HDCN Abstract:  ASN Annual Meeting -- Philadelphia  

Schwarz C, Oberbauer R, Haas M

Renal tubular acidosis in kidney transplant recipients.

ASN Annual Meeting -- Philadelphia
J Am Soc Nephrol (Nov) 16:43A 2005

Renal tubular acidosis (RTA) after kidney transplantation is a frequent finding. The prevalence, however, and the distribution of the RTA subtypes is unknown.

575 renal transplant recipients were included in this cross- sectional study. All patients had a serum creatinine < 2 mg/dl, no rejection episodes since >6 months and transplant duration of >1 year. The patients were screened for acidosis by a single blood gas analysis. In treated patients bicarbonate therapy was stopped 24h prior to diagnosis. All patients with metabolic acidosis and normal plasma anionic gap were further analysed by an oral bicarbonate loading test. To distinguish between the different forms of renal tubular acidosis the urine-plasma pCO2 difference was calculated. The trans-tubular potassium gradient was evaluated for the diagnosis of the hyperkalemic forms of RTA. Patients transplant history and medication were analysed in a stepwise logistic regression to isolate factors associated with RTA.

Renal tubular acidosis was diagnosed in 13% of the transplant recipients. From all patients with RTA, 35% had RTA type 1 (distal, classic), 15% showed the hyperkalemic form of RTA type 1. RTA type 4 was present in 28% but no one of the patients showed RTA type 2 (proximal). 22% of the patients had a mixed form of (renal) acidosis. The strongest factors that contributed to RTA were immunosuppression with calcineurin inhibitors (OR 12,4 (95%CI:2-134)), treatment with ACE-Inhibitors or AT II receptor blockers (OR 2 (95% CI:1-4) and hyperparathyroidism (OR 1,08 per 10 ng/ml elevated PTH (95% CI:0,2-1,18)) The majority of the patients developed renal tubular acidosis immediately after transplantation. Acute rejections were not associated with the development of RTA. No individual risk factors for the development of different types of RTA could be found.

The main forms of posttransplant RTA are type 1(distal) and type 4 (hyperkalaemic). Risk factors associated with the development of RTA are calcineurin inhibitor therapy, hyperparathyroidism and blockers of the renin-angiotensin-aldosterone system. Subgroup analysis, however, revealed no particular risk factor for the development of a specific RTA form.

© Copyright 2005-2006, American Society of Nephrology. Reproduced with permission.
Until September of 2006, all ASN abstracts from the 2005 Annual Meeting are available at this link.

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