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

doi: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

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

Department of Internal Medicine

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12 Citations (Scopus)

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 language	English
Article number	e0156381
Journal	PloS one
Volume	11
Issue number	6
DOIs	https://doi.org/10.1371/journal.pone.0156381
Publication status	Published - 2016 Jun

Bibliographical note

Funding Information:
The authors of this manuscript have read the journal's policy and have the following competing interests: The authors received funding from CJ HealthCare Corporation and Kureha Corporation, both commercial companies, for this study. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.

Publisher Copyright:
© 2016 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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10.1371/journal.pone.0156381

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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

@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}",

note = "Funding Information: The authors of this manuscript have read the journal's policy and have the following competing interests: The authors received funding from CJ HealthCare Corporation and Kureha Corporation, both commercial companies, for this study. There are no patents, products in development or marketed products to declare. This does not alter the authors{\textquoteright} adherence to all the PLOS ONE policies on sharing data and materials. Publisher Copyright: {\textcopyright} 2016 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2016",

month = jun,

doi = "10.1371/journal.pone.0156381",

language = "English",

volume = "11",

journal = "PLoS One",

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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

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

N1 - Funding Information: The authors of this manuscript have read the journal's policy and have the following competing interests: The authors received funding from CJ HealthCare Corporation and Kureha Corporation, both commercial companies, for this study. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials. Publisher Copyright: © 2016 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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

Abstract

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