Analysis Of Related Factors Of Metabolic Acidosis In Different Stages Of Chronic Kidney Disease

Objective: Metabolic acidosis is a common complication in chronic kidney disease,metabolic acidosis on the human body produce a variety of hazards.The aim of this study is to investigate the incidence of metabolic acidosis in chronic kidney disease and to analyze the relevant influencing factorsMethod: We selected 301 admitted patients in the nephrology department,from January 2016-September 2016,of the Second Affiliated Hospital of Dalian Medical university for this study.In addition,567 in April 2016-December 2016 admitted to patients with chronic kidney disease from the Liaoning Provincial People's Hospital Department of Nephrology.Clusion criteria: diagnosed with chronic kidney disease.Exclusion criteria: 1.Age <18 years old.2.Acute renal failure.3.Who has undergone parathyroidectomy.4.Thyroid dysfunction..5.Lactic acidosis or ketoacidosis 6.Primary renal tubular acidosis.The definition and staging of chronic kidney disease refer to the KDOQI guidelines developed by the American Nephrology Foundation.Estimation of glomerular filtration rate(e GFR),calculated according to CKD-EPI(2007).In this study,190 samples with bicarbonate concentration and carbon dioxide combinding power(CO2-CP)were analyzed.The linear correlation analysis showed that the concentration of bicarbonate has a positive correlation with the combining power of carbon dioxide,and the carbon dioxide combining power can be used as an evaluation index of metabolic acidosis.Therefore,carbon dioxide combining power <22mmol / L is defined as metabolic acidosis in this study.Patients with chronic kidney disease were divided into non-metabolic acidosis and metabolic acidosis group according to CO2-CP 22-30 mmol / L and CO2-CP <22mmol / L.Record the general information: gender,age,height,weight,BMI,systolic blood pressure,diastolic blood pressure,the type of primary disease,whether the merger of hypertension,diabetes,coronary heart disease,whether taking calcium antagonists,?-blockers,ACEI / ARB drugs,whether to perform kidney replacement therapy and type of renal replacement therapy.All blood samples were collected on the day of admission,hemodialysis patients with blood samples collected before dialysis,ECG examination is completed on the day of admission.Testing and inspection of indicators:Serum creatinine,carbon dioxide combining power,HCO3-concentration,hemoglobin,C-reactive protein,triiodothronine(T3),throxine(T4),throid stimulation hormone(TSH),parathyroid hormone,total protein,albumin,globulin,Cystain C,uric acid,triglyceride,cholesterol,high density lipoprotein,low density lipoprotein,lipoprotein alpha,serum potassium,serum sodium,blood chloride,calcium,blood phosphorus.ECG examination: QT interval,QTc interval.All data were analyzed by SPSS23.0 statistical software.Result: 1.General information: A total of 868 patients were enrolled in this study,including 447 males and 421 females,age(19 to 93)years,with an average age of 63.16 ± 14.29 years.There were 47 cases of CKD1,64 cases of CKD2,83 cases of CKD3,88 cases of CKD4,310 cases of CKD5,There were 84 patients with hemodialysis and 192 patients with peritoneal dialysis.Primary disease classification: primary glomerulonephritis 541 cases,type 2 diabetes 192 cases,hypertension 59 cases,30 cases of interstitial nephritis,polycystic kidney 23 cases,4 cases of gout,4 cases of systemic lupus erythematosus,urinary tract infection in 2 cases,ANCA-related vasculitis in 2 cases,Renal cysts in 2 cases,2 cases of allergic purpura,and other 6 cases.2.Analysis of 190 patients with carbon dioxide combining power and bicarbonate concentration data,the results showed that the average concentration of carbon dioxide combining power was 18.65 ± 5.20 mmol / L and the average value of bicarbonate was 19.35 ± 5.31 mmol / L.There was no significant difference between the two groups(P> 0.05).The two groups were analyzed by linear relationship.The Pearson's correlation coefficient r = 0.933(P <0.001)indicates that the combining power of carbon dioxide is positively correlated with the concentration of bicarbonate,carbon dioxide combining power can be used as a measure of metabolic acidosis in the index,therefore,this study defines carbon dioxide combining power <22 mmol / L of metabolic acidosis.3.This study was divided into CKD1-5 group,hemodialysis