Serum anion gap predicts all-cause mortality in patients with advanced chronic kidney disease: A retrospective analysis of a randomized controlled study

Sung Woo Lee, Sejoong Kim, Ki Young Na, Ran Hui Cha, Shin Wook Kang, Cheol Whee Park, Dae Ryong Cha, Sung Gyun Kim, Sun Ae Yoon, Sang Youb Han, Jung Hwan Park, Jae Hyun Chang, Chun Soo Lim, Yon Su Kim

Research output: Contribution to journalArticle

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Abstract

Background and Objectives Cardiovascular outcomes and mortality rates are poor in advanced chronic kidney disease (CKD) patients. Novel risk factors related to clinical outcomes should be identified. Methods A retrospective analysis of data from a randomized controlled study was performed in 440 CKD patients aged > 18 years, with estimated glomerular filtration rate 15-60 mL/min/ 1.73m2 . Clinical data were available, and the albumin-adjusted serum anion gap (A-SAG) could be calculated. The outcome analyzed was all-cause mortality. Results Of 440 participants, the median (interquartile range, IQR) follow-up duration was 5.1 (3.0-5.5) years. During the follow-up duration, 29 participants died (all-cause mortality 6.6%). The area under the receiver operating characteristic curve of A-SAG for all-cause mortality was 0.616 (95% CI 0.520-0.712, P = 0.037). The best threshold of A-SAG for all-cause mortality was 9.48 mmol/L, with sensitivity 0.793 and specificity 0.431. After adjusting for confounders, A-SAG above 9.48 mmol/L was independently associated with increased risk of all-cause mortality, with hazard ratio 2.968 (95% CI 1.143-7.708, P = 0.025). In our study, serum levels of beta-2 microglobulin and blood urea nitrogen (BUN) were positively associated with A-SAG. Conclusions A-SAG is an independent risk factor for all-cause mortality in advanced CKD patients. The positive correlation between A-SAG and serum beta-2 microglobulin or BUN might be a potential reason. Future study is needed.

Original languageEnglish
Article numbere0156381
JournalPloS one
Volume11
Issue number6
DOIs
Publication statusPublished - 2016 Jun

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Acid-Base Equilibrium
blood serum
kidney diseases
Chronic Renal Insufficiency
anions
Mortality
Serum
beta 2-Microglobulin
Blood Urea Nitrogen
Urea
Blood
urea nitrogen
Nitrogen
risk factors
Serum Albumin
duration
glomerular filtration rate
Glomerular Filtration Rate
blood
ROC Curve

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Lee, Sung Woo ; Kim, Sejoong ; Na, Ki Young ; Cha, Ran Hui ; Kang, Shin Wook ; Park, Cheol Whee ; Cha, Dae Ryong ; Kim, Sung Gyun ; Yoon, Sun Ae ; Han, Sang Youb ; Park, Jung Hwan ; Chang, Jae Hyun ; Lim, Chun Soo ; Kim, Yon Su. / Serum anion gap predicts all-cause mortality in patients with advanced chronic kidney disease : A retrospective analysis of a randomized controlled study. In: PloS one. 2016 ; Vol. 11, No. 6.
@article{12cc04fd649f483c99dfc8d252ead17d,
title = "Serum anion gap predicts all-cause mortality in patients with advanced chronic kidney disease: A retrospective analysis of a randomized controlled study",
abstract = "Background and Objectives Cardiovascular outcomes and mortality rates are poor in advanced chronic kidney disease (CKD) patients. Novel risk factors related to clinical outcomes should be identified. Methods A retrospective analysis of data from a randomized controlled study was performed in 440 CKD patients aged > 18 years, with estimated glomerular filtration rate 15-60 mL/min/ 1.73m2 . Clinical data were available, and the albumin-adjusted serum anion gap (A-SAG) could be calculated. The outcome analyzed was all-cause mortality. Results Of 440 participants, the median (interquartile range, IQR) follow-up duration was 5.1 (3.0-5.5) years. During the follow-up duration, 29 participants died (all-cause mortality 6.6{\%}). The area under the receiver operating characteristic curve of A-SAG for all-cause mortality was 0.616 (95{\%} CI 0.520-0.712, P = 0.037). The best threshold of A-SAG for all-cause mortality was 9.48 mmol/L, with sensitivity 0.793 and specificity 0.431. After adjusting for confounders, A-SAG above 9.48 mmol/L was independently associated with increased risk of all-cause mortality, with hazard ratio 2.968 (95{\%} CI 1.143-7.708, P = 0.025). In our study, serum levels of beta-2 microglobulin and blood urea nitrogen (BUN) were positively associated with A-SAG. Conclusions A-SAG is an independent risk factor for all-cause mortality in advanced CKD patients. The positive correlation between A-SAG and serum beta-2 microglobulin or BUN might be a potential reason. Future study is needed.",
author = "Lee, {Sung Woo} and Sejoong Kim and Na, {Ki Young} and Cha, {Ran Hui} and Kang, {Shin Wook} and Park, {Cheol Whee} and Cha, {Dae Ryong} and Kim, {Sung Gyun} and Yoon, {Sun Ae} and Han, {Sang Youb} and Park, {Jung Hwan} and Chang, {Jae Hyun} and Lim, {Chun Soo} and Kim, {Yon Su}",
year = "2016",
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doi = "10.1371/journal.pone.0156381",
language = "English",
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Lee, SW, Kim, S, Na, KY, Cha, RH, Kang, SW, Park, CW, Cha, DR, Kim, SG, Yoon, SA, Han, SY, Park, JH, Chang, JH, Lim, CS & Kim, YS 2016, 'Serum anion gap predicts all-cause mortality in patients with advanced chronic kidney disease: A retrospective analysis of a randomized controlled study', PloS one, vol. 11, no. 6, e0156381. https://doi.org/10.1371/journal.pone.0156381

