. ITT, intention to treat; PP, per protocol.
Fig 2
Fig 2 Restricted cubic spline curve of albumin-adjusted serum anion gap (A-SAG) for all-cause mortality. As A-SAG increased, the log hazard of all-cause mortality increased, but nonlinearly.
Fig 3
Fig 3 Kaplan-Meier survival curve according to the albumin-adjusted serum anion gap (A-SAG) status. Mean (95% CI) survivals of < and ≥ 9.48 mmol/L of A-SAG groups were 6.1 (6.0–6.2) years and 5.9 (5.7–6.1) years, respectively.
Fig 4
Fig 4 Associations between albumin-adjusted serum anion gap (A-SAG) and uremic toxins. A, B, and C designated serum total indoxyl sulfate (IS), serum beta-2 microglobulin (B2MG) and blood urea nitrogen (BUN), respectively.

그림 출처: PubMed Central 공개 논문 (PMC4889106)

Conflict of interest statement

Competing Interests:The authors of this manuscript have read the journal's policy and have the following competing interests: The authors received funding from CJ HealthCare Corporation and Kureha Corporation, both commercial companies, for this study. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

그 밖의 정보
출판 형태
Journal Article, Multicenter Study, Randomized Controlled Trial
저널
PloS one · eISSN 1932-6203
전자 출판
2016-06-01
MeSH
Adult · Aged · Anions · Female · Glomerular Filtration Rate · Humans · Kidney Failure, Chronic / mortality / physiopathology · Male · Middle Aged · Prospective Studies · Retrospective Studies
Substances
Anions
데이터
ClinicalTrials.gov: NCT00860431
참고문헌
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