group and peritoneal dialysis group according to CKD stage.The difference of carbon dioxide combining power between the seven groups was statistically significant(P <0.05).The mean value of carbon dioxide binding in patients with CKD1 was higher than CKD4,CKD5 and hemodialysis patients,the difference was statistically significant(P <0.05).CKD2,CKD3,CKD4 and CKD5 were decreased,and the difference of CO2-CP between the two groups was statistically significant(P <0.05).The mean value of carbon dioxide binding in patients undergoing hemodialysis was lower than that in patients with peritoneal dialysis(22.57 ± 4.58 V vs 25.28 ± 4.41)mml/L,the difference was statistically significant.There was significant difference in the level of carbon dioxide binding between early stage CKD and late stage of CKD.There was no statistically significant difference in the level of carbon dioxide binding between early stage CKD and patients who had undergone renal replacement therapy.4.Comparison of the incidence of metabolic acidosis in different stages of chronic kidney disease.The incidence of metabolic acidosis in CKD1 stage was lower than that in CKD4 stage and CKD5 stage and hemodialysis patients,and the difference was statistically significant(P <0.05).CKD2 ~ CKD5 metabolic acidosis incidence increased,the difference between the two were statistically significant(P <0.05).The probability of metabolic acidosis in hemodialysis patients was higher than that in patients with peritoneal dialysis(P <0.05).5.The incidence of metabolic acidosis in diabetic group was higher than that in non-diabetic group(45.07% vs 40.04%),the difference was statistically significant(P <0.05).Diabetic patients had lower levels of carbon dioxide combining power than non-diabetic patients(22.07 ± 2.19VS22.18 ± 5.47)mmol / L,the difference was not statistically significant.The prevalence of hypertension in metabolic acidosis patients was higher than that in patients with non metabolic acidosis(72.41% vs65.14%),the difference was statistically significant(P <0.05).There was no significant difference in the prevalence of diabetes mellitus between metabolic acidosis group and non metabolic acidosis group(40.05% vs 37.04%),the difference was not statistically significant(P> 0.05).6.Comparison of metabolic acidosis group and non-metabolic acidosis group clinical indicators,the levels of plasma creatinine,urea nitrogen,cystatin C,uric acid,potassium ion,chloride ion,phosphate ion concentration and systolic blood pressure were higher in metabolic acidosis group than non-metabolic acidosis,hemoglobin,hematocrit,T3,albumin,whiteboard ratio,lipoprotein a,plasma calcium ion concentration in metabolic acidosis group lower.The above clinical factors were statistically significant(P <0.05).7.To analyze the relationship between CO2-CP levels and clinical indicators,the results showed that the levels of CO2-CP were positively correlated with e GFR,Hb,Alb,A / G,lipoprotein ? and serum calcium,and CO2-CP levels were negatively correlated with systolic blood pressure,Scr,BUN,uric acid,chloride ion concentration and phosphate concentration.8.Multivariate logistic regression analysis showed that the decrease of glomerular filtration rate(OR = 2.38,P <0.05)and the increase of chloride ion concentration(OR = 1.116,P <0.05)are the risk factors of metabolic acidosis in chronic kidney disease;Lipoprotein a increased(OR = 0.998,P <0.05)is a protective factor for chronic kidney disease metabolic acidosis.Conclusion: 1.Metabolic acidosis is a common complication of chronic kidney disease chronic kidney disease early stage and even CKD1 can occur metabolic acidosis,prevention and treatment of metabolic acidosis should be from the early stage of chronic kidney disease.2.Chronic kidney disease with metabolic acidosis in patients with high prevalence of hypertension than chronic kidney disease without metabolic acidosis patients,metabolic acidosis may be chronic kidney disease in patients with elevated blood pressure or blood pressure is difficult to control one of the reasons.3.With the progress of chronic kidney disease metabolic acidosis incidence was gradually increased,glomerular filtration rate decreased and increased serum chloride concentration are chronic kidney disease metabolic acidosis risk factors,elevated levels of lipoprotein a is a protective factor for chronic kidney disease metabolic acidosis.