Serum anion gap predicts all-cause mortality in patients with advanced chronic kidney disease : A retrospective analysis of a randomized controlled study. / Lee, Sung Woo; Kim, Sejoong; Na, Ki Young; Cha, Ran Hui; Kang, Shin Wook; Park, Cheol Whee; Cha, Dae Ryong; Kim, Sung Gyun; Yoon, Sun Ae; Han, Sang Youb; Park, Jung Hwan; Chang, Jae Hyun; Lim, Chun Soo; Kim, Yon Su.

In: PloS one, Vol. 11, No. 6, e0156381, 06.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Serum anion gap predicts all-cause mortality in patients with advanced chronic kidney disease

T2 - A retrospective analysis of a randomized controlled study

AU - Lee, Sung Woo

AU - Kim, Sejoong

AU - Na, Ki Young

AU - Cha, Ran Hui

AU - Kang, Shin Wook

AU - Park, Cheol Whee

AU - Cha, Dae Ryong

AU - Kim, Sung Gyun

AU - Yoon, Sun Ae

AU - Han, Sang Youb

AU - Park, Jung Hwan

AU - Chang, Jae Hyun

AU - Lim, Chun Soo

AU - Kim, Yon Su

PY - 2016/6

Y1 - 2016/6

N2 - Background and Objectives Cardiovascular outcomes and mortality rates are poor in advanced chronic kidney disease (CKD) patients. Novel risk factors related to clinical outcomes should be identified. Methods A retrospective analysis of data from a randomized controlled study was performed in 440 CKD patients aged > 18 years, with estimated glomerular filtration rate 15-60 mL/min/ 1.73m2 . Clinical data were available, and the albumin-adjusted serum anion gap (A-SAG) could be calculated. The outcome analyzed was all-cause mortality. Results Of 440 participants, the median (interquartile range, IQR) follow-up duration was 5.1 (3.0-5.5) years. During the follow-up duration, 29 participants died (all-cause mortality 6.6%). The area under the receiver operating characteristic curve of A-SAG for all-cause mortality was 0.616 (95% CI 0.520-0.712, P = 0.037). The best threshold of A-SAG for all-cause mortality was 9.48 mmol/L, with sensitivity 0.793 and specificity 0.431. After adjusting for confounders, A-SAG above 9.48 mmol/L was independently associated with increased risk of all-cause mortality, with hazard ratio 2.968 (95% CI 1.143-7.708, P = 0.025). In our study, serum levels of beta-2 microglobulin and blood urea nitrogen (BUN) were positively associated with A-SAG. Conclusions A-SAG is an independent risk factor for all-cause mortality in advanced CKD patients. The positive correlation between A-SAG and serum beta-2 microglobulin or BUN might be a potential reason. Future study is needed.

AB - Background and Objectives Cardiovascular outcomes and mortality rates are poor in advanced chronic kidney disease (CKD) patients. Novel risk factors related to clinical outcomes should be identified. Methods A retrospective analysis of data from a randomized controlled study was performed in 440 CKD patients aged > 18 years, with estimated glomerular filtration rate 15-60 mL/min/ 1.73m2 . Clinical data were available, and the albumin-adjusted serum anion gap (A-SAG) could be calculated. The outcome analyzed was all-cause mortality. Results Of 440 participants, the median (interquartile range, IQR) follow-up duration was 5.1 (3.0-5.5) years. During the follow-up duration, 29 participants died (all-cause mortality 6.6%). The area under the receiver operating characteristic curve of A-SAG for all-cause mortality was 0.616 (95% CI 0.520-0.712, P = 0.037). The best threshold of A-SAG for all-cause mortality was 9.48 mmol/L, with sensitivity 0.793 and specificity 0.431. After adjusting for confounders, A-SAG above 9.48 mmol/L was independently associated with increased risk of all-cause mortality, with hazard ratio 2.968 (95% CI 1.143-7.708, P = 0.025). In our study, serum levels of beta-2 microglobulin and blood urea nitrogen (BUN) were positively associated with A-SAG. Conclusions A-SAG is an independent risk factor for all-cause mortality in advanced CKD patients. The positive correlation between A-SAG and serum beta-2 microglobulin or BUN might be a potential reason. Future study is needed.

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U2 - 10.1371/journal.pone.0156381

DO - 10.1371/journal.pone.0156381

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AN - SCOPUS:84973885432

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