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

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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

All Science Journal Classification (ASJC) codes

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

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    Lee, S. W., Kim, S., Na, K. Y., Cha, R. H., Kang, S. W., Park, C. W., Cha, D. R., Kim, S. G., Yoon, S. A., Han, S. Y., Park, J. H., Chang, J. H., Lim, C. S., & Kim, Y. S. (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, 11(6), [e0156381]. https://doi.org/10.1371/journal.pone.0156381