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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12 Citations (Scopus)


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
Issue number6
Publication statusPublished - 2016 Jun
Externally publishedYes

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.

ASJC Scopus subject areas

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