Abstract：
Metabolic acidosis (MA) is a well-known complication in patients with ileal urinary diversions. It is common in the early postoperative stages and decreases over time. Our objective is to investigate the prevalence of MA after more than one year of follow-up, identify the associated risk factors, and analyze its secondary metabolic consequences.
We conducted an observational study between January 2018 and September 2022 following the STROBE guidelines. MA was defined as a serum bicarbonate level <22mEq/L. Finally, we analyzed 133 patients with a mean follow-up of 55.24 ± 42.36 months.
MA was observed in 16 (12%) patients. Patients with and without MA were comparable in age, sex, and follow-up time. The group with MA presented a higher rate of anemia (68,75% vs 19,65%, p < 0.001) and renal failure (100% vs 45,29%, p < 0.001), statistically significant higher levels of serum creatinine, chloride, potassium, parathyroid hormone, and phosphorus but lower serum values of hemoglobin, renal glomerular filtration rate, total cholesterol, vitamin D, calcium, and albumin (all p < 0.05). Renal glomerular filtration rate was the only independent risk factor related to the development of MA (OR 0.914; 95% CI 0.878-0.95; p < 0.0001), proving a close correlation with venous bicarbonate values (r = 0.387, p < 0.001).
MA is a little prevalent disorder in ileal urinary diversions more than one year after radical cystectomy is performed but it has secondary consequences on hematologic, renal, protein, lipid, and bone metabolism. We recommend to a close follow-up in patients with renal failure for early diagnosis and treatment.
We conducted an observational study between January 2018 and September 2022 following the STROBE guidelines. MA was defined as a serum bicarbonate level <22mEq/L. Finally, we analyzed 133 patients with a mean follow-up of 55.24 ± 42.36 months.
MA was observed in 16 (12%) patients. Patients with and without MA were comparable in age, sex, and follow-up time. The group with MA presented a higher rate of anemia (68,75% vs 19,65%, p < 0.001) and renal failure (100% vs 45,29%, p < 0.001), statistically significant higher levels of serum creatinine, chloride, potassium, parathyroid hormone, and phosphorus but lower serum values of hemoglobin, renal glomerular filtration rate, total cholesterol, vitamin D, calcium, and albumin (all p < 0.05). Renal glomerular filtration rate was the only independent risk factor related to the development of MA (OR 0.914; 95% CI 0.878-0.95; p < 0.0001), proving a close correlation with venous bicarbonate values (r = 0.387, p < 0.001).
MA is a little prevalent disorder in ileal urinary diversions more than one year after radical cystectomy is performed but it has secondary consequences on hematologic, renal, protein, lipid, and bone metabolism. We recommend to a close follow-up in patients with renal failure for early diagnosis and treatment.
摘要：
目的：代谢性酸中毒（MA）是回肠尿路改道患者的一种众所周知的并发症。它在术后早期阶段很常见，并且随着时间的推移而减少。我们的目标是在一年以上的随访后调查MA的患病率，确定相关的风险因素，并分析其次级代谢后果。
方法：我们根据STROBE指南于2018年1月至2022年9月进行了一项观察性研究。MA被定义为血清碳酸氢盐水平<22mEq/L。最后,我们分析了133例患者,平均随访时间为55.24±42.36个月.
结果：在16例（12%）患者中观察到MA。有和没有MA的患者年龄相当，性别,和后续时间。MA组的贫血率较高（68,75％vs19,65％，p<0.001）和肾衰竭（100%vs45,29%，p<0.001)，血清肌酐有统计学意义的较高水平，氯化物,钾，甲状旁腺激素,和磷，但血红蛋白的血清值较低，肾小球滤过率，总胆固醇,维生素D,钙，和白蛋白（所有p<0.05）。肾小球滤过率是唯一与MA发生相关的独立危险因素(OR0.914;95%CI0.878-0.95;p<0.0001),证明与静脉碳酸氢盐值密切相关(r=0.387，p<0.001)。
结论：根治性膀胱切除术后一年以上，MA是回肠尿路改道的一种较普遍的疾病，但对血液学有继发性影响，肾,蛋白质，脂质，和骨骼代谢。我们建议对肾功能衰竭患者进行密切随访，以便早期诊断和治疗。
方法：我们根据STROBE指南于2018年1月至2022年9月进行了一项观察性研究。MA被定义为血清碳酸氢盐水平<22mEq/L。最后,我们分析了133例患者,平均随访时间为55.24±42.36个月.
结果：在16例（12%）患者中观察到MA。有和没有MA的患者年龄相当，性别,和后续时间。MA组的贫血率较高（68,75％vs19,65％，p<0.001）和肾衰竭（100%vs45,29%，p<0.001)，血清肌酐有统计学意义的较高水平，氯化物,钾，甲状旁腺激素,和磷，但血红蛋白的血清值较低，肾小球滤过率，总胆固醇,维生素D,钙，和白蛋白（所有p<0.05）。肾小球滤过率是唯一与MA发生相关的独立危险因素(OR0.914;95%CI0.878-0.95;p<0.0001),证明与静脉碳酸氢盐值密切相关(r=0.387，p<0.001)。
结论：根治性膀胱切除术后一年以上，MA是回肠尿路改道的一种较普遍的疾病，但对血液学有继发性影响，肾,蛋白质，脂质，和骨骼代谢。我们建议对肾功能衰竭患者进行密切随访，以便早期诊断和治疗。
