Kidney International Reports (Jun 2024)
Metabolic Acidosis Is Associated With an Accelerated Decline of Allograft Function in Pediatric Kidney Transplantation
- 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,
- Ryszard Grenda,
- Isabella Guzzo,
- Maria Herrero Goni,
- Julien Hogan,
- Nattaphorn Hongsawong,
- Nele Kanzelmeyer,
- 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,
- Lars Pape,
- Licia Peruzzi,
- Edita Petrosyan,
- Evgenia Preka,
- Nikoleta Printza,
- Andreea Liana Rachisan,
- Ann Raes,
- Mohan Shenoy,
- 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,
- Justine Bacchetta,
- Sevcan Bakkaloglu,
- Marjolein Bontuis,
- Caroline Booth,
- Laurene Dehoux,
- Giacomo Dizazzo,
- Dorota Drozdz,
- Ismail Dursun,
- Michaela Gessner,
- Jaap Groothoff,
- Giuliana Guido,
- Isabella Guzzo,
- Aysun Karabay Bayazit,
- Guenter Klaus,
- Linda Koster-Kamphuis,
- Alexander Lalayiannis,
- Maren Leifheit-Nestler,
- Sinha Manish,
- Chiara Matteucci,
- Jun Oh,
- Ozan Ozkaya,
- Edita Petrosyan,
- Christine Pietrement,
- Agnieszka Prytula,
- 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
Affiliations
- Agnieszka Prytula
- Department of Pediatric Nephrology and Rheumatology, Ghent University Hospital, Belgium
- Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital, London, UK
- Ineke van Gremberghe
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- Kai Krupka
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Germany
- Justine Bacchetta
- Department of Pediatric Nephrology and Rheumatology, CHU de Lyon, Bron, France
- Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Laboratory of Immunopathology and Molecular Biology of the Kidney, Department of Women’s and Children’s Health, Padua University Hospital, Padua, Italy
- Ryszard Grenda
- Department of Nephrology, Kidney Transplantation and Arterial Hypertension, Children’s Memorial Health Institute, Warsaw, Poland
- Isabella Guzzo
- Division of Nephrology, Dialysis and Renal Transplant Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Nele Kanzelmeyer
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
- Bahar Büyükkaragöz
- Department of Pedaitric Nephrology, Gazi University, Ankara, Turkey
- Birgitta Kranz
- Pediatric Nephrology, University Children‘s Hospital, Münster, Germany
- Hülya Nalçacıoğlu
- Pediatric Nephrology Department, Ondokuz Mayis University, Samsun, Turkey
- Jun Oh
- Department of Pediatric Nephrology and Transplantation, University Children’s Hospital, University Medical Center Hamburg/Eppendorf, Hamburg, Germany
- Lars Pape
- Department of Pediatrics II, University Hospital of Essen, Essen, Germany
- Mohan Shenoy
- Royal Manchester Children’s Hospital, Manchester, UK
- Anne-Laure Sellier-Leclerc
- Department of Pediatric Nephrology and Rheumatology, CHU de Lyon, Bron, France
- Burkhard Tönshoff
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Germany; Correspondence: Burkhard Tönshoff, Department of Pediatrics I, University Children’s Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.
- Gema Ariceta
- Atif Awan
- Sevcan Bakkaloğlu
- Marjolein Bonthuis
- Charlotte Bootsma Robroeks
- Antonia Bouts
- Martin Christian
- Marlies Cornelissen
- Ali Duzova
- Nasrin Esfandiar
- Luciana Ghio
- Ryszard Grenda
- Isabella Guzzo
- Maria Herrero Goni
- Julien Hogan
- Nattaphorn Hongsawong
- Nele Kanzelmeyer
- 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
- Lars Pape
- Licia Peruzzi
- Edita Petrosyan
- Evgenia Preka
- Nikoleta Printza
- Andreea Liana Rachisan
- Ann Raes
- Mohan Shenoy
- 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
- Justine Bacchetta
- Sevcan Bakkaloglu
- Marjolein Bontuis
- Caroline Booth
- Laurene Dehoux
- Giacomo Dizazzo
- Dorota Drozdz
- Ismail Dursun
- Michaela Gessner
- Jaap Groothoff
- Giuliana Guido
- Isabella Guzzo
- Aysun Karabay Bayazit
- Guenter Klaus
- Linda Koster-Kamphuis
- Alexander Lalayiannis
- Maren Leifheit-Nestler
- Sinha Manish
- Chiara Matteucci
- Jun Oh
- Ozan Ozkaya
- Edita Petrosyan
- Christine Pietrement
- Agnieszka Prytula
- 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
- DOI
- https://doi.org/10.1016/j.ekir.2024.04.007
- Journal volume & issue
-
Vol. 9,
no. 6
pp. 1684 – 1693
Abstract
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.
Keywords
