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Association between serum Na-Cl level and renal function decline in chronic kidney disease: results from the chronic kidney disease Japan cohort (CKD-JAC) study.
Clin Exp Nephrol. 2019 Feb; 23(2):215-222.CE

Abstract

BACKGROUND

Metabolic acidosis, which reduces serum bicarbonate levels, contributes to the progression of chronic kidney disease (CKD). The difference between sodium and chloride (Na-Cl) may theoretically predict serum bicarbonate levels. This study aimed to evaluate serum Na-Cl level as a risk factor for renal function decline among patients who participated in the chronic kidney disease Japan cohort (CKD-JAC) study.

METHODS

The association between low Na-Cl concentration (< 34 mmol/L) and composite renal function decline events (any initiation of renal replacement therapy or 50% decline in estimated glomerular filtration rate) was evaluated among 2143 patients with CKD stage G3a-4. Using Cox regression analysis, hazard ratios (HRs) were estimated after adjusting for the following covariates: age, sex, diabetes mellitus, diabetic nephropathy, cardiovascular disease, anemia, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists, loop diuretics, cigarette smoking, body mass index, serum albumin, systolic blood pressure, urine albumin-to-creatinine ratio, and CKD stage.

RESULTS

Composite renal function decline events were observed in 405 patients (18.9%) over the 4-year follow-up period. Low serum Na-Cl level (< 34 mmol/L) was independently associated with a greater risk for composite renal function decline events (HR 1.384; 95% confidence interval [CI], 1.116-1.717). Subgroup analyses identified that the association between low Na-Cl level and composite renal function decline events was stronger among patients with CKD stage G4 and those with anemia.

CONCLUSIONS

Our investigation suggests that Na-Cl is an independent predictor of CKD progression, especially among patients with CKD stage G4 and those with anemia.

Authors+Show Affiliations

Division of Nephrology (Fujigaoka Hospital), Department of Medicine, Showa University School of Medicine, Yokohama, Japan.Division of Nephrology (Fujigaoka Hospital), Department of Medicine, Showa University School of Medicine, Yokohama, Japan. tahasegawa-npr@umin.net. Office for Promoting Medical Research, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan. tahasegawa-npr@umin.net. Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan. tahasegawa-npr@umin.net. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan. tahasegawa-npr@umin.net.Statcom Company Limited, Tokyo, Japan.Division of Nephrology (Fujigaoka Hospital), Department of Medicine, Showa University School of Medicine, Yokohama, Japan.Division of Nephrology (Fujigaoka Hospital), Department of Medicine, Showa University School of Medicine, Yokohama, Japan.Nakayamadera Imai Clinic, Takarazuka, Hyogo, Japan.Yaizu City Hospital, Shizuoka, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30168046

Citation

Maruta, Yuichi, et al. "Association Between Serum Na-Cl Level and Renal Function Decline in Chronic Kidney Disease: Results From the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study." Clinical and Experimental Nephrology, vol. 23, no. 2, 2019, pp. 215-222.
Maruta Y, Hasegawa T, Yamakoshi E, et al. Association between serum Na-Cl level and renal function decline in chronic kidney disease: results from the chronic kidney disease Japan cohort (CKD-JAC) study. Clin Exp Nephrol. 2019;23(2):215-222.
Maruta, Y., Hasegawa, T., Yamakoshi, E., Nishiwaki, H., Koiwa, F., Imai, E., & Hishida, A. (2019). Association between serum Na-Cl level and renal function decline in chronic kidney disease: results from the chronic kidney disease Japan cohort (CKD-JAC) study. Clinical and Experimental Nephrology, 23(2), 215-222. https://doi.org/10.1007/s10157-018-1631-x
Maruta Y, et al. Association Between Serum Na-Cl Level and Renal Function Decline in Chronic Kidney Disease: Results From the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study. Clin Exp Nephrol. 2019;23(2):215-222. PubMed PMID: 30168046.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between serum Na-Cl level and renal function decline in chronic kidney disease: results from the chronic kidney disease Japan cohort (CKD-JAC) study. AU - Maruta,Yuichi, AU - Hasegawa,Takeshi, AU - Yamakoshi,Etsuko, AU - Nishiwaki,Hiroki, AU - Koiwa,Fumihiko, AU - Imai,Enyu, AU - Hishida,Akira, Y1 - 2018/08/24/ PY - 2018/02/04/received PY - 2018/08/07/accepted PY - 2018/9/1/pubmed PY - 2019/6/18/medline PY - 2018/9/1/entrez KW - Acid–base disorder KW - Bicarbonate KW - CKD KW - Electrolyte KW - Metabolic acidosis SP - 215 EP - 222 JF - Clinical and experimental nephrology JO - Clin Exp Nephrol VL - 23 IS - 2 N2 - BACKGROUND: Metabolic acidosis, which reduces serum bicarbonate levels, contributes to the progression of chronic kidney disease (CKD). The difference between sodium and chloride (Na-Cl) may theoretically predict serum bicarbonate levels. This study aimed to evaluate serum Na-Cl level as a risk factor for renal function decline among patients who participated in the chronic kidney disease Japan cohort (CKD-JAC) study. METHODS: The association between low Na-Cl concentration (< 34 mmol/L) and composite renal function decline events (any initiation of renal replacement therapy or 50% decline in estimated glomerular filtration rate) was evaluated among 2143 patients with CKD stage G3a-4. Using Cox regression analysis, hazard ratios (HRs) were estimated after adjusting for the following covariates: age, sex, diabetes mellitus, diabetic nephropathy, cardiovascular disease, anemia, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists, loop diuretics, cigarette smoking, body mass index, serum albumin, systolic blood pressure, urine albumin-to-creatinine ratio, and CKD stage. RESULTS: Composite renal function decline events were observed in 405 patients (18.9%) over the 4-year follow-up period. Low serum Na-Cl level (< 34 mmol/L) was independently associated with a greater risk for composite renal function decline events (HR 1.384; 95% confidence interval [CI], 1.116-1.717). Subgroup analyses identified that the association between low Na-Cl level and composite renal function decline events was stronger among patients with CKD stage G4 and those with anemia. CONCLUSIONS: Our investigation suggests that Na-Cl is an independent predictor of CKD progression, especially among patients with CKD stage G4 and those with anemia. SN - 1437-7799 UR - https://www.unboundmedicine.com/medline/citation/30168046/Association_between_serum_Na_Cl_level_and_renal_function_decline_in_chronic_kidney_disease:_results_from_the_chronic_kidney_disease_Japan_cohort__CKD_JAC__study_ L2 - https://dx.doi.org/10.1007/s10157-018-1631-x DB - PRIME DP - Unbound Medicine ER -