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논문분류	춘계학술대회 초록집
제목	Metabolic acidosis and clinical outcomes in CKD patients – multicenter large cohort study using instrumental variable analysis
저자	Jung Nam An1, Sohee Oh2, Yong Chul Kim3, Younglee Jung1, Soie Kwon3, Kwon-Wook Joo3, Yun Kyu Oh1, Yon Su Kim3, Chun Soo Lim1, Jung Pyo Lee1
출판정보	2018; 2018(1):
키워드	Metabolic acidosis \| Chronic kidney disease \| Instrumental variable \| Outcomes
초록	Objectives: Whether low serum total CO2 (TCO2) concentrations, defined as metabolic acidosis, increase a risk for kidney function deterioration and mortality in chronic kidney disease (CKD) was controversial and not clear enough. Large-scale studies for the clinical impacts of metabolic acidosis in Asian CKD patients have been done, neither. Methods: A multicenter cohort study of 42,270 adult nephrology outpatients, from 2001 to 2016, was conducted to investigate the association between serum TCO2 concentrations measured at first outpatient visit and clinical outcomes. The patients diagnosed with end-stage renal disease (ESRD) from the first day of outpatient visit to 3 months were excluded. Instrumental variable was defined as the region divided to 4 groups based on the proportion of patients who have serum TCO2 concentration lower than 22 mmol/L. Results: The patients with initial TCO2 < 22 mmol/L were 10.1%, hypertension and diabetes accounted for 29.3% and 20.9%, respectively. ESRD occurred at 8.5% patients and mortality rate was 12.2% during median 77.0 months follow-up period. Cox-proportional hazard regression model adjusted for initial estimated glomerular filtration rate demonstrated that low TCO2 concentration increased a risk for progression to ESRD (hazard ratio [HR] 1.13; 95% confidence interval [95% CI] 1.04-1.23) and mortality (HR 1.47; 95% CI 1.37-1.59). Cox regression model using instrumental variable also verified a significant association between initial TCO2 concentration and mortality (HR 0.58; 95% CI 0.51-0.66), however, there was no significant hazards of low TCO2 concentration for progression to ESRD. Conclusions: Metabolic acidosis was significantly associated with mortality, but not with progression to ESRD in this study using instrumental variable.
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