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Urine citrate excretion as a marker of acid retention in patients with chronic kidney disease without overt metabolic acidosis.
Kidney Int. 2019 05; 95(5):1190-1196.KI

Abstract

Acid (H+) retention appears to contribute to progressive decline in glomerular filtration rate (GFR) in patients with chronic kidney disease (CKD), including some patients without metabolic acidosis. Identification of patients with H+ retention but without metabolic acidosis could facilitate targeted alkali therapy; however, current methods to assess H+ retention are invasive and have little clinical utility. We tested the hypothesis that urine excretion of the pH-sensitive metabolite citrate can identify H+ retention in patients with reduced GFR but without overt metabolic acidosis. H+ retention was assessed based on the difference between observed and expected plasma total CO2 after an oral sodium bicarbonate load. The association between H+ retention and urine citrate excretion was evaluated in albuminuric CKD patients with eGFR 60-89 ml/min/1.73m2 (CKD 2, n=40) or >90 ml/min/1.73m2 (CKD 1, n = 26) before and after 30 days of base-producing fruits and vegetables. Baseline H+ retention was higher in CKD 2, while baseline urine citrate excretion was lower in CKD 2 compared to CKD 1. Base-producing fruits and vegetables decreased H+ retention in CKD 2 and increased urine citrate excretion in both groups. Thus, H+ retention is associated with lower urine citrate excretion, and reduction of H+ retention with a base-producing diet is associated with increased urine citrate excretion. These results support further exploration of the utility of urine citrate excretion to identify H+ retention in CKD patients with reduced eGFR but without metabolic acidosis, to determine their candidacy for kidney protection with dietary H+ reduction or alkali therapy.

Authors+Show Affiliations

Baylor Scott & White Health Department of Internal Medicine, Temple, Texas, USA; Texas A&M Health Sciences Center College of Medicine, Temple, Texas, USA.Texas Tech University Health Sciences Center Department of Surgery, Lubbock, Texas, USA.Baylor Scott & White Health Department of Biostatistics, Temple, Texas, USA.St. Elizabeth's Medical Center and Tufts University School of Medicine Department of Medicine, Boston, Massachusetts, USA.Baylor Scott & White Health Department of Internal Medicine, Dallas, Texas, USA; Texas A&M Health Sciences Center College of Medicine, Dallas, Texas, USA. Electronic address: Donald.Wesson@BSWHealth.org.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30846270

Citation

Goraya, Nimrit, et al. "Urine Citrate Excretion as a Marker of Acid Retention in Patients With Chronic Kidney Disease Without Overt Metabolic Acidosis." Kidney International, vol. 95, no. 5, 2019, pp. 1190-1196.
Goraya N, Simoni J, Sager LN, et al. Urine citrate excretion as a marker of acid retention in patients with chronic kidney disease without overt metabolic acidosis. Kidney Int. 2019;95(5):1190-1196.
Goraya, N., Simoni, J., Sager, L. N., Madias, N. E., & Wesson, D. E. (2019). Urine citrate excretion as a marker of acid retention in patients with chronic kidney disease without overt metabolic acidosis. Kidney International, 95(5), 1190-1196. https://doi.org/10.1016/j.kint.2018.11.033
Goraya N, et al. Urine Citrate Excretion as a Marker of Acid Retention in Patients With Chronic Kidney Disease Without Overt Metabolic Acidosis. Kidney Int. 2019;95(5):1190-1196. PubMed PMID: 30846270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urine citrate excretion as a marker of acid retention in patients with chronic kidney disease without overt metabolic acidosis. AU - Goraya,Nimrit, AU - Simoni,Jan, AU - Sager,Lauren N, AU - Madias,Nicolaos E, AU - Wesson,Donald E, Y1 - 2019/03/01/ PY - 2018/06/28/received PY - 2018/11/17/revised PY - 2018/11/21/accepted PY - 2019/3/9/pubmed PY - 2020/4/3/medline PY - 2019/3/9/entrez KW - GFR KW - acidosis KW - bicarbonate KW - chronic kidney disease KW - diet SP - 1190 EP - 1196 JF - Kidney international JO - Kidney Int VL - 95 IS - 5 N2 - Acid (H+) retention appears to contribute to progressive decline in glomerular filtration rate (GFR) in patients with chronic kidney disease (CKD), including some patients without metabolic acidosis. Identification of patients with H+ retention but without metabolic acidosis could facilitate targeted alkali therapy; however, current methods to assess H+ retention are invasive and have little clinical utility. We tested the hypothesis that urine excretion of the pH-sensitive metabolite citrate can identify H+ retention in patients with reduced GFR but without overt metabolic acidosis. H+ retention was assessed based on the difference between observed and expected plasma total CO2 after an oral sodium bicarbonate load. The association between H+ retention and urine citrate excretion was evaluated in albuminuric CKD patients with eGFR 60-89 ml/min/1.73m2 (CKD 2, n=40) or >90 ml/min/1.73m2 (CKD 1, n = 26) before and after 30 days of base-producing fruits and vegetables. Baseline H+ retention was higher in CKD 2, while baseline urine citrate excretion was lower in CKD 2 compared to CKD 1. Base-producing fruits and vegetables decreased H+ retention in CKD 2 and increased urine citrate excretion in both groups. Thus, H+ retention is associated with lower urine citrate excretion, and reduction of H+ retention with a base-producing diet is associated with increased urine citrate excretion. These results support further exploration of the utility of urine citrate excretion to identify H+ retention in CKD patients with reduced eGFR but without metabolic acidosis, to determine their candidacy for kidney protection with dietary H+ reduction or alkali therapy. SN - 1523-1755 UR - https://www.unboundmedicine.com/medline/citation/30846270/Urine_citrate_excretion_as_a_marker_of_acid_retention_in_patients_with_chronic_kidney_disease_without_overt_metabolic_acidosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(18)30945-1 DB - PRIME DP - Unbound Medicine ER -