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Comprehensive Associations between Acidosis and the Skeleton in Patients with Kidney Disease
Rebecca V Levy1,2, Donald J McMahon3, Sanchita Agarwal3
1Nephrology, Department of Medicine, University of Rochester Medical Center Rochester, New York, USA.
Journal of the American Society of Nephrology : JASN
|February 7, 2023
Summary
Metabolic acidosis in chronic kidney disease (CKD) is linked to poor bone quality, including lower bone density and altered structure. Further research is needed to see if treating acidosis can improve bone health in CKD patients.
Area of Science:
- Nephrology
- Bone Metabolism
- Skeletal Biology
Background:
- Renal osteodystrophy (ROD) significantly increases morbidity in chronic kidney disease (CKD), notably raising fracture risk.
- Metabolic acidosis (MA) is a known contributor to ROD development, but a detailed skeletal phenotype in CKD-associated acidosis remains undescribed.
- This study aims to comprehensively characterize the bone structure and composition in CKD patients with MA.
Purpose of the Study:
- To elucidate the comprehensive skeletal phenotype associated with metabolic acidosis in patients with chronic kidney disease.
- To investigate the associations between acidosis and bone remodeling, microarchitecture, and mineralization using multimodal approaches.
- To identify potential therapeutic targets by understanding the bone-tissue level effects of acidosis.
Main Methods:
- Retrospective cross-sectional analysis of 180 CKD patients, defining MA as bicarbonate ≤22 mEq/L.
- Assessment of bone turnover markers, dual-energy X-ray absorptiometry (DXA), and high-resolution peripheral computed tomography (HR-pQCT).
- Prospective follow-up in 54 participants and bone biopsy analysis (histomorphometry, microCT, quantitative backscatter electron microscopy) in 22 participants.
Main Results:
- Acidotic CKD patients exhibited higher bone turnover markers and reduced bone mineral density (DXA, HR-pQCT).
- MA was associated with impaired trabecular microarchitecture and cortical expansion, alongside trabecular deterioration over time.
- Bone tissue analysis revealed reduced mineral density and heterogeneous calcium distribution in acidotic individuals.
Conclusions:
- Metabolic acidosis is linked to diverse impairments in bone quality and structure in CKD patients.
- These findings highlight the detrimental effects of acidosis on bone health in the context of CKD.
- Further investigation into the potential benefits of acidosis correction on bone quality and strength is warranted.
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