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Revista Médica del Uruguay

On-line version ISSN 1688-0390

Abstract

GADOLA, Liliana et al. Impacto de la acidosis en la evolución de la cohorte de pacientes del Programa de Salud Renal del Uruguay. Rev. Méd. Urug. [online]. 2013, vol.29, n.1, pp.04-11. ISSN 1688-0390.

Summary Objective: to evaluate the prevalence of metabolic acidosis in chronic kidney disease and its impact on the evolution of the condition. Method: we conducted a retrospective study of patients in the Renal Health Program of Uruguay (from October, 2004 through October, 2011) with two control groups six months or longer apart, and at least one bicarbonatemia datum. We analysed: creatininemia, proteinuria, venous bicarbonatemia and alcalinizing treatment. The start of dialysis, transplant and/or death were considered final events. Statistical analysis: t test, chi2, ANOVA, Kaplan-Meier and multivariate analysis using Cox method (meaningful p < 0,05). Results: we analyzed 921 patients with at least one bicarbonatemia datum (232 patients with two or more data). Creatininemia was greater in the tubulo-interstitial nephritis and in the groups with bicarbonatemia lower than 23 mEq/l (acidosis) or greater than 32 mEq/l, rather than in the intermediate group. Bicarbonatemia was lower in the IV-V stages than in the I-II stages of chronic kidney disease. In stages I-II bicarbonatemia was lower in the presence of proteinuria. Seven point three percent of patients received alkalinizers at the start, and 31% at the end. In the group with acidosis, increase of creatininemia/year (n = 232) was greater and survival (combined) was lower. Bicarbonatemia, creatininemia and proteinuria levels were independently correlated with the combined final event (entering the renal substitution treatment/death). Conclusions: metabolic acidosis may be observed since initial stages of the chronic kidney disease and it constitutes an independent factor of progression and death. Thus, early detection and correction are advisable.

Keywords : ACIDOSIS; RENAL INSUFFICIENCY CHRONIC; EVALUATION; CLINICAL EVOLUTION.

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