The prevalence of metabolic acidosis is high in patients with chronic kidney disease (CKD). For the diagnosis, a blood gas analysis is necessary, but not always available. The aim of the study was to evaluate the base excess (BE) of the sodium-chloride difference (BENa-Cl = Na+-Cl--34mmol/l) as a screening parameter for hyperchloremic metabolic acidosis. We retrospectively performed acid-base analyses of 168non-dialysedpatientswith CKDaccording to the physiologic and to the Stewart's approach. We performed linear regression analysis, Bland-Altman plot and receiver operating characteristics (ROC) analysis of BENa-Cland BE to evaluate the accuracy of BENa-Clpredicting the BE. We further investigated possible confounding factors. The corrected R2for the correlation of BENa-Cland BE was 0.60 (p < 0.001). The Bland-Altman plot showed a good overall agreement. The bias was negligible, but the 95%-limits of agreement showed a wide interval (10.4mmol/l). For BE ≤ 2mmol/l, the ROC analysis yielded an AUC of 0.89 and moderate sensitivity (0.75) and specificity (0.86) for the optimal BENa-Clthreshold (≤ 2mmol/l). Subgroup analysis showed similar results. The main factor for the imprecision of BENa-Clpredicting the BE across all stages of CKD is the variability of the serum anion gap (SAG). The BENa-Clis not an adequate parameter for screening of hyperchloremic acidosis because of the high variability of the SAG. Only, if the BENa-Clis ≤ 5mmol/l, a hyperchloremic acidosis should be suspected. Therefore, a complete blood gas analysis is necessary for the correct diagnosis of acid-base disorders in patients with chronic kidney disease.
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